Leveraging Healthcare Organization Assets for Affordable and Supportive Housing

When hospital patients have supportive housing on a healthcare campus, close coordination between housing and clinical needs becomes possible. Photo credit: iStock.com/gerenme

Housing (and the built environment generally) is recognized as a social determinant of health, a nonmedical factor that influences health outcomes, giving healthcare institutions a substantial interest in the availability of affordable and supportive housing. As a result, some hospitals that serve as anchor institutions in their communities are using their surplus land or development capacity to meet local housing needs. On March 7, 2024, the Federal Reserve Bank of New York and New York University’s Furman Center cohosted an event exploring how healthcare institutions, in collaboration with public and private partners, can produce affordable and supportive housing opportunities for their communities.

Matthew Murphy, executive director of the Furman Center, framed the event by discussing the potential for housing development on hospital-owned land in New York City, where many residents confront affordability challenges and where the existing housing landscape particularly underserves seniors, people experiencing homelessness, and people living with disabilities. Murphy reported that one study of land owned by healthcare organizations found a maximum potential buildout capacity of 25,000 to 30,000 units of new housing based on current zoning codes, with 85 percent of unused capacity located in high-density residential areas.

The Health Care-Housing Connection

Providing housing as a healthcare solution makes intuitive sense, argued Mitchell Katz, president and chief executive officer of NYC Health + Hospitals, who pointed out that the effort and expense of treating unhoused individuals often is effectively squandered in the long run when safe or supportive housing is not available for patients at the end of their medical treatment. Research shows that despite the demonstrated benefits of supportive housing for keeping patients healthier and permanently housed while reducing reliance on costly emergency health care, only approximately 21 percent of those eligible for supportive housing in New York City received this benefit in 2023, said Talor Crawford, community development specialist at the Federal Reserve Bank of New York. This finding can be a result of the fragmenting of funding sources, added Molly Wasow Park, acting commissioner of the New York City Department of Social Services; for example, Medicaid, which can be an important tool for connecting some people to housing, is limited in its capacity to fund supportive housing. Existing subsidies for affordable housing development, Murphy pointed out, already are being fully utilized, posing an additional challenge to maximizing the housing capacity of hospital-owned land.

Hospitals are well positioned as an institutional nexus between health care and housing. According to Carla Nelson, vice president of ambulatory care and population health in the Department of Government Affairs, Communications, and Public Policy at the Greater New York Hospital Association, hospitals can screen patients for social determinants of health, including their housing needs. Medical records can also provide important data if, for example, a patient provides the address of a shelter as their residence. Hospitals, as a point of contact with social service institutions, can also connect patients with legal services such as landlord mediation or eviction prevention if screening reveals a need for them.

Although many hospitals already are putting into practice efforts to leverage their surplus property for housing, the panelists agreed that collaboration with developers, policymakers, and funders remains critical for success. Deborah De Santis, president and chief executive officer of the Corporation for Supportive Housing, shared the example of CAMBA Gardens — a 2-phase affordable and supportive housing development containing more than 500 units built on surplus property owned by Kings County Hospital in Brooklyn — as representative of the results that collaboration between healthcare institutions and affordable housing developers can produce.

Meeting Housing Needs

Although the advantages to hospitals in providing affordable or supportive housing for the community can sometimes be indirect (health outcomes can be improved through stable, affordable, or service-enriched housing, even if residents are not current patients of a sponsoring hospital), in other cases, the sponsoring hospital can benefit in a more direct way. For example, when hospital patients have supportive housing on a healthcare campus, close coordination between housing and clinical needs becomes possible, says Leora Jontef, assistant vice president for housing and real estate for NYC Health + Hospitals.

Seniors, who are more likely than younger people to have medical needs, may also benefit from housing that works in concert with healthcare delivery, noted Sydelle Knepper, founder and chief executive officer of SKA Marin. Focusing on seniors can also have downstream effects, she says, because purpose-built senior housing can free up units for families as older people downsize to better accommodate their needs as they age.

Kirk Goodrich, president of Monadnock Development LLC, added that hospitals can also consider adding workforce housing, noting that in an expensive rental market such as New York City, nonmanagerial employees might struggle to afford housing near the communities they serve. Finally, Doug Shoemaker, president of Mercy Housing California, stated that building affordable housing on hospital land can be a way to make access to high-opportunity neighborhoods more equitable, referencing affordable units under construction on a former University of California San Francisco hospital campus in the affluent Pacific Heights neighborhood of San Francisco.

Through collaborative effort, housing advocates and healthcare professionals can work to advance the goals of both groups, bridging for residents the gap between housing and health care. Katz emphasized that past policy endeavors prove that it is possible for society to provide for the housing needs of all people, even if those past efforts — namely, ensuring that veterans or people living with HIV are housed — have been targeted to specific populations. Although fully developing available surplus hospital land is not a silver bullet, the panelists argued that it does represent a potent strategy for meeting people's housing and social services needs.