Nonprofits in healthcare are expanding the scope of their services through partnerships with housing authorities. Are you using strategic partnerships to address a multifaceted problem in your community? Let us know.
During the Covid-19 pandemic, nonprofits are forming partnerships for a greater impact on healthcare. By expanding the scope of services through strategically formed partnerships, organizations can address the multitude of complex issues impacting the health and well-being of vulnerable communities. This is true particularly when a community’s vulnerability, medical or otherwise, is intricately intertwined with access to housing and other resources—or lack thereof.
The nonprofit sector has seen firsthand how different populations are susceptible to the effects of Covid-19: For individuals who are homeless, the difficult circumstances brought about by Covid-19 are compounded with a living situation that doesn’t provide basic hygiene tools, such as soap and running water, to regularly wash hands.
Once Covid-19 infects an individual in a large unhoused population, the disease can spread rapidly, putting the entire community at risk, due to the proximity of the individuals to one another in a shelter or encampment. Chronic health conditions that homeless individuals face are often compounded by the inability to obtain critical preventive healthcare through a relationship with a primary care physician. Without the regular essential preventive services the relationship provides, many homeless individuals have limited options and are forced to turn to hospital emergency rooms and other expensive healthcare options, which are not an efficient or effective method of providing or receiving routine care.
Communities Facing a Multifaceted Problem Recognize the Time for Multifaceted Solutions
Even before the pandemic, innovative nonprofit hospitals and large healthcare systems were exploring how they could better serve the health needs of their communities. The Affordable Care Act, which requires hospitals to complete a community needs assessment, incentivized nonprofit hospitals to develop more innovative options for providing critical health services for entire communities.
In 2015, the Internal Revenue Service also ruled nonprofit hospitals can use their charitable investment requirement to build affordable housing, further enabling a trend in the philanthropic sector to define housing as a cross-sector need and a critical building block for success in other areas, such as education and job security, as well as health. This change in perspective is leading to ground-breaking projects connecting healthcare systems and affordable housing to create a more comprehensive health system for all.
The Impact of Partnerships: A Wholistic Approach to Serving Communities
In the first half of 2019, Denver Health, the City’s largest safety net hospital, identified more than 100 “long-term” patients, including one who was treated at the hospital for 1,558 days—well over four years. All of these patients had medical conditions leading to the initial treatment, but a lack of housing kept the patients in the hospital long after they would have normally been discharged. Since their medical conditions did not warrant the protracted hospital stay, Denver Health could not bill for them, and other patients were often left waiting in the emergency room since the hospital rooms were occupied.
Denver Health reviewed these patients’ histories and conditions and realized it was hundreds of thousands of dollars cheaper for the hospital to find housing for these patients rather than continue to house the patients in the hospital. Hospital leaders knew they didn’t have the expertise to create the affordable housing or critical services needed to successfully house the patients for the long term.
Instead, the hospitals donated a shuttered 10-floor medical building on the campus to the Denver Housing Authority to turn into affordable housing. Once the project opens in 2021, it will offer affordable housing for seniors as well as fifteen apartments for patients experiencing homelessness to aid in their transition to long-term housing options.
Other hospital systems are making similar calculations. Kaiser Permanente is planning to spend $200 million on affordable housing for people experiencing homelessness in the communities its hospitals serve. Bechara Choucair, MD, senior vice president and chief community health officer, said of Kaiser’s decision, “We’re learning more and more that without a place to live, it’s nearly impossible for a person to take care of their basic health needs.” And in Boston, Boston Medical Center, Boston Children’s Hospital, and Brigham and Women’s Hospital will donate $3 million over the next three years to community housing organizations to prevent homelessness.
Nonprofits’ Growing Recognition of the Influence of Housing on Health
These hospitals are not the only ones identifying affordable housing as a challenge to delivering effective healthcare. In a 2019 survey of nonprofit hospitals and health systems by the Urban Institute, almost all reported an awareness of the lack of affordable housing in their communities. Respondents also agreed that housing is a “fundamental resource” and that they have a responsibility to participate in creating more affordable options that would lead to healthier outcomes for their community.
The report detailing the results of the survey also outlined six reasons these leaders have a significant perspective on and insight into this critical conversation. Two reasons of significance are (1) nonprofit hospitals and health systems are community anchors with knowledge of their diverse communities’ health needs, and (2) the health entities have an obligation as nonprofit organizations to serve their communities. These findings, along with the 2015 IRS ruling, are leading to multiple projects similar to the one led by Denver Health.
Two Massachusetts reports identified a similar decrease in health costs that followed efforts by the health care sector to assist in housing. The first, funded by Blue Cross Blue Shield of Massachusetts Foundation outlined the health savings resulting from seven different housing interventions implemented across the country. These projects, tailored to the needs of diverse housing-unstable populations, including youth in foster care, adults with serious mental illnesses, and children living in low-income families, led to measurably lower healthcare costs for the hospital systems. The second report studied the health needs of 402 individuals living on Medicaid and facing homelessness from 2013 through 2015, compared with a population of nearly 18,650 enrolled in Medicaid during the same period, but with no evidence of homelessness. The study found a 2.5 percent increase in health care spending per year for the individuals without stable housing.
Much of this research and the supported findings are funded by foundations committed to the proposition that housing is a cross-sector building block for individual and family success. Funders for Housing and Opportunity, created in 2018, is a partnership of nine well-known large foundations including the Bill & Melinda Gates Foundation, the MacArthur Foundation, the Ford Foundation, The Kresge Foundation, and the Annie E. Casey Foundation. The collaborative’s website defines housing as a “platform for achieving better life outcomes and thriving communities for all of us.” Specifically, these foundations outline a connection between affordable housing and seniors living healthier and longer lives, parents and children experiencing improved mental health, and a decrease on the reliance of hospital emergency rooms.
Partnerships in Healthcare and Housing: Different Causes, United Mission
The connection between housing and health is even stronger as we live through the current Covid-19 pandemic. Large urban areas are better able to contain the coronavirus when they protect the most fragile members of their community, including those experiencing homelessness. Early in the epidemic, New York, San Francisco, Los Angeles, and many other cities closed shelters and homeless encampments to instead place individuals and families experiencing homelessness in hotels, dorms, and other unused housing. By providing housing, the cities created an environment where vulnerable individuals and families could social distance and follow the stay-at-home orders, thereby limiting the spread of the virus.
Once individuals are housed, it is easier for them to maintain their housing, allowing them to access the regular preventive health services they need. As we reach the other side of this pandemic, community leaders should continue exploring new funding models for building affordable housing and the critical services needed to develop long-term solutions to America’s affordable housing crisis, thereby providing more efficient health services and developing a healthier society for all. Nonprofits partnering together are in a better position to navigate complex issues, reach new beneficiaries, and enhance the impact of their services.
Gayle L. Nelson, Esq. is an attorney and consultant partnering with nonprofit organizations across the county raising millions of dollars in resources, engaging thousands of individuals, and building awareness on critical issues. She has a twenty-year career advocating for criminal justice reform, expanding legal services, empowering leaders with lived experiences, and coaching organization leadership. Gayle’s diverse clients, from foundations to trade associations and diverse nonprofit organizations appreciate her unique mix of development, marketing, financial, and legal expertise. She is a leader fueling nonprofit sustainable growth. Gayle can be reached at email@example.com.