Fixing Multnomah County

Former commissioner shares her plans to solve the county's problems

Multnomah County excels at spending money with virtually no idea whether it’s making a real difference to the people desperately in need of its services.

Last fall, county leadership proclaimed that its $15 million “deflection” program was a success because police transported people to the door of its “deflection center” and dropped them off. Never mind that it didn’t track the number of people who actually went inside, let alone got help. As it turns out, it appears that one person did sign up for a treatment program. But the county couldn’t verify whether the person completed the program or is any better off today. Even more disturbingly, the county didn’t seem to realize that these were the only things that truly mattered.

And for more than a year, the county left people who needed ambulances waiting because it cared more about squabbling over the terms of a contract than ensuring people in crisis got to a hospital in time.

These are just two examples of the county’s failure to even understand the problems it’s supposed to be solving, let alone use the $4.3 billion in its most recent annual budget to solve them.

On a larger scale, despite unprecedented investment—nearly $1 billion in Supportive Housing Services (SHS) funds alone—unsheltered and chronic homelessness have increased fivefold over the past five years. We’ve watched as leaders spent nearly $1 billion of Supportive Housing Services tax revenue over the past four years while the number of people living and dying on our streets has skyrocketed. It is horrifying—yet entirely accurate—to point out that death has verifiably moved more people off our streets than hundreds of millions in county spending.

As a former county commissioner who also volunteered as a street medicine doctor, I would get blue in the face trying to wrestle some accountability from county leadership for these harms.

The response was to continue holding meetings and measure processes and activities masquerading as outcomes: the number of meetings held (without results), people “served” (without outcomes), shelter beds “invested in” (without being filled), people “placed” (but not necessarily remaining) in housing and people “receiving” (one-time) emergency rent assistance. Hundreds of millions of dollars and years later, the county cannot verify that a single person was placed from shelter into ongoing stable housing; that their returns to shelter, jail, or ERs decreased; or that the rent assistance actually prevented their eviction.

Right before the holidays, the current county chair, Jessica Vega Pederson, announced that she was not going to try to defend the county’s record of failure by running for reelection. This started a swirl of conjecture around who was going to run to replace her.

Having run against Jessica four years ago, I am often asked whether I intend to run now. I’ve listened to people speculate about the pros and cons of different potential candidates. And the process itself has been revelatory.

But, to my mind, it seems clear that debating who should run before debating what needs to be done is like asking whose name should appear on the captain’s quarters of the Titanic.

Bottom line: You can’t right the Titanic—it wasn’t savable.

When Jessica ran for chair, I watched with some surprise as she claimed to have a plan to end homelessness. She promised she’d prove it if she got elected. Four years later, no one would suggest that there’s anything resembling a plan in place at the county. Yet we continue electing leaders who peddle the same fake merchandise, with slightly different packaging. To my mind, it’s both naive and shortsighted to continue to believe that problems get solved by politicians winning elections.

We, collectively, need to do better. We need to worry less about who wants to run for office and more about how to fix the county. At least then we can have a constructive dialogue that might actually lead to progress no matter who enters—let alone wins—the next election.

I am hoping to launch that conversation today by sharing an actual plan to fix the county. Not a few pithy bullet points, but a detailed plan with meaningful goals tied to measurable outcomes and aligned departmental budgets. We can do immeasurably more by actually measuring what we are doing, while creating accountability structures along the way.

My plan reorganizes our county government from a collection of siloed, unfocused programs to a results-driven system with short-term results within a year, midterm results within three years and long-term results within five.

It streamlines the county by bringing its 11 fragmented departments together into five functionally integrated hubs; coordinating and streamlining the 400-plus nonprofits that currently deliver core county services and advancing programs with proven performance; building a zero-based budget where every dollar is accounted for and tied to a specific outcome; and rearranging the chaos and programmatic revolving doors we have spinning now into pathways that effectively connect people to the services and supports they need to get to the next stage of their progress.

My plan also recognizes that we are not going to be getting more money anytime soon no matter how much we shake our fists at the state or federal government. On both fronts, we’re pretty much guaranteed to see devastating cuts to basic health and human services funding, so best to plan on it rather than pretend to be surprised and call it a crisis later.

It’s time to stop complaining about having less to spend and start focusing on doing more with what we have.

Fortunately, we don’t have to invent that wheel. Other places comparable to Multnomah County have effectively managed these problems. You can’t do much worse than we’re doing now anyway.

One of the department-specific plans I created builds a homelessness-to-housing continuum of services using best practices from better-performing cities and counties, such as Houston and Minneapolis. It measures what matters—things like decreasing first-time homelessness, preventing returns to homelessness, developing shelter exits to sustained housing and treatment, stopping repeat ER visits, and reducing returns to jail. And it can be done on a 25% reduction in current funds.

Right now, the county is spending its money on optics rather than performance without meaningfully defining or measuring success. It’s one thing to throw money at a problem; it’s another to not even aim.

I have been privileged to have the time, background, healthcare, homeless outreach and county government experience to put the pieces of this puzzle together in ways that I don’t believe anyone else could. I’ve consulted longtime health care colleagues, provider experts and many on the front line of service with little help from the politicians and useless appointees above them. The good news is, the deeper I’ve gone, the more optimistic I’ve become. Because turning around the county is eminently doable.

This work is not as hard as leaders are making it, and we can achieve far more by creating systems that work, rather than throwing money at problems and putting out press releases claiming success without changing anything.

I invite you to read my plan in all its detail on my website and share your thoughts.

I believe that if we begin to form a consensus on the direction the county needs to go, we can all win. Because we will finally be focused on results for the people who really matter: those who desperately need our help and all who long for a healthy, safe and thriving community.