Health Calls Season 7, Episode 2 explores how Catholic organizations across the United States are reimagining the connection between housing and healthcare. Host Brian Reardon and Executive Producer Josh Matejka welcome Rob McCann, President and CEO of Catholic Charities Eastern Washington, to discuss a nationally recognized partnership with Providence that addresses chronic homelessness through housing, medical respite, and supportive services.
Health Calls Season 7, Episode 2 explores how Catholic organizations across the United States are reimagining the connection between housing and healthcare. Host Brian Reardon and Executive Producer Josh Matejka welcome Rob McCann, President and CEO of Catholic Charities Eastern Washington, to discuss a nationally recognized partnership with Providence that addresses chronic homelessness through housing, medical respite, and supportive services.
The conversation examines how stable housing can improve health outcomes, reduce hospital readmissions, lower emergency service utilization, and promote human dignity. McCann explains how the Healthy Housing Initiative grew from a local collaboration in Spokane, Washington, into a model that has inspired Catholic Charities organizations nationwide. By combining affordable housing with mental health support, addiction treatment, healthcare navigation, and community-based care, the program demonstrates how healthcare systems can move beyond clinical treatment to address root causes of poor health.
Brian Reardon (00:06):
Welcome to Health Calls, the podcast of the Catholic Health Association of the United States. I'm your host, Brian Reardon, and with me as always is Josh Matejka, our executive producer. Hey, Josh.
Josh Matejka (00:15):
Hey, Brian, how's it going?
Brian Reardon (00:17):
Good. We are now on our second episode of this season, which we have themed Health Reimagined. And in this episode, we're going to talk about a topic that may not be entirely new, but I think there's an approach to housing that's worth examining and how we reimagine the relationship. And so the topic for this episode is housing and healthcare, reimagining the relationship. And Josh, I guess to help us set the context, how did this topic come up in our discussion for this season of Health Calls?
Josh Matejka (00:46):
Yeah, I think Brian, anybody who listens to Health Calls or is even familiar with the work that we do in Catholic healthcare will probably not be unfamiliar with Catholic Charities and a lot of the great work that happens in that organization all around the United States. But like you said, the name of this episode is Reimagining the Relationship. And so over the years, we've noticed this relationship developing with some of our member organizations and Catholic charities in the Pacific Northwest, and it's something that we've covered in Catholic Health World and that we've covered in some of our other media at CHA. And so as we were really deep diving into this and talking about re-imagining the relationship, we wanted to lean into the relationship aspect of that as well. I think sometimes we can get into this bifurcated mindset of, well, we're doing this care over here and they're doing that work over there.
(01:38):
But really when we think about how much the social factors of health intersect and how much everything around us in our communities intersects with the health of communities, that's where that relationship that I mentioned with Catholic Charities and the Pacific Northwest and Providence really started to come to the forefront. And so when we invited Rob to come on the show, I was really excited because I think he's going to be able to break out the ways that they're doing that specifically in a way that shows that, hey, this is a relationship element, that these two sides are working in tandem to achieve human flourishing, to achieve the type of whole person care that we want to strive for at the Catholic Health Association and all of our members. So I'm really excited to have Rob here because I think he's going to be able to elucidate that for our listeners.
Brian Reardon (02:26):
Yeah, likewise. So let's go ahead and bring in Rob McCann. He is president and CEO of Catholic Charities Eastern Washington. Rob, welcome to the show.
Rob McCann (02:35):
Great to be here. Thanks for having me.
Brian Reardon (02:37):
Yeah, so as Josh mentioned, Catholic Charities is working with Catholic Healthcare, specifically Providence in Eastern Washington on an initiative. It's the Healthy Housing Initiative, which I believe has been around for, oh, almost a decade now. I know we have, like Josh mentioned, covered it. I think there's five communities around the country where this pilot program began. So maybe talk a little bit about backing up and the relationship that Catholic Charities has had with Providence over the years in caring for your communities.
Rob McCann (03:07):
Yeah, I'm happy to talk about this. I love talking about housing. Here at Catholic Charities in Eastern Washington, we're probably one of the biggest, if not the biggest, provider of housing of any Catholic Charities in the country. And you wonder, well, how does Little Old Spokane, Washington become bigger than Chicago, New York, LA, Dallas, Seattle, all of them? And the answer is Catholic Healthcare. We would've never grown to this level without our relationship with Providence Healthcare. When I started here at Catholic Charities 27 years ago, we had nine apartment complexes. We now have 72 apartment complexes. A big part of that growth is because of our partnership with Catholic Healthcare, but specifically with Providence Healthcare here in Eastern Washington, really all over the Northwest, but predominantly here in Eastern Washington. We cover a 13 county region. We have housing in almost every one of those counties, over 3,000 total units, five different homeless shelters.
(04:06):
All of those facilities and locations have a very deep connection with Providence. Either they helped us start it, they helped us build it, they're helping us run it. They came up with the idea in the first place as it was with some of our homeless respite, or they're deeply involved in the day-to-day operations of the housing that we already have.
Brian Reardon (04:25):
And how did those conversations initially start? Was that something that you went to, for example, the CEO, did it start with somebody who worked maybe with the unhoused population, maybe social services? What was the genesis to form this collaboration and partnership?
Rob McCann (04:40):
I started out on the Providence board of directors here locally in Spokane probably, I don't know, maybe 17, 18 years ago. And I did my 12 years on that board and now I'm on the board over in Renton. But I think it started there as I should listen to those board meetings and they would say things like, our mission is to reveal God's love to the poor and vulnerable. Our mission is to know me, care for me, ease my way. And I sat there thinking, God, that's kind of just like us. We do the same stuff. And as I spent more time in Providence board meetings, I realized there's a lot of places we should be connecting that we're not. And there had been places we were connecting for decades long before I got here, but there was more we could do. And really it started long before the Healthy Housing Initiative.
(05:26):
It started with homeless people in the hospitals here in Spokane that the average person, you or I, stays in the hospital about 2.1 nights per visit. The average homeless person stays in the hospital about 13.2 nights. The reason is because Providence is a great Catholic hospital and when a homeless person comes in, they take great care of them. When you and I go to the hospital, we're in there for a couple nights and then when we're ready to get home, they send us home with our meds. We lie on the couch and our loved ones give us chicken soup. We take our meds, we get better. When a homeless person goes to the hospital, they get the same great treatment, they get the same meds, but if they let them back out on the streets, they lose their meds, their meds get stolen, their wounds get reinfected, their sutures reopen, they end up being a readmit.
(06:08):
So they do the great, wonderful Catholic Christian thing. They keep them in the hospital an extra nine point whatever nights, which the state hospital annualized cost per night in the state of Washington is about 3,200 bucks. And so we came up with a system with Providence probably 15, 16 years ago where we designated some of our shelter beds at House of Charity to be rested beds for Providence. And so when that homeless person was in the hospital of Providence ready to be discharged, but the doc was going to keep another nine nights because he had nowhere to go, they'd send him to us in a specialized bed that was staffed with special of our team members and also docs and nurses and they could recover in the shelter and stay in their bed twenty four seven just like it was a hospital bed. And that program was very, very effective right from the get-go.
(06:58):
I think that we started with four beds and those first four beds at House of Charity, I think saved Providence about $16 million in year one. So they immediately came back and said, "Hey, can we have more beds?" And we said, "Of course you can." But how it got there was interesting because you mentioned, did I talk to the CEO? Well, I did, and it didn't necessarily land. And I brought it up at board meetings, I brought it up to the CEO. It didn't land so much. It wasn't until I talked to the CFO that it got some traction because I realized I was explaining math and numbers and cost aversion and money saved to a CEO when I should be explaining that to a CFO. And as soon as I explained how much I thought we could save the hospital on all those extra stays and all those extra nights, the CFO said, "Oh my God, that's a big number." And the number we ended up saving them in year one was probably double what I thought it was going to be.
(07:55):
And so then the CFO was sold and then it created the partnership that's now been replicated all over the country with lots of Catholic hospitals.
Brian Reardon (08:03):
And I think there's another financial angle to this, and of course we want to talk about the end result, the benefit to the individual who's being cared for both by the hospital and in what would be maybe a respite bed or one of your facilities or apartments. But really if you look at the issue of the homelessness in America, there's a lot of cost involved in caring for those individuals, not just in the hospital, not just in a shelter, but really if you look at public safety. So how has the rest of the community been engaged in
Rob McCann (08:33):
This?That's an interesting question. The reality is in Spokane, and these numbers are probably pretty true everywhere in the country, but here in our region, the average chronic street homeless super utilizer will spend anywhere from 50,000 to $250,000 per year per person on police, fire, ER, hospital, jail, court costs, all those things. Or they could be in one of our Catholic Charities apartments where they have mental health and addiction counseling on site. They have medical navigators on site. They can be in that apartment and it costs about $9,000 a year. So it's a clear ROI to the taxpayer, to the person who's having a heart attack on the South Hill. They want the ambulance there in three minutes. They don't want the ambulance there in 12 minutes because they're on their 10th call of the day down at House of Charity. And so if we can get people to not super utilize public services, every time there's a 911 call by a homeless person in downtown Spokane because they're having some kind of emergency, the same thing happens.
(09:39):
A police car, an ambulance, and a firetruck all roll. That costs a lot of money. And if we can cut that down, that saves a lot of money to the taxpayers, to the city, the county, not just Providence that loves that we're reducing super utilization, it's the whole community. We had a guy went to the ER 62.
Brian Reardon (09:57):
Well, no, it's a great example of aligning stewardship. So the individuals that you have in your, I think you said 72 different complexes now, which is amazing, talk a little bit about the environment because it's not just saying, okay, here's a room, here's a key, good luck. There's some, I think you've described as a precious presence. So could you talk a little bit about, we talked about the stewardship angle, now the human dignity angle of these individuals who are really getting this more sort of comprehensive care for a period of their life where they're obviously struggling because they're not able to have a place to stay and really are relying on that. So can you walk us a little bit about what the environment is like for these individuals?
Rob McCann (10:40):
Yeah, I mean the environment is everything. Chronically street homeless individuals anywhere in this country, probably about 85% of the time they're dual diagnosed with mental health and addiction concerns happening at once, SUD concerns. And so there are already a medically fragile population. The street homeless people in Spokane, in your community, anywhere in the US are more than likely the most medically fragile people that are not already in a hospital or in a nursing home. And in some cases they should be in one or the other. And so when you put them in a new environment, you have to have supports. And what we do in our buildings is we don't just say, "Here's your key, sign your lease, good luck." We have a ton of staff in all these buildings. We have mental health professionals in the building, SUD professionals in the building, healthcare navigators, staff whose job is to make sure you get to the doctor's appointments, you get your meds, you get to the pharmacy, you take your meds in the building, peer support specialists in the building, security in the building, lots of property managers and maintenance and housekeepers in the building.
(11:46):
You have to have all these folks in the building. We call it the precious presence, all the folks in the building to make sure things are going okay. Because with this population, they can relapse very quickly, they can have a mental health situation very quickly that's very profound and troubling. And so you have to have people in the building that can address it in the moment or else you're going to have people that go back to the streets, go back to jail, or you're going to have the SWAT team or front page of the paper kind of things happening because these are very vulnerable people. Now on the other hand, if you have the precious presence, if you have all the staff, we have a 94% success rate in these buildings, meaning it's a HUD metric. It means 94% of the time you go from street homelessness to one of our buildings that are filled with all this staff, all this precious presence, lots of Providence docs and nurses are coming to our buildings all the time.
(12:37):
If you have that, 94% of the time they're not going back to the shelter, they're not going back to the street, they're not going back to jail. They're also not going back to superutilizing the ER and the hospital. 94% success rate, that's a huge success rate for this population. The national average for that success rate is more like 50%. The reason we get all those extra percentage points is because of that precious presence.
Brian Reardon (12:59):
That's great. And I know you in your Catholic Charities, you've been sort of apostles of this program. You've been out, I think you've mentioned you've talked to hundreds of different organizations. What is it that you try to really emphasize when you're talking to others about why they should sign up for a similar program? I guess I don't want to use the word sell, but in many ways, how do you market this collaborative agreement so that others could adopt it and apply the same sort of learnings in their communities?
Rob McCann (13:28):
Well, and that's the Healthy Housing Initiative with Cafe Charities USA. It's a great introduction to that topic because what we were seeing is we were building all this housing in Spokane, having all this great success with Providence and with homelessness and shelters and respite and housing. And other cafeterias around the country, they kind of said a couple things. First they said, "Well, how does Spokane have all this housing and how do they have more than New York City or Boston or Chicago? It's not possible. It's a small town and we are." And the next thing they said is, "Maybe we ought to figure out what the secret sauce is and let's replicate it." And Healthy Housing Initiative was the first five Catholic Charities organizations in the country that said, "Hey, can you show us how to do this?" And so we put together a Healthy Housing Initiative playbook.
(14:12):
I think it's like 90 pages long. It says to any cafeteries in the country, if you don't have any housing or any shelters, but you want to get started and you want to do shelters or respite or housing, here's how you do it step by step. You start with your bishop, you start with the priests, you start with your board, you got to convince them. Then you got to convince your donors, you got to convince the parishes, then you got to convince the local Catholic healthcare institution to jump on board and partner with you. And so we created this playbook. We had five pilot cities to help them build their first project. In the background, there was probably a dozen other cities that were calling me and asking me, "Hey, can you help us do this?" And we said, "Yeah, this is open source." I think we've had 23 different Catholic Charities agencies from around the US who have sent teams, flown into Spokane, spent a week with us, visited all of our housing, and we share policies, procedures, tax credit applications, job descriptions, budgets, proformas, best practices, all of it.
(15:09):
We share it with all of it. They've all come to Spokane and we're happy to share the open source code here. And we were more than happy to do it with the five cities for the Healthy Housing Initiative with Catholic Charities USA, which would've never happened without Catholic Charities USA leading into it.
Brian Reardon (15:24):
And what are some of the toughest questions or maybe challenges that you've encountered in trying to convince other organizations to basically adopt your playbook?
Rob McCann (15:33):
The biggest challenge is fear. Most Catholic Charities organizations are like this one. It's a bunch of good-hearted social workers, people who just care about their fellow human beings. They're not necessarily big or mature financial organizations. They don't have in-house attorneys, and most Catholic charities are pretty risk averse. Most Catholic bishops and most Catholic Charities boards are risk averse, rightfully so. You got to be careful. And these projects are full of risk. And so it's very hard often to convince a local bishop or a local board of directors it's going to be okay. These tax credit projects are super complicated. They take a couple years to put them together. If the application is a binder this thick, it's filled with legalese and you need lots of specialized attorneys and accountants to get it done, but it's going to be okay. Most bishops, most boards look at that and go, I don't think so.
(16:24):
That's way too much for me. That's way too much risk. What if it goes wrong? These are 20 and 30 million projects and if they get upside down, the Catholic charities is on the hook. You're making all these guarantees that you're going to run it for 15 years. What if something goes wrong? What if the SWAT team does come and you're on the front page of the paper? Is that going to scare away my donors? Those are the big things that I have to talk most bishops and most boards through. The good news is most of them eventually can look at us or look at other Catholic charities that have done these successfully and say, yeah, if they could do it in Spokane, of course we could do it in Chicago. Why not? We're bigger than they are and they are.
Brian Reardon (17:01):
Yeah. And I think this is such a huge problem in this country. I think in any community you live in, you're going to see individuals who are unhoused. And I think a problem this big requires some bold thinking. And so what you've come up with, and I think you're right, there is always a risk in taking on something so bold, but I think would you say the reward would outweigh the risk or at least is worth that sort of bold action because of what a serious problem this is?
Rob McCann (17:29):
Yeah. I mean, the reward is it's Catholic social teaching. It's every human being is made in the image of life to God. And if you believe that, you believe that everyone deserves dignity and respect and compassion and things like healthcare and things like a safe place to live. And that's the reward. I think for us, it's a national issue. Homelessness is a huge national issue and there's a lot of argument about it, about how to fix it and how it started and who's to blame for it, but there's a lot of negativity around the discussion of homelessness and a lot of people that'll try and convince you it's too big of a problem, it can't be solved, you're not making a difference. But here's the reality. We live in the greatest, most powerful country in the history of the planet earth. We could drop a Mars Rover on a dime 60 million miles away.
(18:17):
I can read the entire library Congress on this thing. You can't tell me we can't solve homelessness and we can. And you just have to start with a place of optimism that yeah, we can make a difference. There's 5,120 some odd men women and children going to put their heads on Catholic Charity Spokane pillows tonight. And that's just little old Spokane. Imagine if we did that in every major city in the US, and it's obviously a scalable problem. We don't have 20,000 homeless people on the streets like they do in LA. I get it. But if we can get towards solving it here, you can get towards solving it anywhere. The language of the enemy, the language of the opposition is don't even bother. It's too big. You can't solve it. We don't like the language of negativity out here. Catholic Social Teaching says that we see a problem, we have to help our brother and sister in need, treat people like you would want to be treated yourselves in CatholicCharity, Spokane, all of our housing.
(19:13):
We have lots of metrics and measures and we have dashboards for everything, but we have one rule, one rule that all 500 of our staff can recite to you on the spot, anywhere they are. And it's the most important rule is would I put my mother in this apartment? The answer is yes, we're doing it right. It's financially healthy. It's a good community. It's clean. It's got curbside appeal. It's safe. If the answer is no, I wouldn't put my mom in there. Then we're doing something wrong. We need to fix it. And it really is as simple as that.
Brian Reardon (19:39):
I'm going to bring Josh back in as we wrap up the conversation. Josh, any takeaways from what Rob shared?
Josh Matejka (19:45):
One thing I do want to ask follow-up question about is this precious presence that you're talking about. You cited the national averages of success rate in this type of initiative and then what you're seeing on your end and you attribute that to that precious presence. To me, that is an organizational culture question, getting that many people to buy into that type of care and that type of presence. How do you and other leaders at Catholic Charities and maybe other leaders at other organizations that you partner with instill that organizational culture? Because to me, that's something that could be potentially a big stumbling block because if you're not able to get the right people in, you're not able to instill that type of culture that really wraps care around these people.
Rob McCann (20:32):
Well, here's the problem with the precious presence. It's super expensive and that's a big problem. It's a big obstacle. There's plenty of nonprofits building tax credit projects for the homeless all over the country. Some are Catholic Charities, some are just other nonprofits. And there are plenty that just build the apartment complex. They have a property manager and a maintenance person, and they do hand the keys to someone and say, "Here's your lease, here's your keys, good luck." And that's it. There are plenty around the country that use the Housing First model, which is our model, but they use it that way because they can't afford mental health counselors and addiction counselors and peer navigators and healthcare navigators and security and all the extra bodies that we put in the building. It costs a lot of money. The tax credit awards will give you every penny you need to build the brick and mortar to build the building.
(21:18):
They will not give you one penny to operate it. And so you have to choose how you're going to operate it. You can just have a property manager and a maintenance person and hand people the keys and then wish everyone luck. It's going to get pretty spicy pretty quick if you do it that way. Or you could have that precious presence, but it costs a lot of money. And the way that we answered that problem many years ago, Catholic healthcare was the answer. Our relationship with Providence, Providence is our number one funder in all of Catholic Charities Eastern Washington, probably for the last 50 years. They are the first ones to make a donation when we're doing a capital campaign. They give us land, they give us volunteer docs and nurses. They help us do these things so that we can afford to have the precious presence.
(22:03):
And not every cafeteries that build these things can have the staffing levels that we have, but they can strive towards them. And if you build enough of this housing, tax credit projects actually can throw up quite a bit of revenue for the organization. Our housing portfolio throws off enough revenue to not only pay for all that precious presence, it also pays to run our other programs like immigration services and senior services because property management and developing housing is a way to make a decent amount of profit and we put it right back into serving poor people every time. And for us, putting it back in means paying for the precious presence.
Brian Reardon (22:39):
Now it really is a re-imagination of how to work together to solve a very big problem. So again, Rob McCann, he's president and CEO of Catholic Charities in Eastern Washington. Thanks for spending time and really just sharing your passion for this work. It really came through and I think what you shared was very enlightening and informative, so thank you for your time.
Rob McCann (22:58):
Thanks to the Catholic Health Association. We would not be at this place after my 27 years here. It's nothing to do with me. There's no magic sauce in this space. It's everything to do with Catholic healthcare. That's why we're here, that's why we're successful. It's the reason and Providence is part of that Catholic Health Association group.
Brian Reardon (23:17):
Yeah. And I think just the Catholic collaboration and what the church is doing is a really example of ministry in work. So again, thanks again. This has been another episode of Health Calls, the podcast of the Catholic Health Association of the United States. Again, I'm your host, Brian Reardon. With me was Josh Matejka. And again, we had Rob McCann, President and CEO of Catholic Charities from Eastern Washington. And if you're looking for health calls and more information, some of the articles that Josh mentioned, please check out our podcast page at chausa.org/podcast. You can find all the information in all previous episodes there. And of course, you can always download and listen to Health Calls on all of your favorite podcast streaming platforms such as Apple Podcasts, Google Play, Spotify. Encourage you to do that. And if you do, we'd love to hear your feedback. We'd love to get a rating.
(24:09):
Thanks again also to Sarah Marchant, our scheduling producer and to Once Films who produces Health Calls. And as always, thanks for listening.