With hospitals required to demonstrate they are meeting health needs in their communities, some have gone so far as to partner with community-development agencies, governments and the private sector to build affordable homes, knowing that having a clean, safe place to live can improve a person’s health.
New Jersey could see its own such collaborations soon, as a state agency has plans to partner with hospitals and help finance as many as three new supportive home developments in the state.
“Housing is healthcare,” said Charles Richman, executive director of the state Housing and Mortgage Finance Agency. “Permanent, stable, supportive housing is key to overall health. Here we have the opportunity to both create affordable apartments and help people stay healthy.”
Richman called the HMFAwith the New Jersey Hospital Association “an innovative approach to address our shared goal of community well-being.”
Such a program is exactly what housing advocates are looking for by cooperating with the healthcare community — providers and insurers — over a shared interest in seeing that all people can live in safe, affordable homes.
Hospitals have some responsibility to help people in the communities they serve under the Affordable Care Act. Among other requirements, the law obligates hospitals to conduct periodic community-health needs assessments and draft plans for implementing programs that address the needs identified by the assessments.
The Robert Wood Johnson Foundation has done research that shows that where a person lives can impact health — Trenton residents have a life expectancy of 73 years, while 10 miles away in Princeton Junction, people can expect to live 14 years longer, to age 87.
RWJ is also researching how housing investments can improve health. One successful example in New Jersey involves the Cooper Foundation, which is the philanthropic arm of Cooper University Hospital in Camden. Cooper bought properties around the hospital, renovated them and then sold them to local residents. In San Bernardino, California, Dignity Health is a partner in a mixed development called Arrowhead Grove that is to include 400 affordable units.
“It proves there can be a shift if you change how people live,” said Donald F. Schwarz, senior vice president of the Robert Wood Johnson Foundation. A hospital can benefit, too, he said, as “their property value goes up and they have healthier patients.”
The supportive housing program will be the first led by a state agency here. As part of this pilot, the HMFA will provide funds, to be matched by participating hospitals, to build homes near facilities. NJHA president and CEO Cathy Bennett said the initiative gets to the very foundation of one of the key social determinants of health.
“It is well documented that where and how people live directly affect their well-being,” Bennett said. “Those experiencing housing instability are likely to be hospitalized more frequently with longer lengths of stay and require more care than patients with stable living arrangements.”
Among the possible types of projects approved as part of this pilot are affordable housing developments with units set aside for frequent users of hospital emergency services and mixed-use developments that may include community-based healthcare services and affordable housing. Officials from the state and hospital association are meeting with hospitals to identify potential participants. Because the pilot is in the early stage, it is unclear when construction may begin and how much the program may cost.
Angela Mingo, the community relations director at Nationwide Children’s Hospital, which has partnered with a local community-development organization to revitalize the South Side of Columbus, Ohio by eliminating blight and creating affordable homes, said New Jersey is ripe for more collaborations.
“This region has a host of anchor institutions — hospitals and universities — who would be prime building partners,” she said. “At the end of the day, the anchor institutions are stewards. There’s a level of social responsibility the anchors have to take on. When there is interest and desire, it’s just a matter of time before the collaborations grow.”
A number of health agencies in the state have launched other initiatives related to housing that have had a positive impact on low-income residents.
For instance, Horizon Blue Cross Blue Shield of New Jersey has launched a pilot project in four Newark zip codes with large numbers of high-risk members. The insurer has community health workers visiting members to help them address issues impacting their health, ranging from access to medication to transportation or parking at doctors’ visits. Horizon has seen positive results from this program, including a reduction in emergency-room visits and hospital readmissions and an increase in access to behavioral health services.
“Horizon understands and appreciates that socioeconomic and behavioral factors significantly influence the clinical outcomes of our members,” said Florence Kariuki, clinical design lead at Horizon. “Horizon is committed to continue improving the health of New Jersey by addressing the comprehensive needs of our members, in order to achieve better clinical outcomes.”
The insurer is dedicating some of the tax rebates it is getting from last year’s federal tax-reform law toward addressing social determinants of health, which could include an inability to get enough healthy foods or living in a crime-ridden or dirty apartment building. It is also participating in an initiative by the Blue Cross Blue Shield Association to provide over the next three years one million rides, one million meals and one million medical interventions to needy people across the country as part of the insurer’s nationwide effort to help its members nationwide.
In New Brunswick, nurses working with Triple C Housing, an organization that provides housing for people with disabilities, who are homeless and who were affected by Superstorm Sandy, have partnered with RWJ Barnabas Health to provide urgent health services to residents of Promise House, a development with 10 supportive housing apartments for individuals with special needs who are at risk of homelessness.
“Our work is just one example of the innovative ways that community developers — from all parts of our sector — are working to improve the health of residents and the places they live,” said Leslie Stivale, vice president of the board of directors of the network and Triple C Housing’s president and CEO.
Josh Leopold, senior research associate with the Urban Institute, said state leadership is important in driving projects. New York, for instance, has invested a half billion dollars of Medicaid funds in supportive housing construction and rental subsidies.
“If there are good state policies, you can do things on a big scale,” he said. “If not, there’s still a lot you can do on a local level.”
Leopold said these kinds of collaborations don’t happen overnight. They take time and patience. Political leadership helps.
For the last eight years, the administration of Gov. Chris Christie in Trenton showed little interest in fostering affordable housing development. Gov. Phil Murphy campaigned on the issue and Richman’s announcement is proof that there is at least some shift in attitude in this administration.
Berger said she expects the number and depth of partnerships to continue growing. “We need to bring people to the table,” she said. “The conversations are beginning.”