County · adopted FY2027 plan
605
adult shelter units being cut
Plus 90 family scattered-site vouchers. The County cites a funding tradeoff between shelter capacity and housing assistance.
Adopted budget · p. 49Where the path out of homelessness breaks.
Too few places. Staffing limits. Housing units sitting vacant while people wait. See where the evidence identifies a failure—and the questions we still need answered.
What a working system connects
Safe tonightA place that meets the person’s needs
A suitable home + a funded move
A lasting homeRent the household can afford
Care + benefits + tenancy help
Support that staysHelp that follows changing needs
4,187beds for 10,526 people
January 2025: year-round shelter and transitional inventory versus people experiencing homelessness in Multnomah County.
See the matched-date capacity comparison ↓~½of exit destinations unknown
In the County’s FY25 adult shelter review. An unknown destination does not mean a return to the street.
County shelter review · FY25 ↗−21.7%in the homeless-services operating budget
FY27 adopted versus FY26 adopted: $242.9m, down $67.3m. Funding reductions and allocation choices affect different parts of the path.
See the adopted budgets and local costs ↓01 / The capacity question
Is there a bed for everyone?
No. Shelter capacity was far below need.
On the same January 2025 count, Multnomah County reported more than twice as many people experiencing homelessness as shelter and transitional beds. There were not enough of those beds for everyone at once.
6,339people above the year-round bed inventory
This is the January 2025 inventory gap, not the number of new beds needed today. People can also move directly into housing; everyone does not need to pass through a shelter.
What this comparison establishes
The population count refers to January 22, 2025. The inventory is the same CoC’s January 2025 count of operating shelter and transitional beds. Both include adults and children. The bars use the same numerical scale; beds are potential places for people, not a count of vacant spaces.
The 5,090 people presumed unsheltered were identified through administrative records, not all encountered on count night. The count has uncertainty and predates 2026 closures. The arithmetic is 10,526 − 4,187 = 6,339; it does not determine the mix of shelter, housing and care needed now.
Permanent-housing inventory is separate: it includes places serving people who are already housed. It cannot be added to this chart as if those homes were empty. Nor does subtracting the sheltered population from bed inventory establish usable vacancies.
The next failure point
A listed bed still has to be usable.
A capacity total answers only the first question. These are the checks needed to turn a place on paper into an offer someone can use.
- Listed
Does the place exist?
An inventory counts physical capacity.
- Staffed
Can it operate safely?
The necessary staff and services must be in place.
- Vacant
Is a space available?
It cannot already be occupied or held for someone else.
- Suitable
Can this person use it?
Household, access and support needs have to fit.
- Accepting
Can someone get in?
Intake, referral and arrival have to connect.
A current count passing every check is not established by these public sources. This is a checklist, not a measured funnel.
A documented closed door
Roseway has rooms. It is taking no new participants.
The County says intake has stopped ahead of its planned October 30, 2026 closure. Remaining physical capacity therefore cannot be treated as an available offer.
HSD closure update · checked Sept. 8, 2026Other doors require a particular route: Banfield and Stark accept referrals from congregate shelters; Rockwood Bridge requires an approved permanent-housing placement. HSD access directory · July 2026
What has changed since that count?
In 2026, funded capacity is shrinking.
Closures are happening now. Future capacity estimates need to be shown separately from places operating today.
City · projected winter capacity
580 from 876
regular adult overnight beds
The August 24 plan projects 296 fewer beds. Northrup’s 200 beds are scheduled to close September 18.
City shelter changes · Aug. 24, 2026County · confirmed closures
Places already lost
- Laurelwood
- June 30, 2026
- Walnut Park
- July 14, 2026
- River District Navigation Center
- August 31, 2026
These scopes overlap and use different units. Do not add the City’s beds to the County’s unit reductions, or subtract either from the January 2025 inventory to invent a current total.
02 / Locate the failure
The failures are not all the same.
A shortage of beds needs a different response from an unfilled shift, a delayed move-in or a contract that is not properly monitored. Here is where each problem shows up.
Shelter → a usable bedBuilt capacity.
Vacant apartments.
Known risks.
Built capacity.
Not enough staff to use it.
Kenton Women’s Village could not operate at full capacity early in FY25 because of staffing shortages.
County shelter review · FY25 Ready unit → move-inVacant apartments.
Veterans waiting.
The latest SHS report identifies delayed unit turnovers and a placement backlog tied to property management.
County SHS report · FY26 Q4 Contracts → reliable servicesKnown risks.
Incomplete oversight.
In April 2026, the Auditor again sought stronger high-risk monitoring and independent provider oversight.
County Auditor · April 21, 2026The operating diagnosis
Which part is broken—and in what way?
16 functions. Seven possible constraints. Read across a row, then open it for the evidence and the exact question to investigate.
!Documented problem↳Access rule / boundary?Question unresolved here—No finding assigned
A red mark identifies a specific reported problem, at the date shown. It does not mean every provider fails. An access rule may be appropriate; the question is whether an alternative exists. A question mark is a research gap, not a verdict.
Focus on
16 of 16 functions shown · Open any row
Keep the homePreventionBenefits funded. Delivery still needs proof.FY27 adopted budgetPlaces: No finding assignedWorkers: No finding assignedFunding: Question not resolved hereAccess: No finding assignedHandoffs: No finding assignedExecution: Question not resolved hereOutcomes: Question not resolved here
Question not resolved here
What the source establishes
The adopted budget adds $565,000 in one-time funding for a mobile eviction-prevention team serving Home Forward tenants. The expected $7.8 million in Medicaid rent vouchers is a forecast.
County adopted-budget release · June 5, 2026 · Amendment for mobile eviction prevention ↗Why this matters
Funding an enrollment team does not yet show how much rent was paid before households lost their homes.
The next investigation
How many eligible households receive help in time to stay housed?
- Records that would answer it
- Applications, eligibility decisions, rent payments, time to payment and housing follow-up; unserved eligible requests.
- Who holds the next step
- County Human Services · Home Forward · health plans
Resolve the housing crisisProblem solving / diversionThe service exists. Its reach is not established here.November 2025 policyPlaces: Question not resolved hereWorkers: No finding assignedFunding: Question not resolved hereAccess: No finding assignedHandoffs: No finding assignedExecution: No finding assignedOutcomes: Question not resolved here
Question not resolved here
What the source establishes
Coordinated Access includes housing problem solving, mediation and limited financial help. The policy describes a process, not how many households get a durable solution.
County Coordinated Access policy · November 2025 · pp. 7–8 · Housing Problem Solving ↗Why this matters
A conversation may identify a safe option that still needs cash, landlord agreement or follow-through.
The next investigation
Where are suitable alternatives found but never funded or completed?
- Records that would answer it
- Requests, assistance offered and paid, unresolved cases, time to resolution and later housing status.
- Who holds the next step
- County HSD · housing problem-solving providers
Reach people outsideOutreach and engagementContacts are counted. Coverage is harder to establish.April–June 2026 · SHS-funded outreachPlaces: No finding assignedWorkers: Question not resolved hereFunding: No finding assignedAccess: No finding assignedHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: Question not resolved here
Question not resolved here
What the source establishes
HSD reports 6,327 contacts and 212 newly engaged people in FY26 Q4. Its narrative uses ArcGIS because HMIS did not capture all outreach engagements.
County SHS report · FY26 Q4, updated Aug 28, 2026 · pp. 5–6 · Outreach reporting ↗Why this matters
We cannot diagnose too few workers—or ineffective outreach—from contact totals alone.
The next investigation
Are people missed, repeatedly contacted without an offer, or offered places they cannot use?
- Records that would answer it
- Filled outreach roles, shift coverage, caseloads, unique people reached, suitable offers and confirmed arrivals, by team and area.
- Who holds the next step
- County HSD · City Street Services · outreach providers
Leave a hospital or institutionDischarge and in-reachCoordination can meet without a housing resource.Published program scope · reviewed Sept 2026Places: Question not resolved hereWorkers: No finding assignedFunding: No finding assignedAccess: Access rule / service boundaryHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: No finding assigned
Access rule / service boundary
What the source establishes
County cross-sector case conferencing links housing, health and disability systems, but explicitly provides no housing resources itself.
County Cross Sector Case Conferencing · Program scope and limitations ↗Why this matters
A care plan and a meeting do not guarantee a receiving place. This is a program boundary, not proof that every discharge fails.
The next investigation
How often does someone leave without a suitable, confirmed place and continuing care?
- Records that would answer it
- Discharge destinations, receiving-provider acceptance, arrivals, care continuity and delays by reason; separate hospital, jail and treatment routes.
- Who holds the next step
- Discharging institutions · County HSD and Health · receiving providers
Enter crisis or sobering careCrisis response / soberingA 24/7 building is not a walk-in offer.County sobering rules · July 2026Places: Question not resolved hereWorkers: No finding assignedFunding: No finding assignedAccess: Access rule / service boundaryHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: No finding assigned
Access rule / service boundary
What the source establishes
County sobering has up to 13 stations and operates 24/7. Admission is voluntary and referral-only, with medical and behavioral criteria.
County sobering services · reviewed July 2026 · Access, eligibility and referral partners ↗Why this matters
A station may exist without being an appropriate or accessible destination for this person. Clinical criteria are not inherently a failure.
The next investigation
Which appropriate referrals cannot enter, and where do excluded people go instead?
- Records that would answer it
- Staffed capacity, occupancy, referrals by hour, declined admissions by reason and completed transfers to suitable care.
- Who holds the next step
- County Health · crisis responders · receiving clinical providers
Move from detox to treatmentWithdrawal management264 placements after 1,554 recommendations.Hooper assessments · 2022 cohortPlaces: Documented problemWorkers: No finding assignedFunding: No finding assignedAccess: Documented problemHandoffs: Documented problemExecution: No finding assignedOutcomes: Question not resolved here
Documented problem
What the source establishes
CCC reports 1,554 Hooper assessments recommended ASAM 3.5 residential care in 2022; 264 resulted in residential placement at discharge—about 17%.
CCC treatment-transition analysis · published Nov 2024 · What does the data show? ↗Why this matters
This documents a shortfall in recommended transfers. Assessments need not represent different people; it is not a current system-wide rate.
17% placed in residential care at discharge · 2022 cohort
What also matters: CCC’s 74-bed 16 x Burnside center opened in May 2025 and serves adults needing ASAM 3.5 or 3.7 care. Updated transfer outcomes are needed to measure improvement.
CCC 16 x Burnside Recovery Center · current program page ↗The next investigation
After subsequent capacity additions, how many recommended transfers now happen without a gap?
- Records that would answer it
- Updated recommendation-to-admission cohorts, waiting days and reasons no transfer occurred, split by required level of care.
- Who holds the next step
- Withdrawal and treatment providers · OHA · health plans
Receive acute psychiatric careInpatient psychiatryPreservation and break-even payment are proposed; the operating baseline needs records.Council briefing · September 9, 2026Places: Question not resolved hereWorkers: Question not resolved hereFunding: Question not resolved hereAccess: Question not resolved hereHandoffs: No finding assignedExecution: No finding assignedOutcomes: No finding assigned
Question not resolved here
What the source establishes
The Council deck proposes preserving inpatient psychiatric capacity and achieving break-even reimbursement. It does not supply a dated facility-level baseline of staffed, accepting capacity or operating margins.
Council behavioral-health presentation · September 9, 2026 · slides 4, 12–14 ↗Why this matters
A licensed bed can be unavailable because of staffing, payment, eligibility or a blocked onward placement.
The next investigation
Which staffed services are accepting clinically appropriate referrals, and what would keep them operating?
- Records that would answer it
- Capacity by status and service; closures; admission waits and denials; discharge-ready days; costs and reimbursement by payer.
- Who holds the next step
- OHA · hospitals · health plans · Legislature
Transfer to psychiatric supportPsychiatric subacute / respiteSpecify the receiving care, then test the bottleneck.Council briefing · September 9, 2026Places: Question not resolved hereWorkers: Question not resolved hereFunding: No finding assignedAccess: Question not resolved hereHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: Question not resolved here
Question not resolved here
What the source establishes
The deck distinguishes subacute psychiatric supervision from psychiatric respite, and proposes expansion. These descriptions do not establish current licensed categories, available places or the number of blocked discharges.
Council behavioral-health presentation · September 9, 2026 · slides 12–14 ↗Why this matters
Someone ready to leave acute care may still need substantial psychiatric support; medical respite and bridge housing are not interchangeable substitutes.
The next investigation
Which assessed care needs lack an accepting service, and how much delay comes from capacity, authorization or other barriers?
- Records that would answer it
- Service definitions; staffed accepting capacity; authorization and receiving-provider decisions; transfer delays; confirmed arrivals; continuing care and housing follow-up.
- Who holds the next step
- Hospital · receiving provider · payer · OHA · County transition and housing teams
Find treatment that fitsResidential substance-use treatmentA family treatment program has stopped new admissions.Admissions paused July 2026 · closure announced for Oct 31Places: Documented problemWorkers: Documented problemFunding: Documented problemAccess: Access rule / service boundaryHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: No finding assigned
Documented problem
What the source establishes
CCC paused Letty Owings admissions in July and announced an October 31 closure. Its September 1 FAQ cites complex care needs, workforce challenges and funding shortfalls.
CCC Letty Owings closure FAQ · updated Sept 1, 2026 · Why Now? · Timeline · Continuity of Services · Client Impact ↗Why this matters
CCC’s 16 x Burnside can treat parents, but children and infants cannot live onsite. A treatment place may still leave the family without a suitable arrangement.
What also matters: CCC plans treatment completion or safe transfers for current clients and lists other Oregon programs, including CODA Gresham and LifeWorks Project Network. Available places and family eligibility still need confirmation.
The next investigation
Can families find appropriate treatment that meets both parent and child needs, without a gap in care?
- Records that would answer it
- Aggregate transition outcomes and program continuity plans; declined referrals; family-compatible vacancies; funding and staffing analysis; successor-provider efforts.
- Who holds the next step
- CCC · OHA · health plans · child welfare and receiving providers
Recover after an illnessMedical respite / daily careA respite bed may require more independence than someone has.Provider access rules · reviewed Sept 2026Places: Question not resolved hereWorkers: Question not resolved hereFunding: No finding assignedAccess: Access rule / service boundaryHandoffs: No finding assignedExecution: No finding assignedOutcomes: No finding assigned
Access rule / service boundary
What the source establishes
CCC Recuperative Care requires independent daily activities and medication management. People needing more assistance require a different match.
CCC Recuperative Care · access criteria · Referral criteria ↗Why this matters
A standard respite referral cannot substitute for nursing, personal assistance or long-term care when those are needed.
The next investigation
How many people are waiting because they need help eating, bathing, moving or managing care?
- Records that would answer it
- Referrals denied for care needs, days waiting, appropriate staffed alternatives and successful follow-on placements.
- Who holds the next step
- Hospitals · care providers · health plans · County aging/disability services
Use a shelter placeEmergency and alternative shelterShort staffing kept a village below full capacity.Kenton Women’s Village · FY25–FY26Places: Documented problemWorkers: Documented problemFunding: Documented problemAccess: No finding assignedHandoffs: No finding assignedExecution: No finding assignedOutcomes: Documented problem
Documented problem
What the source establishes
The County review links Kenton Women’s Village’s early-FY25 underuse to staffing shortages. Its profile also reports two Housing Transitions staff cut for FY26. Across the review, roughly half of exit destinations were unreported.
County Adult Shelter Review · FY25 · pp. 13, 25, 35, 140 · dated findings, not current staffing ↗Why this matters
Physical capacity, operating staff and housing-navigation capacity are separate resources. A shortage in any one can stop a placement.
What also matters: FY27 adopted program 30302B adds $7.13 million for placement services, including up to $2.1 million for recovery housing. Its 465 housing-placement target excludes recovery placements; funded targets still need delivery checks.
County HSD adopted budget · FY27 · p. 80 · program 30302B ↗The next investigation
Which beds are unusable because of staffing—and which occupied beds lack a funded housing exit?
- Records that would answer it
- Planned versus staffed beds by site and shift; funded/filled roles; navigation caseloads; attached housing assistance; exit destinations.
- Who holds the next step
- City and County shelter funders · operators
Have a place between servicesBridge / transitional housingA funded line item is not an available place.FY27 adopted budget · program 30207Places: Question not resolved hereWorkers: Question not resolved hereFunding: No finding assignedAccess: No finding assignedHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: No finding assigned
Question not resolved here
What the source establishes
The County’s Bridge Housing program has a $2.95 million adopted budget and a 42-unit target. It is one program, not the whole transitional inventory.
County HSD adopted budget · FY27 · p. 65 · program 30207 ↗Why this matters
The budget establishes funded provision. It does not establish current vacancies or whether the program can meet a person's care needs.
The next investigation
Which transitions have no suitable place to wait, and for how long?
- Records that would answer it
- Actual staffed units, referral criteria, occupied and held spaces, declined referrals, length of stay and confirmed next placements.
- Who holds the next step
- County HSD · bridge providers · referring institutions
Turn an assessment into a matchCoordinated AccessThe clock exists. Compliance needs to be shown.November 2025 policyPlaces: No finding assignedWorkers: No finding assignedFunding: Question not resolved hereAccess: Question not resolved hereHandoffs: Question not resolved hereExecution: Question not resolved hereOutcomes: No finding assigned
Question not resolved here
What the source establishes
County policy expects provider contact within 15 days of referral and enrollment within 30 days, with extensions communicated to HSD for exceptional circumstances. Compliance is a separate question.
County Coordinated Access policy · November 2025 · pp. 15–16 · Housing Referral Outreach & Engagement ↗Why this matters
Assessment counts do not tell us how many people have a suitable funded match or how long unresolved cases have waited.
The next investigation
Are delays before matching, after referral, or between enrollment and an actual move-in?
- Records that would answer it
- Pending matches, referral/contact/enrollment/move-in dates, expired matches, provider denials, household declines and reasons.
- Who holds the next step
- County HSD · Coordinated Access partners · receiving housing providers
Get rent assistance and move inRent assistance / housing slotsSHS Housing Only programs stopped new referrals.FY26 Q4 report · updated Aug 28, 2026Places: Documented problemWorkers: No finding assignedFunding: Question not resolved hereAccess: Documented problemHandoffs: No finding assignedExecution: No finding assignedOutcomes: No finding assigned
Documented problem
What the source establishes
SHS-funded Housing Only programs reached capacity and stopped new referrals. HSD expects to sustain existing households but anticipates no new FY27 placements in these programs.
County SHS report · FY26 Q4, updated Aug 28, 2026 · p. 5 · Housing Only, not all rent assistance ↗Why this matters
An assessment or referral cannot create a slot in a program that is full. Other housing routes must be assessed separately.
The next investigation
What funded alternatives are actually accepting people, and what limits new slots?
- Records that would answer it
- Slots in use, new allocations, assistance issued and leased, closed referral routes and available alternatives by program.
- Who holds the next step
- County Human Services · HSD · participating housing providers
Move into supportive housingPermanent housing + servicesUnits sat vacant while veterans waited.FY26 Q4 report · updated Aug 28, 2026Places: Documented problemWorkers: Documented problemFunding: Documented problemAccess: No finding assignedHandoffs: No finding assignedExecution: Documented problemOutcomes: No finding assigned
Documented problem
What the source establishes
HSD links inconsistent property management to delayed unit turnovers, vacancies and a veteran placement backlog. Some smaller supportive-housing sites also struggled to fund round-the-clock staffing and care.
County SHS report · FY26 Q4, updated Aug 28, 2026 · pp. 7, 9 ↗Why this matters
Here, the failure includes turning an existing unit into a ready, supported tenancy—not only building more units.
What also matters: HSD reports reallocating resources and supporting higher-need sites, with a deeper review of actual operating costs planned for FY27. The next test is whether vacancies and waits fall.
The next investigation
How many units are held up by repairs, property management, staffing, matching or missing support funding?
- Records that would answer it
- Vacant-unit days by reason; turnover deadlines; referrals waiting; funded/filled support roles; service cost and move-in dates.
- Who holds the next step
- Housing operators · County HSD · property managers · health partners
Keep the placement workingTenancy support / retentionMissing follow-up obscures who is still housed.County follow-up presentation · May 2025Places: No finding assignedWorkers: Question not resolved hereFunding: No finding assignedAccess: No finding assignedHandoffs: Question not resolved hereExecution: No finding assignedOutcomes: Documented problem
Documented problem
What the source establishes
A County presentation reported unknown housing status for 53% of a 2,436-person placement cohort because of missing data or loss of contact.
County budget follow-up · May 14, 2025, slide 11 ↗Why this matters
A headline retention rate cannot describe everyone when follow-up is incomplete. Unknown status is not evidence of an eviction or a successful tenancy.
What also matters: The presentation’s separate 88% retention statistic uses a differently described measure. Do not combine it with this cohort to infer a whole-system success rate.
The next investigation
Who is confirmed housed, who returned to homelessness, and whose support or follow-up was lost?
- Records that would answer it
- Move-in cohorts with 6/12-month status, contact coverage, observed returns, support continuity and unknown outcomes shown separately.
- Who holds the next step
- County HSD · placing and support providers · health partners
So, do we have enough workers?
Workers and teams are operating. Specific staffing constraints are documented above. This review does not establish today’s total gap in outreach workers, case managers or clinical staff. The missing comparison is funded roles → filled roles → staffed shifts → caseloads → completed placements, by program.
Ask for staffing and caseload records →These functions can happen together. Their order here is an explanation, not a treatment or housing eligibility sequence. Dated findings require follow-up before being described as current at every site.
See how these constraints interrupt a placement
Prevent the loss of housing, or move directly into a home
Needs a safe placeOutside or at risk of losing housing
Safe interim placeShelter or a suitable care settingWhen needed
A lasting homeAffordable, suitable and supported
Housing work Rent help, a suitable unit and a way in
Support throughout Health care, recovery, daily living and tenancy help
Housing resources
A shelter stay needs a way out.
A shelter can provide safety while the person still waits for a suitable home, rent assistance or support.
What the local source shows
The County’s shelter review found unequal access to the resources that help people move into housing.
County shelter review · FY25The handoff is part of the service. Funding a place is only one part of making it usable.
03 / The clinical gap
Different care. Different receiving places.
Psychiatric care, addiction treatment, recovery from physical illness and housing provide different capabilities. The receiving service must match the person’s needs.
The September 9 Council materials identify a specific clinical gap: preserving acute psychiatric care and creating appropriate receiving care after hospitalization. A discharge-ready patient can still need substantial psychiatric support. A downstream delay can keep an upstream hospital bed occupied.
These are source descriptions and proposed directions, not a verified inventory of services accepting referrals or evidence that Council adopted the proposals.
Council behavioral-health presentation · September 9, 2026 · slides 11–14 ↗Inpatient psychiatry
Hospital-level psychiatric assessment and treatment when clinically indicated.
Check the fit: Admission needs clinical assessment, an accepting hospital and the applicable payment or legal pathway. A shelter vacancy cannot replace this care.
What to measure and where this comes from
Staffed beds; admission waits and denials; discharge-ready days; completed receiving placements.
Council behavioral-health presentation · September 9, 2026 · slides 4, 11–14 ↗Psychiatric subacute care
The presentation describes secure, round-the-clock psychiatric supervision for people who no longer meet full acute inpatient criteria but still need close monitoring and treatment.
Check the fit: The proposed service description is not a verified local license category or an available bed. Required staffing and entry criteria need confirmation.
What to measure and where this comes from
Appropriate referrals accepted; staffed capacity; time awaiting transfer; onward care and housing.
Council behavioral-health presentation · September 9, 2026 · slide 13 ↗Psychiatric respite
The presentation describes 24-hour support, peers, skill-building, medication management and coordination, as a step-down or an alternative to hospitalization.
Check the fit: Clinical capabilities and entry rules vary. This psychiatric service is distinct from recovery after a physical illness and from ordinary bridge housing.
What to measure and where this comes from
Access by referral source; support actually staffed; completed arrivals; repeat crises and continuing care.
Council behavioral-health presentation · September 9, 2026 · slide 13 ↗Residential substance-use treatment
Treatment for substance-use needs at an appropriate clinical level, with continuing treatment and housing planned together.
Check the fit: Residential addiction treatment does not establish capacity for acute psychiatric illness; co-occurring needs require an explicit capability check.
What to measure and where this comes from
Recommended level of care versus admitted level; waiting time; treatment continuity; discharge destination.
Council behavioral-health presentation · September 9, 2026 · slides 6–7, 11 ↗Medical respite
Recovery after physical illness or injury for someone without an appropriate place to recuperate.
Check the fit: CCC’s published criteria require independence in daily activities and medication management. People needing more assistance require another care arrangement.
What to measure and where this comes from
Referrals declined for care needs; time to suitable care; readmissions and housing connections.
CCC Recuperative Care · Provider criteria reviewed September 2026 · Referral criteria ↗Bridge housing
An interim place while a longer-term housing and support arrangement is secured.
Check the fit: A housing program’s name does not guarantee clinical staffing. Verify what the receiving program can provide.
What to measure and where this comes from
Usable units; eligibility; time to a lasting placement; housing and care after exit.
County HSD adopted budget · FY2027 · p. 65 · program 30207 ↗A completed clinical transfer is not a housing outcome. Continue housing navigation, benefits, medication and clinical follow-up through the move. Measure a suitable arrival and later housing stability separately. Explore the psychiatric transition example ↓
Who funds, authorizes, operates and controls admission?
This is a responsibility map to verify for each service and person. Assigning the transition to one agency does not give that agency control over every decision.
Authorize and pay for covered care
CCOs and health plans; OHA for applicable state-funded or direct services
Which payer covers this service and person, what authorization is needed, and who resolves a denial?
Fund and license the service
OHA; Legislature; relevant facility regulators
Are capital, continuing operations and the required license all in place?
Accept and deliver care
Hospital or receiving provider
Can the staffed service meet this person’s assessed needs, and has it accepted the referral?
Provide safety-net and transition support
County Health / community mental-health program; HSD and housing partners
Who coordinates continuing care, benefits, the housing resource and follow-up?
Enable local delivery and advocate
City permitting, program funders and Government Relations
Which siting, permit, local funding or legislative action can the City actually take?
Determine legal admission routes
Courts and state authorities under applicable law and orders
Which civil or forensic route applies? A city policy cannot override a federal order.
State Hospital civil access is constrained, not categorically nonexistent
The memo’s blanket statement about access outside the justice system is too broad. The court monitor recorded 35 civil patients at OSH on March 1, 2026 and ten approved expedited civil-admission requests in January–February. These statewide historical counts concern different populations and periods; they are not a current vacancy count or an admission rate.
Check current civil and forensic protocols and orders before describing access today. The reviewed case listing includes a September 4 motion to purge contempt and September 8 opposition; neither filing establishes release from contempt. Meeting an admission deadline and a court ruling on contempt are different events.
Mink/Bowman court monitor’s third report · March 16, 2026 · p. 21 ↗Mink case documents · Listing reviewed September 9, 2026 ↗Construction, operating finance and usable capacity
A funded building still needs a licensed service, a staffed team, continuing reimbursement and an accepting provider. Compare service-level operating costs with payment by payer, uncovered care, authorization delays and staffing requirements. The presentation’s break-even reimbursement proposal needs a specified payment mechanism and a recurring budget.
Statewide, multiyear appropriations are not Portland’s annual operating budget or beds currently available. Reconcile funded projects, closures, opening dates and staffing against OHA’s project records before calculating capacity or a cost per bed.
Federal matching shares describe how Medicaid is financed. OHA pays predetermined monthly capitation amounts to CCOs. Lower claims can affect plan finances under their risk arrangements and later rate-setting; they do not automatically divide into federal and CCO savings at the matching rate.
SHARE is a potential reinvestment mechanism subject to financial conditions and spending requirements. Its housing priority does not automatically reserve money for a County-selected project.
Council behavioral-health presentation · September 9, 2026 · slides 6, 12–14 ↗OHA behavioral-health capacity investments · Dashboard reviewed September 9, 2026 ↗OHA: OHP rate development · Reviewed September 9, 2026 ↗OHA: 2026 SHARE guidance · 2026 guidance ↗Build on existing programs and obtain the regional model
Health Share describes hospital addiction consultation, emergency-department medication initiation, outreach and peers, wound care, Regional Integration Continuum coordination and EMS service coordination. Investigate each program’s reach, staffing and completed connections; a program description does not establish adequate coverage or effectiveness.
Health Share regional behavioral-health projects · Program descriptions reviewed September 9, 2026 ↗A February 2024 regional announcement allocated $500,000 to a two-year OHSU capacity-modeling project. The County’s original action plan assigned the named regional model to CareOregon and Health Share with a December 2025 due date. Confirm whether this is the model cited in the Council deck and obtain its methods, validation, scenarios and results.
Our educational flow simulator assumes four annual treatment episodes per staffed bed and a 35% durable homelessness-exit rate. Those planning assumptions do not describe acute psychiatry, subacute care or psychiatric respite. No numerical psychiatric scenario is added without supporting evidence.
Health Share and partners’ investment announcement · February 8, 2024 ↗County original Homelessness Response Action Plan · 2024 plan · historical deadlines · p. 23 · action 3.1.2 ↗Prepare a model evidence request ↓Explore the local cohort evidence and unresolved comparisons
Local evidence · Council briefing, September 9, 2026
Behavioral-health needs follow people across the housing system.
The presentation’s high-acuity behavioral-health cohort is defined by a claims diagnosis of stimulant use disorder, opioid use disorder, psychosis, or unintentional substance-associated overdose. Our pathways describe the help someone needs now. These claims records describe diagnoses recorded for a population.
A recorded diagnosis is not a current clinical assessment. These figures do not estimate the share of homeless people who need inpatient care.
9% of members; a larger share of spending
Share of each spending category attributed to this cohort in the Council deck:
Council behavioral-health presentation · September 9, 2026 · slide 7 ↗Overlap extends into permanent housing
Reported high-acuity share among people represented in each program:
Council behavioral-health presentation · September 9, 2026 · slide 8 ↗Housing and care can proceed together. Someone may need hospitalization today while housing planning begins immediately. A need for clinical care does not establish a general sobriety or treatment-completion requirement for housing. Psychiatric services also do not replace prevention or affordable homes.
Read the spending units and all program categories
| Service | High-acuity cohort | Comparison cohort |
|---|---|---|
| Emergency department | $81 | $16 |
| Medical inpatient | $389 | $54 |
These monthly averages are across cohort members, not costs per visit, hospital day or homeless person. The deck does not supply the observation period or full comparison-cohort exclusions. Medical inpatient spending is distinct from psychiatric inpatient spending. The difference is not an estimate of avoidable cost or savings from new psychiatric beds.
| Program | High-acuity share | Reported high-acuity count |
|---|---|---|
| Emergency shelter | 56% | 4,184 |
| Permanent supportive housing | 52% | 886 |
| Street outreach | 51% | 1,260 |
| Homelessness prevention | 13% | 1,718 |
| Transitional / treatment housing | 70% | 1,003 |
| Coordinated entry | 44% | 2,815 |
| Supportive services only | 40% | 2,253 |
| Rapid rehousing | 37% | 1,631 |
| Other | 35% | 1,043 |
| Permanent housing with services | 45% | 149 |
Do not sum categories, extrapolate to everyone outside, or interpret the percentages as need for institutional care. The transitional category is treatment housing; the slide notes alcohol-use disorder is outside this cohort definition.
Council behavioral-health presentation · September 9, 2026 · slides 7–8 ↗Conflicting estimates and claims awaiting clarification
Returns to homelessness: two published estimates
Council slide 9 reports 3.5× greater likelihood. An earlier County KPI document reports preliminary returns of 9% versus 5% (about 1.8×), across rapid rehousing, PSH and other long-term placements with services.
Unresolved comparison: periods, definitions, adjustment and follow-up coverage may differ. Neither estimate establishes a housing model’s causal effect. Request the underlying cohorts; do not present this as a measured worsening.
Council behavioral-health presentation · September 9, 2026 · slide 9; County KPI pp. 5–6 ↗County HRS KPI definitions · November 2025 planning document ↗Membership and costs: versions, not a trend
October 2025 Health Share guidance describes 8% of adult members and 24% of spending; the Council deck reports 9% and 29%.
The published definitions differ, and the deck omits its observation period. Do not plot a trend until the membership denominator and claims rules are reconciled.
Council behavioral-health presentation · September 9, 2026 · slide 7; Health Share strategy pp. 1–2 ↗Health Share HABH strategy · October 2025 ↗Mortality: comparator not supplied
Council slide 9 reports a fourfold mortality risk.
The slide does not specify the comparison population, period, absolute death rates or adjustment. Retain this as an attributed, unresolved claim rather than a headline or a forecast of deaths prevented.
Council behavioral-health presentation · September 9, 2026 · slide 9 ↗What the peer-reviewed local study adds
A study of 2023 Health Share adult members found a medical inpatient admission among 29.7% of housing-insecure members with the specified substance-use or psychotic disorders, compared with 12.4% of housing-secure members with those disorders. These are proportions within the two housing-status groups, not admission rates for Portland’s homeless population.
The study concerns the Portland tri-county service region. It excludes members without medical claims; housing insecurity is broader than street homelessness. Its cross-sectional association supports studying housing and health together, but does not establish causality or validate the deck’s retention or mortality multipliers.
Housing insecurity, behavioral health and acute care · Published April 27, 2026 · 2023 observations ↗04 / Follow a person
Different needs. Different routes home.
A rent crisis, a hospital discharge and an unusable shelter offer need different responses. Explore four illustrative situations and compare the handoffs.
98% wanted stable housing among 350 local survey respondents asked. This is not a countywide estimate. PSU Pathways · April 2026 ↗
Illustrative journey 01
Keep the home. Prevent the crisis.
A renter needs help closing a financial gap so they can stay in the home they already have.
Housing routeIllustrative bottleneck
Still at home
Rent is becoming unaffordable.
Help without a solution
A conversation does not pay the arrears.
Home still at risk
The financial gap remains.
Support alongside housing
- Ask about the housing crisis
- Assistance not secured
- Housing status uncertain
The missing link
Housing problem solving already exists. The missing link in this example is timely financial help and an agreement that lets the renter stay.
The next outcome to verify
Was assistance delivered, was the housing crisis resolved, and is the renter still housed at follow-up?
Evidence & existing resources
- Multnomah County · Coordinated Access policies
November 2025, pp. 7–8: housing problem solving includes mediation and sometimes limited financial assistance; coverage is limited.
- Multnomah County · Rent assistance
The county lists Medicaid rent-assistance and other housing-support routes. Eligibility and available funding must be checked.
Illustrations, not individual case records. Better handoffs are proposals, not guaranteed placements or outcomes.
Ask what the person needs.Housing, care, safety and household needs shape the match.
Verify what the place provides.An available bed may not be a usable placement.
Confirm that the connection happened.One worker’s referral needs another worker’s arrival record.
05 / Follow the outcome
What happens after someone says yes?
A City report makes a crucial distinction visible: interest, acceptance and using a bed are separate results. Lasting housing requires further follow-up.
Reported City weekly totals
11
Interested in a referral
People reported as interested in shelter referral
3
Accepted a referral
People reported as accepting shelter referral
3
Used a shelter bed
People reported as using a bed for at least one night
?
Reached lasting housing
These weekly reports do not follow people through to housing.
Not reported hereA referral, an arrival and a home are three different results.
These totals show the importance of checking each handoff. They do not tell us why a connection failed, or what happened to each person afterward.
Each green square = one person in that reported total.City Street Services · Aug 3–9, 2026 ↗
Why this is not a conversion-rate chart
The City publishes weekly aggregates, not linked records tracing the same people through each step. These figures are not all people contacted or all shelter offers. Dividing them would imply a person-level conversion rate the report does not establish. The two weeks are examples, not a trend. Unknown housing outcomes are not evidence of a return to the street.
“The handoff is part of the service.”
06 / Follow the money
What does a place actually cost?
Shelter operating costs, rent benchmarks and adopted budgets answer different questions. Choose a view to see the dollars, the year and what they buy.
Reported costs · FY2025 · 24/7 adult shelters
A bed has a price. So does the next step.
Selected comparisons · approximate averages
July 2024–June 2025. These are the report’s averages, not the total bill divided by all beds.
The decision
Fund the move to housing alongside the place to wait.
Source & what this comparison includes
Multnomah County’s January 2026 review covers 31 City- and County-funded adult shelter programs. Figures reflect reported FY2025 program costs. The overall average includes other models, including motels.
External housing-placement funds are excluded. Occupancy, partial-year operation, shared expenses, double occupancy, and differences in residents’ needs affect comparisons. A lower operating cost alone does not establish a better outcome. Freeing a bed does not automatically save its annual cost.
Read the Adult Shelter Review · pp. 49–59, 91–9407 / Change the result
Fund the connections. Verify the result.
These are proposed priorities built on services already operating locally. Open a change to see who can act and how the public could track progress.
01Resolve the rent crisis early
Some people need a financial bridge to stay housed.
Resolve the rent crisis early
Some people need a financial bridge to stay housed.
Build on existing housing problem-solving and prevention services. Make flexible assistance, benefit enrollment and landlord mediation available before a household loses its home.
- Who can act
- County HSD · prevention providers · housing authorities
- Proposed public measure
- Time to assistance; housing status at 6 and 12 months; unmet eligible requests
02Make an offer people can use
A vacancy needs a fit check before it becomes an offer.
Make an offer people can use
A vacancy needs a fit check before it becomes an offer.
Record household, safety, accessibility, pet and care needs with the person. Verify that the receiving setting can meet them. Publish barriers to placement by reason, including options the person found unsuitable.
- Who can act
- Receiving providers · referring teams · County HSD
- Proposed public measure
- Suitable vacancies; time to a usable offer; reasons a match fails
03Close the loop on every handoff
Assign responsibility through confirmed arrival.
Close the loop on every handoff
Assign responsibility through confirmed arrival.
Use a named receiving contact, agreed arrival time, transport and a fallback if the place falls through. Build on existing referral and denial tracking. A sent referral should remain open until its outcome is confirmed.
- Who can act
- Referring worker + receiving provider
- Proposed public measure
- Accepted referrals with a confirmed arrival; elapsed time; failed connections by reason
04Fund the route from shelter to housing
Safety tonight needs a funded next step.
Fund the route from shelter to housing
Safety tonight needs a funded next step.
Pair shelter with housing navigation, rent assistance and access to suitable units. Compare resources and outcomes within similar populations before shifting money between shelter models.
- Who can act
- County HSD · City · housing providers · housing authorities
- Proposed public measure
- Time to funded housing match and move-in; resources available per household
05Bring housing and care together
A care plan and a lease solve different needs.
Bring housing and care together
A care plan and a lease solve different needs.
Use the County’s existing cross-sector case conferencing and health navigation. Identify daily-living assistance, clinical care and benefits alongside housing. Give the plan access to actual housing resources; conferencing alone does not supply them.
- Who can act
- County · health plans · health and housing providers
- Proposed public measure
- Time to appropriate care and housing; unmet support needs; housing stability
06Count stable housing—and what is unknown
Show the outcome and the follow-up coverage together.
Count stable housing—and what is unknown
Show the outcome and the follow-up coverage together.
Publish linked placement cohorts with confirmed housing status, observed returns, other known outcomes and unknown follow-up. Reconcile conflicting shelter-exit totals. Compare like populations and use privacy-preserving public aggregates.
- Who can act
- County HSD · City · participating providers
- Proposed public measure
- 6- and 12-month housing status; unknown share; returns to homelessness
September 9 Council briefing · proposal
A proposed 2027 behavioral-health agenda
The September 4 memo frames a possible focus for the City’s 2027 legislative agenda. The packet does not establish Council endorsement. Expected benefits remain forecasts; these milestones are proposed accountability measures.
City Council briefing memo · September 4, 2026 · pp. 1–3 ↗Council behavioral-health presentation · September 9, 2026 · slides 12–14 ↗Preserve acute care and add appropriate step-down
Preserve acute care and add appropriate step-down
The Council presentation proposes preserving inpatient psychiatric beds, backfilling closures and expanding psychiatric subacute and respite care.
- Decision-makers
- OHA · Legislature · hospitals · health plans · operators
- Evidence still needed
- Facility-level needs assessment, model scenarios, workforce and ongoing operating commitments
- Proposed milestone and measure
- Dated staffed capacity by care level, net additions after closures, admission waits and completed transfers
Make continuing operations financially viable
Make continuing operations financially viable
The presentation calls for break-even inpatient reimbursement. Capital funding alone does not keep a clinical service operating.
- Decision-makers
- OHA · health plans · hospitals · Legislature where funding or authority changes
- Evidence still needed
- Costs and reimbursement by payer, authorization denials, staffing costs and recurring funding requirements
- Proposed milestone and measure
- Agreed payment mechanism, service-level revenue and cost coverage, staffed capacity retained and access delivered
Resolve siting, permitting and licensing barriers
Resolve siting, permitting and licensing barriers
The presentation proposes faster local siting and permitting and separate licensing requirements for subacute and respite care. Specific rule changes and safeguards still need to be evaluated.
- Decision-makers
- City permitting · OHA licensing · Legislature as needed
- Evidence still needed
- Project-level delays and the proposed rule or statutory text, including staffing and patient protections
- Proposed milestone and measure
- Project milestones, time lost by reason, approved service standards and actual opening dates
Improve psychiatric access outside criminal proceedings
Improve psychiatric access outside criminal proceedings
The presentation proposes prioritized OSH access outside Aid & Assist and community alternatives. Civil access has existed; the proposal needs a current legal and capacity analysis.
- Decision-makers
- OHA / OSH · Legislature · courts within their respective authority
- Evidence still needed
- Current orders and admission protocols, civil and forensic capacity, and effects on existing obligations
- Proposed milestone and measure
- Access and waiting time by legal pathway; community options; compliance and safe transitions
An opportunity already in the FY27 budget
Turn eligibility into rent that gets paid.
The County funded a team to help eligible Home Forward households access Medicaid rent benefits. Track whether that help arrives and keeps people housed.
County adopted-budget release · June 5, 2026 ↗$565kfunded for the team
$7.8mexpected rent benefits
ApplyApprovePayStay housed
The $7.8m is a County forecast, not realized savings or a measured return. Track each step above.
08 / Get the missing evidence
Turn a red flag into an investigation.
Choose the question you want answered. Each request names the records that could distinguish a capacity problem, a staffing problem and an execution problem.
Proposed records request
How much of the capacity can someone actually use?
Separates a shortage of physical places from closures, staffing limits, admission rules and a mismatch with the person’s needs.
Ask for these records
- Monthly inventory by public program, site and service type: designed or licensed spaces, funded spaces, staffed/operable spaces, occupied spaces, reserved spaces and temporarily closed spaces. Identify whether each figure counts beds, rooms, units or people.
- Published admission hours, referral channels, household and accessibility criteria, care level, and the date each rule or capacity change took effect.
- Existing monthly counts of referrals not admitted, grouped by reason and broad time of day; distinguish no space, no staff, intake closed, eligibility, care mismatch and unknown reason.
Copies text only. No request is sent.
Read the full request before sending
09 / Go deeper
The services behind the story.
Definitions, existing local programs and primary sources—available whenever you want to go deeper.
Overlapping functions, grouped by what they do. A person can use several at once: living in shelter, looking for a home and receiving care. These are not mandatory steps someone must complete.
Keep a housing crisis from becoming homelessnessPrevention · housing problem solving
Prevention
Help a household keep its housing through timely financial assistance, benefits, negotiation or other support.
Source context and limits
The County funds eviction-prevention assistance and an in-reach team to help eligible households access support.
County Human Services adopted budgetProposed measure
Days from request to payment; housing status after assistance; how many outcomes remain unknown.
Housing problem solving and diversion
Explore safe housing options with the household, including help to preserve or restore an arrangement they choose.
Source context and limits
Coordinated Access policies already include housing problem solving, with mediation and limited financial help.
Coordinated Access policies and proceduresProposed measure
People receiving help; time to a verified arrangement; subsequent homelessness, with follow-up coverage disclosed.
Make contact and connect the next placeOutreach · institutional transitions · assessment and matching
Outreach and engagement
Build a working relationship, understand what someone wants and connect them with suitable help.
Source context and limits
City Street Services reports campsite activity, interest in shelter referrals, accepted referrals and initial bed use.
Portland Street Services weekly reportProposed measure
Unique people reached; suitable offers; completed arrivals; reasons an accepted offer did not become a placement.
Institutional in-reach and discharge coordination
Connect housing and support before and after a person leaves a hospital, jail or treatment setting.
Source context and limits
County case conferencing connects housing, healthcare and disability providers. Housing resources must still be secured.
Cross Sector Case ConferencingProposed measure
Confirmed receiving place and support; completed arrivals; unsuccessful handoffs by reason and release setting.
Assessment and housing matching
Match a household’s preferences and support needs to an appropriate, funded resource while housing search continues.
Source context and limits
Coordinated Access policies set matching and provider responsibilities, including preferences and denial tracking.
Coordinated Access policies and proceduresProposed measure
Time from assessment to funded match and move-in; pending cases; rejected matches and their reasons.
Provide care alongside the housing planCrisis support · psychiatric care · withdrawal and addiction treatment · medical respite
Crisis stabilization and sobering
Different services respond to urgent mental-health needs and intoxication. They have different staffing and admission criteria.
Source context and limits
The County’s sobering program is one specific referral-based, voluntary service; it is not a substitute for emergency care.
Multnomah County sobering servicesProposed measure
Appropriate referrals; arrivals; declined admissions by reason; confirmed next connections after discharge.
Withdrawal management
Clinician-directed support for withdrawal, with ongoing treatment and housing connections planned together.
Source context and limits
Hooper provides inpatient and outpatient care and describes transition planning among its services.
Central City Concern Hooper Detoxification Stabilization CenterProposed measure
Time to suitable care; access barriers; continuity of treatment; the person’s destination after the episode.
Residential substance-use treatment
Care in an appropriate treatment setting when indicated, with a plan for housing and support afterward.
Source context and limits
OHA’s facility study distinguishes psychiatric, residential and withdrawal-care settings and their staffing needs.
OHA Behavioral Health Residential+ Facility StudyProposed measure
Staffed and usable capacity by care level; wait time; discharge-ready delays; completed follow-on connections.
Inpatient psychiatry
Hospital-level psychiatric assessment and treatment when clinically indicated.
Source context and limits
Admission needs clinical assessment, an accepting hospital and the applicable payment or legal pathway. A shelter vacancy cannot replace this care.
Council behavioral-health presentationProposed measure
Staffed beds; admission waits and denials; discharge-ready days; completed receiving placements.
Psychiatric subacute care
The presentation describes secure, round-the-clock psychiatric supervision for people who no longer meet full acute inpatient criteria but still need close monitoring and treatment.
Source context and limits
The proposed service description is not a verified local license category or an available bed. Required staffing and entry criteria need confirmation.
Council behavioral-health presentationProposed measure
Appropriate referrals accepted; staffed capacity; time awaiting transfer; onward care and housing.
Psychiatric respite
The presentation describes 24-hour support, peers, skill-building, medication management and coordination, as a step-down or an alternative to hospitalization.
Source context and limits
Clinical capabilities and entry rules vary. This psychiatric service is distinct from recovery after a physical illness and from ordinary bridge housing.
Council behavioral-health presentationProposed measure
Access by referral source; support actually staffed; completed arrivals; repeat crises and continuing care.
Medical respite after physical illness or injury
A place to recover with support after illness or injury, matched to the person’s actual daily care needs.
Source context and limits
CCC Recuperative Care publishes its referral and independence criteria; people needing more assistance require a different match.
Central City Concern Recuperative CareProposed measure
Referrals accepted or declined and why; time to an appropriate setting; housing and care continuity afterward.
Offer a suitable place during the transitionEmergency shelter · bridge and transitional housing
Emergency shelter
Temporary safety with a practical route to housing, in a setting that can meet the household’s needs.
Source context and limits
The County’s FY25 review examines shelter models, operating costs, outcomes and access to additional housing resources.
Multnomah County Adult Shelter Review FY25Proposed measure
Usable capacity; housing resources attached; length of stay; destinations, with unknown outcomes shown separately.
Bridge and transitional housing
An interim setting while a longer-term housing and support arrangement is secured. Program models and eligibility vary.
Source context and limits
The FY27 adopted HSD budget includes Bridge Housing program 30207, with funding and a unit target.
Homeless Services Department adopted budgetProposed measure
Operating capacity; who can use it; time to a suitable longer-term placement; outcomes after leaving.
Reach a home and help it lastRapid rehousing · permanent housing and support · retention
Rapid rehousing
Housing search and time-limited rental assistance, with support and reassessment as the household’s circumstances change.
Source context and limits
HSD funds housing-placement programs; its budget follow-up includes rapid-rehousing retention reporting.
HSD budget worksession follow-up: housing retentionProposed measure
Time to move-in; assistance received; housing status after the subsidy ends; transfers to ongoing support.
Permanent housing with ongoing assistance
A lasting home with rent assistance when needed. Supportive housing also connects tenancy with ongoing services.
Source context and limits
Coordinated Access connects households to housing programs. The rent subsidy, unit and service capacity are separate resources.
Coordinated Access policies and proceduresProposed measure
Funded matches; vacant-unit delays; move-ins; services available; housing outcomes by support need.
Housing retention and tenancy support
Respond to tenancy problems and changing support needs after move-in, and establish whether the person remains housed.
Source context and limits
County reporting already includes retention measures and identifies missing follow-up information.
HSD budget worksession follow-up: housing retentionProposed measure
Confirmed housing, observed returns, other outcomes and unknown status at 3, 6 and 12 months.
Sources you can inspect38 primary reports, policies, budgets and provider documents
- Council behavioral-health presentation
September 9, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- PSU Pathways: housing experiences and preferences
April 9, 2026 · survey fieldwork in 2025
Methods and sample, pp. 20–28; housing preferences, pp. 44–49. A purposive sample, not a population census.
- Multnomah County Adult Shelter Review FY25
January 2026 · July 2024–June 2025 operations
31 reviewed programs; costs and housing resources. Exit totals differ across sections; see the method note below.
- Coordinated Access policies and procedures
Version 1.1 · November 2025
Housing problem solving, assessment, matching preferences, provider responsibilities and denial tracking.
- Portland Street Services weekly report
August 3–9, 2026 · published August 11
Campsite activity and shelter-referral measures have different units. Weekly totals are not a linked person-level journey.
- Home Forward voucher payment standards
Effective January 1, 2026
Administrative gross-rent benchmarks by bedroom size; not available listings, average subsidies or service costs.
- County HSD adopted budget
FY2027
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Changes for Portland’s city shelter services
July 21, 2026 · updated August 24
Announced site changes and effective dates. Future inventory is not current availability.
- Cross Sector Case Conferencing
County information · reviewed September 8, 2026
An existing link between housing, health and disability providers. The conferencing program itself supplies no housing resources.
- CCC Recuperative Care
Provider criteria reviewed September 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- HSD budget worksession follow-up: housing retention
May 14, 2025 · slide 11
Retention reporting and missing follow-up information; percentages refer to differently described cohorts.
- Central City Concern Hooper Detoxification Stabilization Center
Provider information · reviewed September 8, 2026
Inpatient and outpatient services, access and transition planning. Program hours and admission windows differ.
- OHA Behavioral Health Residential+ Facility Study
June 2024 final report · historical planning study
Facility types and modeled need. Its Portland/North Coast area extends beyond the three metro counties.
- Multnomah County sobering services
County page last reviewed July 13, 2026
Referral partners, voluntary access and program scope. Published capacity does not establish an available place now.
- County Human Services adopted budget
FY2027 · prevention programs, pp. 119–120
Eviction-prevention and in-reach appropriations with output targets. Budgeted help is not yet a verified housing outcome.
- 2025 Tri-County Point-in-Time Count report
November 4, 2025 · January 2025 count
Multnomah County totals, pp. 23–25, including sheltered, surveyed unsheltered and presumed unsheltered categories. This is a dated estimate, not a count of people outside today.
- HUD 2025 Housing Inventory Count: Portland / Gresham / Multnomah County
2025 inventory · CoC OR-501, p. 1
Year-round emergency, safe-haven and transitional beds for the capacity comparison. Inventory is not the number of vacant, staffed or suitable beds.
- Multnomah County shelter updates
Published May 6, 2026 · closure schedule reviewed September 8
Shelter closure dates, transition plans and intake changes. Announced reductions and completed closures must be distinguished.
- Multnomah County shelter directory and access rules
County information · reviewed September 8, 2026
Published referral routes and program conditions, including referral-only and approved-housing-placement requirements. A listing is not a live vacancy offer.
- Multnomah County Supportive Housing Services report: FY26 Q4
April–June 2026 · updated August 28, 2026
Outreach reporting and Housing Only referral capacity, pp. 5–6; supportive-housing vacancies, property management, staffing and service costs, pp. 7 and 9. These findings concern the reported programs and period.
- Multnomah County approach to unsheltered homelessness
County information · reviewed September 8, 2026
Existing outreach and coordinated placement practices. Describing a service does not establish complete geographic coverage, adequate staffing or successful arrivals.
- Central City Concern: meeting the region’s need for treatment beds
November 12, 2024 · Hooper assessments in 2022
1,554 assessments recommended residential care and 264 led to residential placement at discharge. Assessments need not be unique people; the historical result is not a current system-wide rate.
- Central City Concern 16 x Burnside Recovery Center
Opened May 2025 · provider page reviewed September 8, 2026
Subsequent treatment-capacity addition and published levels of care. Added beds alone do not demonstrate improved recommendation-to-admission outcomes.
- Central City Concern Letty Owings Center closure FAQ
Updated September 1, 2026 · closure announced for October 31
Admissions pause, provider-stated care, workforce and funding challenges, and transition plans. Listed alternatives do not establish a suitable place is available for every family.
- Multnomah County FY27 adopted-budget announcement
June 5, 2026
One-time mobile eviction-prevention funding and expected Medicaid rent assistance. The forecast is not a record of benefits delivered or evictions prevented.
- County Auditor request to implement audit recommendations
Memorandum to the Board · April 21, 2026, pp. 3–4
The Auditor’s assessment of high-risk provider monitoring and the unresolved advocacy/oversight role conflict. The memo does not establish that all providers misuse funds or explain every service disruption.
- City Council briefing memo
September 4, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- County HRS KPI definitions
November 2025 planning document
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Health Share HABH strategy
October 2025
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Housing insecurity, behavioral health and acute care
Published April 27, 2026 · 2023 observations
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Health Share regional behavioral-health projects
Program descriptions reviewed September 9, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Health Share and partners’ investment announcement
February 8, 2024
September 9 update: see the clinical section for claim-level qualifications and source locations.
- County original Homelessness Response Action Plan
2024 plan · historical deadlines
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Mink/Bowman court monitor’s third report
March 16, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- Mink case documents
Listing reviewed September 9, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- OHA: OHP rate development
Reviewed September 9, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
- OHA: 2026 SHARE guidance
2026 guidance
September 9 update: see the clinical section for claim-level qualifications and source locations.
- OHA behavioral-health capacity investments
Dashboard reviewed September 9, 2026
September 9 update: see the clinical section for claim-level qualifications and source locations.
Reviewed September 8, 2026. These sources document a program or a reporting period; they do not establish whether a place is available today.
How to read the evidenceFacts, proposals, unknowns and the September 8, 2026 revision
- Documented
- A finding or program rule in a named source, limited to its population, place and reporting period.
- Proposed
- Portland Civic Lab’s recommendation or illustrative journey. A suggested connection is not a measured result.
- Unknown
- The reviewed evidence does not establish the answer. Missing data do not prove a service is absent or a person returned to the street.
A source conflict remains open
The FY25 shelter review gives different exit totals and unreported-destination shares in different sections, including pages 13 and 35. It supports the finding that roughly half of exits had unreported destinations. An exact outcome diagram needs a reconciled worksheet; this page does not turn a rounded percentage into an exact number of people.
Inspect the Adult Shelter ReviewCompare the same thing
Campsites are not people. Annual program outputs are not a current waiting list. A facility’s licensed capacity is not its available capacity. A published budget is not actual spending. Cost comparisons need the same unit, period and included services; rates need a defined denominator.
From a question to records
The investigation templates ask for public, aggregate or de-identified records that could test a specific explanation. Likely record holders are starting points, not confirmation that a complete dataset exists. Copying a template does not send a request. No personal case files or identifying health information are requested.
Updated September 9, 2026
Added shared Council evidence, separate psychiatric care settings, a psychiatric-transition example, operating-finance distinctions and five draft evidence requests. Council proposals and unresolved estimates remain explicitly attributed.
September 8 foundation retained
Restored a diagnosis for all fourteen overlapping housing and care functions, with dated findings on capacity, staffing, funding, access, handoffs, execution and outcomes. Added a historical capacity comparison, current announced service changes and records-request templates. Removed unsupported coverage calculations and the unverified $16,000 supportive-housing comparison. Kept observed costs, budgets and rent benchmarks separate, and made source conflicts and missing follow-up explicit.
Illustrative journeys are fictional examples. Editorial lines are Portland Civic Lab’s own. The proposed design is an analysis of the cited public records, not a clinical or legal protocol.
Behavioral-health evidence added September 9, 2026; continuum review September 8, 2026. Each figure retains its own reporting period.Explore the broader homelessness deep dive →