Skilled Nursing Facility Patients Need Stable Housing

Porthaven Post Acute Staff (Photo courstey of Porthaven)

Porthaven Post Acute provides skilled nursing and care for patients with severe, complex or life-threatening illness or injury who require intensive, continuous medical care for serious health issues.

But their problems are made worse because many of these patients lack stable housing, a problem that is getting worse as homelessness continues to grow.

“Porthaven routinely accepts patients that many other facilities cannot,” said Maritza Kritz, Porthaven’s director of hospital admissions and marketing. “Many of the patients we admit arrive with complex wounds, tracheostomy, dialysis needs, substance abuse disorders and chronic homelessness.”

Porthaven Staff (Photo courtesy of Porhaven)

This creates significant barriers to safe discharges and puts an “immense strain” on Porthaven’s clinical and social services teams.

And racism is also a factor for patients’ quality of care, she said.

“A hard truth we see every day is that people of color are disproportionately represented in these high-risk categories,” she said.

Kritz said that longstanding inequities, systemic racism and limited access to preventative care mean many Blacks and other patients of color arrive with more serious medical conditions.

“These inequities intersect directly with Oregon’s housing crisis, where communities of color experience higher eviction rates, homelessness and reduced access to affordable housing,” she said.

Skilled nursing facilities like Porthaven were never meant to serve as emergency housing or addiction treatment facilities, but they are increasingly forced into those roles, according to Kritz.

With a 90-bed capacity, Porthaven stays pretty full, she said, but many insurance companies only cover stays of 20 to 25 days, which means that patients don’t always get enough time for a full recovery.

The services these patients truly need, long-term housing, detox programs, residential treatment and community-based recovery supports, either do not exist, have restrictive criteria or have months-long waiting lists, she added.

According to a recent article in Willamette Week, Home Forward, Portland’s housing authority, is sitting on 956 empty affordable apartments out of a total of 6,847 total affordable units in the area (https://www.wweek.com/news/city/2025/12/03/portlands-housing-authority-sits-on-955-empty-apartments).

Meanwhile, according to the latest data from Multnomah County, 7,500 people “are living unsheltered on Portland’s streets every night.”   

As the article points out, while the primary cause of the homelessness crisis is a lack of supply, the problem is more nuanced than that, depending on different percentages of units available to varying annual median income levels and rising rents for the 0-30 percent annual median income, or deeply affordable housing, which can make them no longer affordable to those in that income bracket.

Portland Mayor Keith Wilson, according to Oregon Public Broadcasting, has met his campaign goal of securing funding to open 1,500 shelter beds, but as of Nov. 30, only 890 beds are open for use.

But a shelter bed is not a home, and with no social workers, no health care, no addiction services, no meals or no storage for belongings, these new beds “offer little in the way of a path out of homelessness.”

The lack of statewide resources for homelessness also creates ongoing challenges, Kritz said.

They include: the inability to safely discharge medically stable patients, higher risks for rehospitalization due to unstable living environments, safety concerns for both staff and residents, capacity limits that prevent admitting more Medicare or rehab patients, and clinical teams absorbing responsibilities far outside the traditional scope of skilled nursing facilities.

“People of color face additional barriers,” Kritz said, “including higher displacement rates, disproportionate homelessness, fewer culturally specific programs, and reduced access to treatment and long-term supportive housing.”

But without following the Housing First model, where homeless people are housed first along with treatment and services, nothing else works, she said.

“We can stabilize someone medically, but without a place to go, they end up cycling between hospitals, skilled nursing facilities and the streets,” Kritz said.

At the same time, she said, Portland has many vacant buildings and unused units owned by investment groups or real estate companies that are often intentionally kept empty because they cannot rent them at the price they want.

“Meanwhile, medically complex, chronically homeless individuals have nowhere to go,” she said. “This practice deepens the crisis for both patients and frontline healthcare workers.”

This must change, Kritz said, and she list real solutions to the houseless crisis:

1. Vacancy taxes or penalties Discourage long-term empty units and bring them back into the housing market.

2. Incentives for converting vacant buildings into supportive housing Provide tax credits, grants, or expedited permits to create transitional or medically focused housing.

3. Public–private leasing agreements Allow cities or counties to temporarily lease empty units for medically fragile individuals, seniors, people with disabilities, and those exiting hospitals or skilled nursing facilities — a faster and more cost-effective approach than new construction.

4. Strengthening Housing First programs Stable housing supports treatment, improves recovery outcomes, and reduces use of "hospitals" skilled nursing facilities.

5. Expanding culturally responsive housing and treatment Communities of color need culturally specific housing, recovery programs, and medical navigation to close longstanding gaps.

“Oregon urgently needs more addiction treatment programs, low-barrier shelters, long-term supportive housing, and culturally responsive services,” Kritz said. “Until these systems exist, skilled nursing facilities like Porthaven will continue absorbing responsibilities we were never built for and the disparities affecting people of color will continue to deepen.

“Porthaven will always stabilize and support every patient we can, but we cannot solve Oregon’s addiction, housing and health equity crisis alone.”