The Lowcountry’s Missing Middle: ‘Where Can I Live?’

Healthcare workforce challenged by lack of affordable housing here

Organizations and businesses are comprised of people, and those people are what truly drives success.

Banks don’t run without tellers. Schools need teachers. Restaurants rely on cooks, servers, and hosts. And hospitals can’t function without healthcare workers — both clinical and nonclinical — many of whom, including those at Beaufort Memorial, are struggling with the cost of living in the Lowcountry.

The team member who took your information at registration in the emergency room might commute over an hour to work every shift because single-bedroom apartments here are out of their price range.

The nurse who started your IV may be exploring job openings in Greenville or Spartanburg because staying in Beaufort County simply isn’t sustainable with the fast-paced escalation of housing prices here.

The technician taking your blood sample may not know how they’re going to afford groceries for their family this month on top of their recent rent increase, car payment and expensive childcare costs.

Every day, healthcare workers are forced to make difficult decisions due to the cost of housing in Beaufort County.

Even with $5 million in pay adjustments across the health system in 2024, keeping up with the cost of housing is a challenge for Beaufort Memorial. The same faces other employers across the region.

And it’s not just Beaufort Memorial; it’s the EMT who cared for you in the ambulance and the firefighter who responded to the 911 call. It’s the deputy who provided additional security at the Water Festival in July. It’s your third grader’s teacher that they come home gushing about every day.

These workers constitute the region’s “missing middle,” explained Claude Hicks, Beaufort-Jasper Housing Trust Executive Director.

After a late-July trip to the Beaufort Memorial Pratt Emergency Center, Claude was able to hear concerns directly from workers in our community’s missing middle, who navigate the high cost of housing in the Lowcountry daily.

A Trip to the ER

At around midnight one evening in late July, Claude started experiencing some worrying symptoms.

Having contracted Legionnaire’s Disease over a decade ago – a condition that left him extremely ill, in a coma for four days and hospitalized for two weeks – he wasted no time in getting to the emergency room at Beaufort Memorial.

It was his first ER visit at the nonprofit community hospital, and while his harrowing experience with Legionnaires’ Disease was at the forefront of his mind, ER staff members immediately put him at ease.

“I was kept totally comfortable the whole time; the nurses on each shift all introduced themselves, and so did the technicians,” Claude recounted. “I didn’t see anyone that was not friendly and professional during the entire visit – and I saw lots of technicians and nurses.”

Claude said that he was also impressed with the teamwork of the ER staff; the physician collaborated with Beaufort Memorial pulmonologists to reach his diagnosis. Claude had not contracted the deadly disease once again and instead was experiencing a bout of atypical pneumonia.

His ER visit and subsequent brief hospital stay was seamless and comfortable, he said. Both his ER intake and hospital discharge were quick and easy, and he was struck by the compassion, professionalism and efficiency of every staff member that he encountered.

Their professionalism and friendliness allowed Claude to engage with them beyond his medical care; he was able to hear boots-on-the-ground input from healthcare workers navigating the challenges of finding affordable housing in the Lowcountry.

As Executive Director of the Beaufort-Jasper Housing Trust, Claude paid close attention.

Beaufort Memorial Voices

In Claude’s position, he’s faced with questions and concerns every day surrounding affordable workforce housing in the Lowcountry.

It’s a very familiar topic to Beaufort Memorial staff members, too. The issue isn’t a new one, but for many healthcare workers in the Lowcountry, it’s a huge part of their everyday life.

“We’ve known it’s an issue for a long time,” Claude said. “But it’s made real when you have people in front of you, treating you, talking about how difficult it is to live here and how there are very few housing options.”

Claude received treatment in the ER and on the hospital’s third floor, offering him a wide range of employees and perspectives on the topic.

“A lot of the staff had unusual circumstances. I think there are people who would like to live here long term but cannot either rent or buy a home close enough to the hospital to make it feasible,” Claude said. He even spoke to an employee whose family is based in the upstate area of South Carolina, and she commutes to the Lowcountry to work at Beaufort Memorial because of the rental climate here.

The general feeling among staff members?

“It takes more than one income, maybe two or three incomes, to be able to afford to live in the Beaufort area,” Claude said. “It’s a reality that everyone is aware of.”

Beaufort County’s ‘Missing Middle’

The very first question asked by workers considering Beaufort County as their home is a seemingly simple one: “Where can I live?”

The answer, for many of these workers, is not so simple.

The concept of the “missing middle” refers to members of the workforce that do not make enough money through their income to be able to afford the median rent or home costs here but earn too much money to qualify for any sort of tax credit aid.

This is a large percentage of the workforce, Claude said, and many of these workers are the young professionals in the area.

“This ‘middle’ is made up of your nurses, your young professionals, your policemen, your teachers,” explained Claude at the Beaufort Regional Chamber of Commerce’s 2025 State of the Community presentation in February at Dataw Island, where he highlighted some of the key housing trends facing the Lowcountry. “Their options are almost zero. What they do then is make choices – they take on a roommate. They work an extra job. They do whatever they need to do to pay rent.”

These cost-burdened workers who often pay over 30 percent (and sometimes 50 to 60 percent) of their income on their rent, often end up leaving the area due to lack of affordable housing.

Healthcare workers make up a large piece of the missing middle, which presents a population like Beaufort County’s with a challenge: how can a rapidly growing, aging community’s critical healthcare needs be met when healthcare workers can’t afford to live there?

“If you combine these wages with the extraordinary cost of real estate, sooner or later workers make a decision about how they want to live,” Claude said. “Often, that decision is that they want to live somewhere else.”

The aging population here means that the need for medical care will only increase, and right now, the housing crisis renders the region unable to keep up.

“We are going to have to do something that builds, creates and develops workforce housing that is affordable, where people can at least live while deciding their plan or working toward buying a home,” Claude added. “Until we do that, we will continue to lose really good staff.”

Finding a Solution

In 2023, Beaufort Memorial purchased a 10-acre property in Bluffton with the goal of developing affordable workforce housing with the approval of the Town of Bluffton’s Affordable Housing Committee.

This project, LiveWell Terrace by BMH, is a collaboration between the nonprofit health system, Beaufort County, the Town of Bluffton and Woda Cooper Companies, and will include 120 affordable housing units along Buckwalter Parkway in Bluffton.

The site of the workforce housing project is less than a mile from where the new Beaufort Memorial Bluffton Community Hospital is being constructed. This project and future Beaufort Memorial workforce housing projects currently in the works around the area – including Beaufort and other locations in the southern part of the county – are a great starting point toward finding a solution for the widespread housing crisis, Claude said.

“These projects will make enough of a dent that other developers can look at that model and think, ‘This is something I can do,’” he added.

The Beaufort-Jasper Housing Trust is no stranger to teaming up with Beaufort Memorial to help find solutions to the housing crisis here, having awarded a $45,000 grant to Beaufort Memorial Foundation in 2024 to assist with expansion of the employee down payment assistance program at the organization.

In addition, the Beaufort Memorial Foundation spearheaded its first-ever employee housing expo in mid-June at the hospital campus, drawing employees from all different hospital departments to learn about feasible housing options.

The expo, sponsored by SouthState Bank, brought together lending institutions, real estate companies, rental experts and insurance professionals – over 20 vendors offered housing information and resources to Beaufort Memorial staff members. Beaufort Memorial is also working with area housing communities to become established as a preferred employer, with special pricing and offers for organization employees.

These cross-industry partnerships and collaboration are the only way to tackle the overwhelming housing challenges for healthcare workers in the Lowcountry, Claude said.

“Nothing happens in the housing industry without partnership,” Claude said. “We hope the collaboration between Beaufort Memorial and the Housing Trust continues to produce reasonably priced workforce housing.”

Beaufort Memorial's down payment assistance program is available to eligible employees of the organization in partnership with Community Works Carolina.

Browse current job openings at Beaufort Memorial.