Technical Paper Affordable Housing Investment: A Guide for Nonprofit Hospitals and Health Systems
Kathryn Reynolds, Eva H. Allen, Martha Fedorowicz, Joycelyn Ovalle
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Tackling the affordable housing crisis will require actors from every sector to finance housing development for low- and moderate-income people. We developed this guide to help nonprofit hospitals and health system understand how their institutional assets and prestige can support affordable housing development projects—and to offer practical information and encouragement to start investing in much-needed affordable housing.

The guide is informed by Urban Institute’s research examining the current practice as well as the motivations, opportunities, and barriers nonprofit hospitals and health systems face to initiating and broadening investments in housing development. Our findings suggest that while nonprofit hospitals and health systems may be increasingly aware of and involved in addressing housing concerns of their patients and communities, few invest in construction and rehabilitation projects.

This guide presents key concepts and strategies for designing and implementing housing development projects, complemented by examples and supplemental resources. We first guide the readers through steps and considerations when exploring and formulating an appropriate affordable housing investment strategy, including assessing community needs, identifying the target population, engaging community members, examining the policy context, selecting partners and internal champions, and measuring progress. We then describe concrete ways in which nonprofit hospitals and health systems can provide invaluable support and financing for affordable housing projects. These include using their financial position to enhance credit, therefore lowering borrowing risks and costs; providing in-kind resources, such as land and staff time, to help affordable housing development; and providing capital (as a grant or a direct loan) to cover construction or rehabilitation costs.

Research Areas Health and health care Nonprofits and philanthropy Housing
Tags Housing affordability
Policy Centers Research to Action Lab