How can the affordable housing industry—and our partners—ensure the right housing is built for those who will benefit from it now and in the years to come? We offer five steps to create an “affordable housing reboot” that addresses this question and the many societal concerns that go along with it.
1. Redefining Who Affordable Housing Helps
Typically, housing providers plan for residents who can pass stringent standards for employment, criminal background checks, etc., and do not coordinate with other sectors when considering perspective tenants. But to truly reduce the number of very low-income people facing homelessness, the affordable housing industry should change this dynamic by establishing referral relationships with health-sector partners, creating set-asides for people with special needs, and reducing all but the most significant barriers with a screen-in, rather than a screen-out, approach.
In some places, health-care partners are already stepping up to the plate and implementing much of this direction.
For example, the University of Illinois Hospital leads the “Better Health Through Housing” initiative, which has provided 42 homeless individuals with affordable supportive housing. Since the program began in November 2015, UI’s research has revealed significant benefits for hospitals to house the homeless. Their efforts have resulted in a 21% decrease in health-care costs, a 67% drop in emergency department visits, and a similar reduction in in-patient hospitalizations.
2. Harnessing the Right Data
Although the industry has spent decades making the case for affordable supportive housing through evaluation, program monitoring, and outcome tracking, a successful reboot will require even more strategic use of data to demonstrate impact on people, communities, and systems.
Kaiser Permanente’s recent $200 million housing and health-care pledge might never had happened without solid research that produced meaningful data specific to needs. Kaiser assessed many aspects of their client’s daily lives and found that 9%, or 12,000, of those interviewed reported some level of housing insecurity. Data like this tipped the scales for the health-care giant to earmark funds for housing to reduce both long-term costs and current strains on resources.
3. Investing in Services Delivery
The reboot must include significant investment in meaningful on-site or closely located resident services. Every affordable housing provider should build strong connections to community-based services, or partner with agencies that can. Additional relationships and funding sources are needed beyond the health-care sector.
On top of on-site resident services that focus on academics, healthy lifestyle, and financial education, we advocate for the development of partnerships with social service caseworkers, hospitals, and local units of government. These partners can help affordable housing providers extend their reach, develop the most helpful services, and access new resources.
4. Co-Developing Community Infrastructure
The affordable housing industry must intensify its focus as a co-developer of infrastructure that supports community development and wellness.
The Blackburn Building, being developed by Central City Concern in Portland, Ore., is a co-location of affordable and supportive housing with respite care and an on-site health clinic servicing the campus as well as the entire community. The innovative project design was developed as part of the “Housing is Health” alliance attracting over $21.5 million in direct investments from organizations including Kaiser and CSH.
Another, Paseo Verde, is a mixed-use housing development in Philadelphia that includes units dedicated to households earning between 20% and 60% of the local income range, and some apartments for supportive housing. The project provides comprehensive health and social services for seniors living in the building and the community at large.
5. Reimagining Housing Finance
According to former New York state Medicaid director Jason Helgerson, “Fee for service is out, value-based payment is in.” This shift can be seen in health care from capitated rates to penalties for readmissions. It makes health care responsible not just for providing services, but for achieving longer-term health benchmarks. Housing is not immune to this kind of analysis, especially when it comes to proving its pivotal role as a social determinant of health. This means developers must look at housing finance and performance through different, creative lenses.
Fortunately, Pay for Success contracts and financing for housing are providing new possibilities for private capital, and also supplying the structures to drive and show demonstrable public savings and social returns. Also, Opportunity Zones are quickly developing what is expected to be a trillion-dollar market for private investment in low-income communities demonstrating high needs and the potential for economic growth, including that tied to the development of affordable supportive housing.
The Way Forward
As more governments and private health-care providers recognize the impact and societal benefits of affordable housing and health connections, greater outreach and capital commitments to expand on these partnerships are needed. New avenues for cooperation across sectors and private participation will open more doors.
A successful reboot that relies on such realities will result in people living in safe, stable affordable housing while realizing improved health.
Although housing alone does not cure disease, reunify families, or prevent crime, the blending of housing and services unlocks potential, and no one does this better than the affordable housing industry, which helped invent the idea of projects reaching across multiple sectors.
It will take a major, all-hands-on-deck commitment to realize our reboot in affordable housing, but we all share a responsibility to ensure existing and future housing is available and accessible to those who truly need it.
