A unique, mixed-use development strategy that combines affordable housing with commercial space for health care services and community use is gaining increasing traction in Portland and, as the debate about health care reform rages, serving as a national model for how to reduce health care and housing costs.
Cascadia Behavioral Healthcare is building Garlington Center in Northeast Portland with the goal of integrating affordable housing with health care and wellness services. When completed in 2018, the $28-million development will include commercial space that will house a health care clinic and pharmacy, a community wellness center and a fitness room.
The 1.5-acre property also will have a food pantry, teaching kitchen and a community garden, and will connect with the housing component via a courtyard. The apartment building will offer 52 units, 10 of which are designated for military veterans and another 10 for behavioral health tenants.
Located on Martin Luther King Jr. Boulevard between Northeast Morris and Monroe streets, the center replaces Cascadia's existing facility at 3034 N.E. MLK Jr. Blvd. It is named in honor of the late Rev. Dr. John W. Garlington Jr., a prominent leader and advocate for the African American community in Portland during the late 1970s and early '80s.
In a website post about the project, the Eliot Neighborhood Association said it welcomes the addition of an "architecturally beautiful and well-lit building to activate MLK."
Lisa McClellan, principal with Scott Edwards Architecture, which designed the project, said the concept of "whole person wellness" is increasingly playing a role in the firm's work for community-based health care clients.
"What's really interesting to me about this project was the housing and the clinic combined. When we first came on board, it was thought this would be a mixed-use project with the clinic on the first floor and housing above it," she said.
However, height restrictions were squeezing the ability to carry that out from a design and construction standpoint, so the project team looked into dividing the development into a two-story building for the commercial space and a four-story building for the residential space, with a courtyard linking the two.
"I do think breaking down the scale is going to be a finer-grain development for the neighborhood," McClellan said. "It won't feel so monolithic and imposing."
She noted that the neighborhood surrounding the new development tends toward a lower scale, with the buildings next door at two stories and single-family homes nearby. The design team sought to create two buildings that look similar but also are distinct, while creating a connection with the community through the commercial space, courtyard and patios on some of the residential units.
"The clinic is on the ground floor and it's open and glassy to show the commercial space more," McClellan said, adding windows on the second-floor are narrower in a style that references the Albina area's historic storefront look.
Housing Development Center (HDC) serves as Cascadia's property development consultant on the project, and Mary Bradshaw is its construction manager. She noted that not only did Cascadia want the development to be a place that is open to the community, but it also wanted the center to serve as an anchor within the neighborhood.
"I think folks are moving in that direction more because they are starting to better understand the whole person approach. Someone can't take care of their physical and mental health if they don't have a place to live and vice versa," she said.
Bradshaw said Cascadia is already looking into developing a similar type of mixed-use facility in other areas of Portland.
"Cascadia is not looking at Garlington Center as a one-off and they do see this as the future of how they deliver their services," she said. "I think it's a groundswell that is happening, and we'll have to see what happens in the future, but I think the funding sources, at least for the time being, are available to encourage more integration between housing and health care."
In March, Cascadia announced that it had secured $4.5 million in New Markets Tax Credits. The project is funded in part by a combination of tax credits along with public and private grant and philanthropic support. The investment is a partnership with National Community Fund, a community development entity affiliated with United Fund Advisors.
"We are striving to create a valued space where being mindful and treating the whole body is easy and accessible for our community," Dr. Derald Walker, Cascadia's president and chief executive officer, said in a release announcing the tax credits. "Securing this level of funding is key to our capital redevelopment plans of the Garlington Center."
In a similar development model, six Oregon health care organizations — Adventist Health Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science University and Providence Health & Services — announced last September that they planned to invest $21.5 million in a partnership with the nonprofit Central City Concern to develop a trio of affordable housing projects.
The investment will support 382 affordable housing units across three locations, including one with an integrated health center in Southeast Portland. The Eastside Health Center's first-floor clinic will serve medically fragile patients and people in recovery from addictions and mental illness. The clinic will be topped with 176 affordable housing units. The center will also become the new home for Eastside Concern, an existing Central City Concern program that provides 24-hour medical staffing.
Also part of the investment are the Stark Street Apartments, which will provide 155 units of workforce housing, and the Interstate Apartments in North Portland, which will provide 51 units designed for families. Both are slated for completion in 2018.
Development that integrates affordable housing and health care services may be on the rise in the future, as a 2016 study by the Center for Outcomes Research and Education and Enterprise Community Partners Inc. found that pairing them reduces emergency department visits and Medicaid costs. The study found that after moving into affordable housing, Medicaid costs were $48 lower per resident per month, for a total annual reduction of $936,000 for the study group.