The blog of the Urban Institute
April 18, 2019

Three Ways Hospitals and Health Systems Can Improve How They Invest in Affordable Housing

Adequate, safe, and affordable housing is one of our most basic needs. But in the US, access to housing is not guaranteed. Demand for affordable housing is growing, especially as housing costs increase beyond wage growth in many communities.

Hospitals and health systems are stepping in to help fill this gap. Because of their mission orientation, the importance of stable housing on health outcomes, and policy changes initiated by the Affordable Care Act, hospitals and health systems are increasingly investing in and supporting the creation of affordable housing in their communities.

Health system and hospital administrators looking to invest in housing as part of their social determinants of health strategies gathered at the Urban Institute in April to share insights with housing and community development organizations. Three themes emerged from the workshop about best practices for the intersection of the health and housing fields.

Collecting outcomes data can better measure impact.

Though many hospitals and health systems have already begun to invest in housing and community development, few collect outcomes data to measure the impact of their work. Some participants said that because housing investment work is mission-driven, investing alone was enough to show alignment with the mission. Others cited a lack of knowledge in how to track health-related outcomes from their housing and community development work.

One participant shared that hospitals’ data systems are not equipped to track more than a few social determinants of health measures, such as housing stability or homelessness. Many hospitals also expressed difficulty attributing health outcomes specifically to improvements in social determinants of health—especially given the many factors that contribute to a person’s health status.

Our forthcoming literature review confirms this difficulty. Despite the abundance of hospital-led, affordable housing investments across the country, there is a relative dearth of information on individual and community-based health outcomes from these investments.

Hospitals and health systems could fill a critical gap by collecting outcomes data related to housing investments while also using these data to improve hospital services, increase outreach to the community, and reduce unnecessary hospitalizations and emergency room visits. But they will need to dedicate resources and find technical support to accomplish these goals.

To make the case for housing investment, context matters.

As with any large-scale housing project, many factors combine to determine success. Hospital representatives at the workshop emphasized the need to align housing investments with the hospital’s mission and goals.

In addition to being mission-driven, any viable housing investment needs to fit within the hospital’s business model and internal capacity. This could mean that some hospitals pursue housing development, some invest in a capital stack run by a local community development financial institution, and some provide health services in an existing housing development. No matter what option the hospital chooses to pursue, it should fit within the hospital’s financing capabilities and long-term investment strategy.

Many workshop participants emphasized the need for a champion, both within the hospital and in the community, who can work with partners to steward the project forward. Without a housing champion, the will to invest in housing—which many in the health care field see as outside of a hospital’s purview—will fall to the wayside in favor of other, more familiar forms of community benefit work.

Engaging with community members while developing plans can help avoid negative repercussions.

Unlike most services that hospitals and health systems provide, housing work has ripples that extend beyond the person or family receiving the service. Building or investing in new housing can change the fabric of a neighborhood and have both positive and negative repercussions.

To prevent possible negative effects from housing investment, such as displacement of existing residents, hospitals should engage with their surrounding community members to develop plans that fit within the vision residents have for their neighborhoods and avoid disrupting the social infrastructure of communities.

Partnering with a local community development corporation or community-based organization during project development can be a good way to become familiar with community challenges and opportunities while also sharing responsibility for the project with an organization that regularly interacts with residents and has a stake in its success.

We plan to tackle these themes and more through evidence-based advice to health systems and hospitals in a toolkit that will be published later this year.

Photo by Helen H. Richardson/Getty Images.

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