Northwest Pilot Project’s mission is to offer opportunities for a life of dignity and hope to low-income seniors in Multnomah County. Housing case management is one of our primary tools to meet our mission. But what exactly is housing case management, and how does it work?
Listening to needs and goals
As rents continue to increase, housing stability is more challenging. And navigating from houselessness to stable housing isn’t easy. Housing case managers are there to make sure people in need, such as our own older adult clients, don’t have to face those challenges alone.
“Housing case management is really meeting someone where they are and trying to help them put together a plan that meets their needs,” says Celine Mazoyer, who oversees Northwest Pilot Project’s team of case managers. “Everything we do is with the goal of trying to get that person into housing as quickly as possible, and in the most supportive environment available.”
Understanding the process
To understand housing case management, it might help to put it in context. Case management is part of a larger process that has four main stages: assessment, case management, move-in, and retention.
- Assessment: Helps determine where a client is in their journey to stable housing, an individualized follow-up, and referral to case management.
- Case Management: Clients are paired with a case manager to develop a housing plan which will address barriers and identify action steps.
- Move-in: Moving a client into permanent or stable housing is a major milestone in the housing case management process. Move-in includes moving belongings and providing furniture, toiletries, personal items, food, etc., as well as helping complete change of address forms or setting up utilities at the new place.
- Retention: Once a client has moved into stable housing, NWPP’s Retention Team keeps in contact with them periodically to ensure they are doing well and are not facing any issues that could threaten their housing.
Making a housing plan
The ultimate goal of housing case management is stable housing. But services such as health care, transportation, or addiction services often complement that effort (as with Permanent Supportive Housing).
If subsidized housing is available, a client may be able to move straight into a unit they can afford. But generally, Celine says, that’s not the case. Because of the limited availability of subsidized units (meaning the client’s rent obligation is about 30% of their income), intermediary steps are often necessary before a client can move into permanent housing. A housing case manager works with their client to create a housing plan outlining those steps, based on the client’s goals and needs. Steps in a housing plan can include moving from living on the streets into a shelter. From there, the client may be able to move into market-rate (that is, housing priced by the property owner) housing if it can be made affordable through a voucher or other temporary subsidy. Then, the client can be in housing while waiting to come up on a list for permanently subsidized housing.
Sometimes, Celine says, a housing case manager can help the client achieve other goals that aren’t directly related to housing. And sometimes they can reach client goals for specific types of housing, such as living in a community with people who share their culture. “Sometimes clients have a lot of goals, and we love that,” Celine says, “but we’re housing case managers, so we always try to keep what moves the client towards housing as the priority. And then if we have time, we can try to supplement additional things that they might need.”
Preparing to apply
Clients often need help with things to prepare them to apply for housing, especially if they have been houseless for a long time. Three main areas housing case managers typically work on with new clients are collecting documents necessary for the housing application process, addressing barriers or challenges to housing, and accessing health care.
Most people don’t know that a personal identification card is required for many housing applications. Documents like a birth certificate and Social Security card can be required for our clients to get that personal ID. Some clients may also need help with other documents, such as those related to immigration. Especially for clients who have been experiencing unsheltered homelessness for extended periods, these documents can take time and effort to obtain. Housing case managers help clients with this process so they have the documentation they need to continue their journey to stable housing.
Housing case management, above all, is a way of helping people deal with the challenges and barriers to stable housing that they face. These may include aspects of their rental history, such as evictions or landlord debt, other kinds of debt, or a record of interactions with the criminal justice system can make it hard for them to find housing. Personal challenges such as mental health issues, addiction, or cognitive impairment are also barriers. These challenges are very commonly encountered in case management and overcoming them can be complicated and take time—which often is why we can’t get people into housing quickly enough.
Whatever the client is facing, the housing case manager is there to do what they can to help the client overcome the barriers and connect to the resources they need to find and keep their housing. This can be where the truly hard—and often intense—work of housing case management comes in, Celine says. “There’s a lot of holes in our system, and I think one of the hardest things that case managers face is the fact that we don’t have enough services, or we don’t have the right services for somebody. To see that, to not be able to meet that need for someone, is one of the top things that takes a toll on case managers because it feels inhumane.”
Seeking medical care for a client before moving forward with a housing plan, Celine says, sometimes serves two purposes. First, the client needs this care to get or stay healthy enough for their housing journey. Second, in some cases the client’s medical history may have contributed to their housing struggles, and resolving health care needs can clear the path to becoming housed. The case manager may be able to explain to a landlord, “this person was disabled, they lost their job, they couldn’t pay their rent, that’s why they got evicted, but now they’re on disability income or they’re working towards that, so let’s give them another chance,” Celine explains. Case managers refer to that explanation as a “reasonable accommodation,” and that is often an action that makes the difference between getting into housing or not.
What it takes to be a housing case manager
The challenges a housing case manager helps clients face, and the limited resources available, make this work as difficult as it is rewarding. “I think everybody that seeks this line of work has to have an inherent compassion for all people,” Celine says.
But compassion alone isn’t enough. “The ability to ask questions and learn is, I think, crucial to being successful in this job,” she says. “You have to be observing your clients and seeing what their needs are, and figuring out how to meet those needs, and oftentimes that means how do you navigate that system. So you have to be really hungry for that knowledge at all times of the job, because things change constantly. We’re always having to relearn systems and really listen to our clients.”
Finally, Celine says, it’s essential for a housing case manager to be highly organized. “We are literally holding people’s lives in our hands, oftentimes, and mistakes on our part can really negatively impact vulnerable people, so we have to be really organized,” she says. “When you’re juggling complex cases, where each person has three big goals that they’re working on, but then maybe twenty steps of things that have to get done before achieving that goal, and you’ve got thirty people on your caseload, that’s a lot of things to juggle at one time.”
Despite the difficulties, including limited resources, case managers often find the work fulfilling. “I enjoy this work because it’s an opportunity to tangibly empower someone who’s been through an incredible amount of trauma,” Celine says. “Even if we can’t help them fix all their problems, we can at least offer them respect, compassion, and a safe space to feel seen and heard regardless of their past.”
The systems that are supposed to help low-income older adults are complicated and not easy to navigate. For example, to get subsidized housing, a person needs a birth certificate, Social Security card, and photo ID. To get the photo ID, they need a birth certificate and proof of residency. To get the Social Security card, they need a photo ID and a birth certificate. Case managers have to know where to start, since government agencies don’t necessarily have the capacity to help clients.
Getting approved for Supplemental Security Income or Social Security Disability Insurance, Celine says, is incredibly complicated and burdensome to the very disabled individuals these programs are supposed to help. Subsidized housing criteria, meanwhile, excludes many clients with criminal histories—but people of color are disproportionately impacted by both homelessness and by the criminal justice system.
Case managers, Celine says, have to be aware of the ways these systems impact clients. “Our job is to advocate for an incredibly diverse group of people who have been failed by a lot of different systems and we can try to bear some of the burden of navigating these inaccessible systems. When someone gets their basic need for housing met, it’s amazing to watch them flourish and have space to do things that bring them joy or pride since they’re no longer in survival mode.”
Are you interested in being a housing case manager? Check our Employment page for our latest job openings. And, of course, you can support Northwest Pilot Project’s work by making a donation. Together, we can achieve our mission of keeping Multnomah County seniors housed.