Key Takeaways:
- Housing is only the beginning: People transitioning from long-term homelessness often need ongoing behavioral health, mental health, and recovery support to remain stably housed.
- MacRes provides a higher level of care: Maybelle Center’s Macdonald Residence (MacRes) is a 54-unit assisted living facility in downtown Portland, Oregon, serving adults with complex behavioral health needs, trauma histories, and mental illness. A majority of incoming MacRes Residents have a history of living unhoused.
- Individualized, on-site support is key: MacRes provides personalized Behavior Support Plans, on-site counseling, behavioral health staff on every floor, recovery services, and trauma-informed care.
- Our measurable housing outcomes: Among Residents who moved directly from living unhoused into MacRes between Jan 2024 and Dec 2025, 100% were still living at MacRes after six months and 70% after 12 months.
- MacRes is a model for supportive housing: MacRes demonstrates how individualized care, consistent relationships, and accessible behavioral health services can help people transition indoors and remain housed.
This fall, Willamette Week reported that some of Portland’s largest housing nonprofits face rising costs from damaged units and fast-rising insurance. One leader said some people are “not ready to be housed yet.” He called for more places where people can get support and stabilize.
We know this challenge well. And we agree that a key and a lease are not enough on their own. At Macdonald Residence (MacRes), our 54-unit assisted living facility in Old Town, we have spent the past few years learning what it takes to help people stay housed after a long time outside.
Who lives at MacRes today
Since our state contract changed in 2023, MacRes welcomes adults with some of the highest documented care needs in Multnomah County. Many have been turned away elsewhere. Of the Residents who moved in during 2024 and 2025:
“A lot of times, people think that once someone is housed, that’s it,” says Sam, our Director of Behavior Services. “But it actually can be a really challenging transition.”
After years outside, four walls can feel confining. Living with neighbors, following house routines, or just letting staff know where you’re going can take real adjustment. For many people, so does recovery from substance use.
What support looks like
That’s why we built a Behavioral Health Department. Every new Resident gets a Behavior Support Plan. It names their specific challenges, gives staff ways to help prevent problems before they start, and lays out clear steps if something does happen.
Residents also get:
- Counseling that comes to them. When our main mental health provider ran out of room, Sam’s team found a new partner. Counselors from Stronger Oregon now meet with Residents right here at MacRes. “Residents don’t have to navigate transportation, get up early for appointments, or travel across town to see a provider,” Sam says. That makes it easier to keep going to appointments. We’re also looking at adding peer support, skills training, and help managing psychiatric medications.
- In-house groups on de-escalation, quitting smoking, and Seeking Safety, a proven approach for trauma and substance use.
- A Behavioral Health Aide on every floor. We’ve grown our team of Behavioral Health Aides (BHAs) so there’s one on every floor. They help Residents manage symptoms, build coping skills, and keep up with daily routines. For people who have lived through trauma, seeing the same familiar face every day matters. “Instead of waiting until someone is in crisis, our BHAs can recognize early signs that a Resident may be struggling and intervene before a situation escalates,” Sam says.
- Recovery support that meets people where they are. This year we brought a Certified Alcohol and Drug Counselor (CADC) onto the team. They led recovery groups, helped Residents one-on-one with relapse prevention plans, and connected people to recovery meetings. Residents responded well, and we plan to fill the role again. “Not everyone is ready or interested in abstinence,” Sam says. “Our approach is rooted in harm reduction, meeting people where they’re at, building trust, and helping them work toward their own goals.
Sam’s team supports staff with regular training, including Pro-ACT, a crisis de-escalation training. Earlier this year, members of our team also trained in Dialectical Behavior Therapy (DBT), an approach that builds skills for handling strong emotions and conflict.
“The staff does challenging work every single day, and they’re committed and passionate about it,” Sam says. “I’ve never worked at an organization where people are so committed to their work.”
It’s working
Of the Residents who moved into MacRes directly from living outside:
Of Residents who moved directly from homelessness into Macdonald Residence Assisted Living, 100% remained at MacRes for at least six months and 70% remained for at least 12 months. That means 7 in 10 people who came to us who were unhoused at admission were still living at MacRes a year later. These are people with some of the most complex needs in our county.
This number only counts people who still live at MacRes. It doesn’t yet show where people went after they moved out, whether to their own apartment, a higher level of care, or somewhere else. We’re working on tracking that so we can tell the fuller story.
Not every move-in works out, and we are honest about that. Some Residents end up needing a higher level of care than we can provide. “We haven’t always gotten it right,” Sam says. “But we’re working to hone our process so we’re getting people who can be successful here.”
What we’ve learned
MacRes is assisted living, so it’s built for people who also need help with daily tasks like taking medications or getting dressed. It isn’t the right fit for everyone leaving homelessness.
But what we’ve learned here reaches beyond our walls. Housing works when support is built in from day one: a plan made for each person, staff trained to calm hard moments, mental health and recovery care close at hand, and people who check in every day.
Being ready isn’t a line people have to cross alone. The right support helps build it.
For people with complex needs, a key is the first step. The support around it is what helps them stay.
Sam Swindells (she/her) is a results-driven behavioral health specialist and project leader with a strong track record of improving client care and supporting sustainable growth. She holds a BS in Psychology, a master’s degree in clinical psychology, an MA in General Psychology, and a Post-Baccalaureate Degree in pre-med. Sam is the Director of Behavioral Services at Maybelle Center’s Macdonald Residence Assisted Living.
