The Health Through Housing program provides a road map for exiting homelessness, and it’s working.
On Thursday, King County’s Department of Community & Human Services (DCHS) released its 2024 data showing the success of the Health Through Housing initiative, which provides permanent supportive and emergency housing for people exiting homelessness. DCHS pointed to improved housing stability and improved health outcomes for their residents via the program.
In 2020, County Executive Dow Constantine announced the Health Through Housing initiative. Hoping to capitalize on cheap real estate during the Covid-19 pandemic, the program aimed to buy former hotels and other suitable buildings to convert into single-unit housing, saving money and time by avoiding having to build similar housing from scratch.
The initiative took effect at the beginning of 2021, with the implementation of a 0.1% sales tax in King County. Raising about $70 million per year at that time, the King County Council allocated the tax’s proceeds to the initiative, intended to purchase and convert properties into emergency and permanent supportive housing and provide onsite services.
The program’s objective was to provide 1,600 housing units, and has secured 1,434 units at the end of 2024. This represents a 41% increase in people served compared to 2023.
Its buildings span across 17 locations in seven cities: Auburn, Burien, Federal Way, Kirkland, Redmond, Renton, and Seattle. Meanwhile, the County plans to open three more buildings this year.
In addition to permanent supportive housing, the initiative provides emergency housing units, which do not have a kitchenette. People who accept emergency housing do not have to sign a lease and retain their homeless status, which means they are still eligible for other permanent supportive housing options that may arise while remaining welcome to stay in emergency housing.
The program provides a variety of supportive services in addition to housing, including 24/7 staffing, case management, transportation and food assistance, employment resources, and community events. Residents are eligible for free ORCA transit cards, and participants’ use of public transportation greatly increased over the course of 2024. Buildings also offer free laundry service.
In order to be eligible for the program, residents must have a disability, behavioral health condition, or chronic illness, which makes access to health care critical. On-site health care offerings, including mental health care and substance use treatment, vary from property to property. Residents are also offered transportation assistance to important medical appointments off-site.
The data shows that 95% of the permanent supportive housing residents remained housed over the course of one year. This is in contrast to its emergency housing, where only 58% of residents maintained their housing.
“It validates decades of research in supportive housing,” said Kelly Rider, the director of DCHS. “It’s also incredibly exciting to see us get to this point in the Health through Housing initiative, specifically where we’re seeing lives change, we’re seeing the impact of the particular residents that we’ve been able to house. The project of Health through Housing was always about bringing supportive housing to scale, and to see that we have brought it to scale and it is effectively serving its residents is a really good confirmation that we’re on the right track.”
Meanwhile, the 2024 Point-in-Time Count in King County found that the number of unhoused people in our region continues to grow, with an increase of 26% between 2022 and 2024. On any given night, 16,868 people were homeless in King County in 2024.
Health improvements
The Health Through Housing initiative is firmly grounded in the tenets of Housing First philosophy, and its success thus far offers additional support to that approach. Housing First programs prioritize finding stable housing options for homeless people as an initial step, without requiring they first solve problems like behavioral health issues and substance use disorder. The philosophy espouses the idea that services and treatment tend to be more effective when they are chosen instead of forced.
“The idea of giving folks housing first actually improving their health all by itself is absolutely good to see reinforced through this data,” said Rider.
This is the first time the initiative has collected data about health outcomes, comparing data from the residents’ year prior to enrollment in the program. Emergency department visits decreased by 17% after one year in the program, and the average in-patient hospital stay decreased by 33%. The average number of inpatient hospital stays also decreased by 22% after the first year.
The number of participants enrolled in Medicaid only increased by 7%, as many people have already signed up for Medicaid before living in one of the Health Through Housing buildings.
“I was very happy to see the connection between folks getting housing and having some access to health care,” said Jelani Jackson, the manager of the Health Through Housing initiative. “Because that just tells the story of consistent case management that a resident receives, and that resident being able to then go after goals to improve their life, housing, health care, ability, and income, connection to their community, eating healthy, etc.”
Jackson spoke of the difficulty experienced by homeless people in maintaining their health. They have fewer medications they can be prescribed, due to not having access to refrigeration and regular toilet use. They have trouble staying clean, leading to skin abrasions and chronic infections. They may not have regular access to a sink and soap to wash their hands.
“It’s sort of an under-discussed aspect of homelessness, but it’s really difficult to maintain your physical and mental health while being on the street night after night, not experiencing safety,” Jackson said. “You know, homeless folks, unfortunately, are incredibly vulnerable. They experience high rates of violence, and there’s a trauma associated with that.”
Rider referenced a study conducted by researchers at the University of Washington in 2009, studying residents of the permanent supportive housing at 1811 Eastlake. The scientists found that the program saved taxpayers over $4 million.
“This research reminds us of that,” Rider said. “It tells us that when you take folks who are living on the streets with disabilities and you bring them inside, the safety and security and the stability and the community bringing them inside helps them feel better.”
The Health Through Housing initiative also saves taxpayers money. It costs about $33,000 per year to operate one of their units. By contrast, in February, King County Councilmember Sarah Perry said a night at the King County Jail now costs $250, which adds up to $91,250 annually.
“Nearly $4,000 is saved for every inpatient hospital stay that’s avoided,” Jackson said.
The goal of racial equity
One of the goals of the program is to provide equitable access to permanent supportive housing, which means community partners are carefully selected. Current partners include the Chief Seattle Club, Lavender Rights Project, Downtown Emergency Service Center (DESC), the Urban League, and Catholic Community Services.
The 2024 Point-in-Time Count found that 6% of people experiencing homelessness in King County identified as American Indian, Alaskan Native, or Indigenous, while that group makes up less than 1% of King County’s population. Similarly, the count found that 15% of people experiencing homelessness identified as Black, while only 7% of the total population is Black.
In 2024, 55% of Health Through Housing residents identified as Black, Indigenous, and people of color. This includes a significant increase in American Indian and Alaska Native residents from 3% in 2022 to 16% in 2024, which can be at least partially credited to the program’s partnership with Chief Seattle Club.
“It’s not just as simple as getting somebody four walls and a ceiling and thinking that their problems are solved,” said Derrick Belgarde, Chief Seattle Club’s executive director. “There’s a lot of healing that needs to be done for people who are chronically homeless. In particular, we’ve focused on Native Americans that suffer from a lot of traumas intergenerationally that haven’t been addressed, from government policies to boarding schools to all kinds of things that affect our community still today.”
Belgarde spoke about the compounding issues caused by intersectional crises: of homelessness, of substance use, of mental health, and of displacement. “If you go and you look at the streets of downtown and other areas that have a lot of encampments and things, this is what society looks like after 40 plus years of defunding mental health systems,” Belgarde said. “And it’s going to continue to get worse until we start building one back up as a society.”
Chief Seattle Club operates the Salmonberry Lofts and the recently opened Sacred Medicine House through the Health Through Housing initiative. They expect to open the Sweetgrass Flats later this year, and they will be offering property management support to the Lavender Rights Project, who will be operating a new building in Capitol Hill.
At their buildings, Chief Seattle Club offers a traditional mental health counselor. Individual and group sessions are available, presented in culturally appropriate ways, such as talking circles, drum groups, and providing traditional plant medicine and sage smudges. Residents also go on field trips to sweat lodges.
“Obviously, you know, everything we do is kind of culturally grounded and […] traditional principles, and it’s about working with our relatives and healing the community. That’s our target,” Belgarde said. “We’re not in the business of housing people or feeding people. We’re in the business of healing people and trying to get that next generation stronger than what we found.”
Chief Seattle Club provides a social club for Native people, building a community where they will feel welcome. Belgarde emphasized how important having a shared experience is to helping Native people who have experienced chronic homelessness.
“If you’re going to provide services to address Native American needs, it’s got to come from other Native American people where they could fill that trust,” Belgarde said. “If we start serving just the broad community, once you get to a certain point, Native Americans will stop coming because it’s no longer a safe space for them.”
“When we have organizations that reflect the communities that they serve, we feel that folks will have an easier time accepting services and trusting the system,” said Jackson.
What’s next?
The data shows that 97% of Health Through Housing residents had previous ties in the neighborhood where they now live, a fact that Rider said will make it easier to site new buildings in the future.
“The ability to really show jurisdictions that we are serving their residents has been an important part of this initiative, and we’re excited to be able to share that the residents that we’re serving are indeed homeless and connected to the communities that they’re now living stably in,” Rider said.
However, challenges remain. While the initiative itself is funded by a county sales tax, making it more resilient in the face of federal cuts, many of the residents housed through the Health Through Housing program rely on federal programs such as Medicaid/Apple Health and SNAP that could soon be facing large cuts. Belgarde pointed out the government might make changes to the system that would make claiming benefits more difficult.
“People of color have paper trauma, have form trauma,” Belgarde said, referring to the difficulties people facing homelessness already encounter navigating bureaucracies and applying for aid programs, which requires seemingly endless paperwork.
Belgarde expects that deep federal cuts could cause many people to drop out of federal programs, even if they’re theoretically still eligible, since people will have even lower expectations that aid will come through or be unable to navigate increased bureaucratic demands.
The need is great. The Seattle Office of Housing estimated that Seattle alone will need 28,572 new permanent supportive housing units by 2044.
“We’re going to continue as DCHS to work with the region on expanding permanent supportive housing, but more importantly, to make the best use of the current supportive housing that we have available,” said Rider.
For the time being, the Health Through Housing initiative is having an impact on people it serves who are recovering from homelessness, helping them regain both their dignity and a greater sense of safety.
“The dignity of having clean clothes, the dignity of having access to a bathroom and a toilet that is all yours and doors that you can lock is just tremendous,” Jackson said.
Amy Sundberg is the publisher of Notes from the Emerald City, a weekly newsletter on Seattle politics and policy with a particular focus on public safety, police accountability, and the criminal legal system. She also writes science fiction, fantasy, and horror novels. She is particularly fond of Seattle’s parks, where she can often be found walking her little dog.