Stable housing could have prevented my brother-in-law’s murder

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One year ago, my brother-in-law, Chris Lundegaard, was murdered. He was stabbed to death at a bus stop in Edina, waiting to ride home after picking up some groceries the night before Thanksgiving. The stabbing was an act of random violence. Chris had no affiliation to Adam Garcia, the man charged in his killing. Garcia had become homeless, is schizophrenic and had a history of minor brushes with the law, including trespassing, loitering, and peeing in public.

When I watched the TV news report of the murder I might have registered the tragedy and moved on, as we all do from terrible stories of violence we see on the news, were the victim not my brother-in-law. After all, this is the narrative that many hold regarding homeless individuals — the desperation of living on the street and the “bad character” of people who put themselves into that position in the first place.

I know better. My family experience tells me otherwise. My oldest brother, Jeff, was schizophrenic. At his worst when he was self-medicating (meaning stopped taking his medicine), he became paranoid, screwed his apartment windows shut and bought a gun. Off his meds, he disassociated himself from his family, leading him on a downward spiral toward, very likely, homelessness.

Health care systems and affordable housing providers know the impact that stable housing has on the health and well-being of an individual and a community. They are inextricably linked. Housing is health care.

In Jeff’s case, his erratic behavior and the advocacy of his family led to his placement in the state mental hospital in St. Peter. That is probably the most expensive form of stable housing, behind only the emergency room, where we see many homeless individuals end up. Jeff got back on his medication and was released after a few months. He settled in Winona in a Section 8 apartment close to a nearby drop-in center where he went to take his meds daily.

I am pleased to say that with stable housing and minimal support, he lived a content and happy life in the Winona community for 20 years. He read, wrote poetry, dabbled in photography and remained an important part of our family, always there to celebrate the holidays, especially Thanksgiving and Christmas, his favorites. When we would visit, he loved taking us to the Minnesota Marine Art Museum or the Great River Shakespeare Festival. He had relationships with other residents in his building and with drop-in center staff. When he died of a heart attack during the pandemic, it was that support system in the community that alerted us.

I believe this family history led me to my current job as the director of housing and health equity at the nonprofit Greater Minnesota Housing Fund (GMHF). I work to bring together two complex systems — health care and housing. In partnership, we explore new and innovative ways to link and advance investments in housing that improve community health outcomes while at the same time reducing health care costs.

Post-COVID, the link between housing stability and health has become more widely acknowledged. Health systems now accept that housing stability is the foundation for addressing multiple social determinants of health. Research shows these determinants, such as education, nutrition, socio-economic status and housing, account for 80% of a person’s or family’s health.

Our health care systems are working to understand these factors more. However, 96% of health care financial resources are still targeted at supporting medical services in doctor’s offices, clinics and hospitals, while only 4% are targeted at the 80% of community health factors that dictate a person’s health, according to one estimate. This is an obvious mismatch. Health care systems are now beginning to shift focus to prevention, which is a much-needed change.

I believe deeply that Chris’ death was preventable. His assailant could have been my brother had he been in a stable housing situation instead of spiraling at a bus stop. Had he had a place to live, with support that stabilized his life, that up-front investment could have prevented the pain, loss and spiraling costs that Garcia now drives in treatment, jail (housing) and court systems. (Garcia is still in the court system awaiting evaluation, determination of competence and a murder trial.)

My organization knows exactly how difficult it is to build and sustain affordable housing with support services given the resources available within the housing and community development sector. This is where health care funding and housing finance should come together.

The affordable housing industry in Minnesota has been a leader in connecting housing and services that provide stability. Our community built some of the country’s earliest supportive housing developments. Supportive housing is a highly effective strategy that combines affordable housing with coordinated services to help people struggling with chronic physical and mental health issues maintain stable housing and receive appropriate health care. Because of the link between housing stability and health outcomes, the health care industry benefits from service-enriched housing, as Jeff himself did. Minnesota has an opportunity to lead the way in how we continue to build better housing with health and stability, driving integrated investments to build and operate supportive housing. But more action is needed.

Currently, there are a few separate reviews exploring health-care-related support for housing in Minnesota. One is a process led by the Office of Medicaid in the Minnesota Department of Human Services that is creating a road map to implement interventions to address unmet health-related social needs, including housing, which could be reimbursed by using existing funding through Medicaid. Another is a review of an existing state program, Housing Stabilization Services, which should be more useful to supportive housing developments given its goals. The housing industry would be able to leverage these opportunities to deliver and build on successful supportive-housing models.

These efforts could provide insights to the Minnesota Legislature in 2025. The report with recommendations for a road map is due to the Legislature in March.

Medicaid waivers are increasingly being used around the country to support housing-related services that help individuals and families stabilize and sustain their housing as the most critical social determinant of health. Currently, 19 other states have been approved for health-related social needs (HRSN) waivers, allowing them to expand the use of Medicaid resources to provide housing-related services. Four of those (Arizona, New York, Oregon and Washington) have approval to use Medicaid to pay for up to six months of rent/temporary housing and utility costs while individuals are transitioning from homelessness to housing stability. Medicaid spending on housing stability is a wise investment for health care systems at a time when Minnesotans need housing the most. More committed investment from Medicaid and the health care industry in the housing industry can keep other systems from absorbing the rising costs related to homelessness, encampments, policing, prisons and the courts.

Funding through the health care industry for stable housing will improve people’s health, help affordable housing to be more financially sustainable, and make communities safer and healthier places for all. Linking these complex systems and providing sustainable supportive housing for people like Garcia and my brother Jeff can offer a life-changing path for our most vulnerable citizens.

Eric Muschler is the director of housing and health equity at the Greater Minnesota Housing Fund.