Interview with Rachel Solotaroff | March 14, 2016

Central City Concern is one of Portland’s leading care centers for the homeless. Finding affordable housing, employment, and medical care are all offerings that are provided at CCC. Chief Medical Officer Rachel Solotaroff is one of the reasons CCC is so instrumental in endeavor of solving homelessness in Portland.

“I work with our staff to ensure other ‘bread and butter’ health conditions, such as diabetes, hypertension, and tobacco dependence are looked at systematically, meaning we not only use best evidence to treat them, but ensure we have systems and structures in place that make that evidence applicable to a homeless, or really vulnerable population,” Solotaroff explains.
Although this sounds like a lot, it is only one-third of Solotaroff’s duties. Solotaroff also is in charge of overall management and strategy as well as seeing patients 2-3 days a week.
“My favorite part of my job is seeing patients. It’s also the hardest part of my job. What makes it so hard is that many of the things our patients need cannot be solved by a health care system, but a visit with a doctor is one of the few places where homeless have access to resources, power and privilege. All their needs often come tumbling out in that exam room.”
Throughout all of the interviews I have done about this topic, that is something that I hear constantly from people who work with the homeless community. What makes it so hard for people to care for the homeless is often times they don’t need something that doctors can tangibly give them. Doctors are trained to cure illness and help pain, but often times homeless need either mental health care or simply someone just to listen. The needs of the homeless are rarely met through the traditional ways of practicing medicine, Solotaroff explains
“It strikes me how perverse it is that we spend 15% of our GDP on health care, but so little on housing and education. It’s as if we actually thought we could solve poverty through Medicaid and Medicare. I wish we could take a good chunk of the money we [get] through the Affordable Care Act and spend it on access to housing, education, economic opportunity, clean air and fresh foods for our patients. It would do exponentially more than a visit to primary care.”
Because it is so difficult to meet all the usual health needs of a homeless patient, Solotaroff has changed her practice to focus on exactly what the patient wants – often throwing away any medical solution that doctors are used to giving.
“[Something] I learned very early on is that my agenda as a doctor is really the least helpful thing; it often gets in the way. My ideal outcome for patients is that they feel a sense of dignity and pride in themselves, that the fragmented narratives of their lives become stitched together in a way that makes them feel whole. The real tragedy is when they die before that happens. My job is to keep them alive until it does.”
This question of how to care for the homeless begins at the understanding of who these people are and what it means to be homeless. A huge issue in Portland – as well as most growing cities in America – is the lack of affordable housing. Back to when I spoke with City Commissioner Dan Saltzman, we talked about this issue for quite a while. Portland’s current growth spurt increases the demand for housing, and with the city boundary staying at the same size, the supply can’t keep up. This drives up the cost of housing, allowing landlords to charge top dollar. Solotaroff explains that the average rent of the last several thousand rental units that went on the market in Portland is almost $2,000 per month. Her patients who are on SSI get around $700 a month total. This makes housing impossible for people to obtain.
But affordable housing isn’t the only factor that is forcing people to be homeless. Solotaroff explains the “de-institutionalization of people with mental illness.”

“Starting in the 1960’s, states and communities were supposed to care for these people with community mental health centers, but those [were] unfunded, and thousands of people with mental illness poured into nursing homes, hospitals, jails and the streets. Today, people with serious mental illness are vastly over-represented among the homeless and the incarcerated.”
Until these issues are solved, homelessness will continue to be a huge struggle for so many.
“Trauma and tragedy beget homelessness, [and] homelessness begets further trauma and tragedy. Some people recover, many do not. Two people a week die on the streets in Portland. We [can’t] say we live in a civil society when we allow anyone to live under such incredible, imminent threat.”
On the City
“I think the City is being as creative and as flexible as it can with policies around camping and some sanctioned camps. Camping is not a long-term answer, but in the short-term, having access to safe, clean sites, perhaps with some ‘micro-homes’ seems much better than sleeping under a bridge.”

About Rachel
Age: 45

Family: husband Tony; 2 kids Esther (9 yo) and Joseph (7yo)

Where did you grow up?: Minneapolis

Hobbies: “Running. Lots of running. Playing sports, watching sports, reading about sports, enjoying inspirational sports movies (that is, in fact, the only movie genre I will watch).”

Fun Fact: “Even though my personal grooming is not optimal (eg. I wear jeans and a sweatshirt to work every day), I am actually an obsessive cleaner and tidier. My poor kids have become completely neurotic about crumbs on the floor. I guess that’s more of a disturbing fact than a fun one.”

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