Housing is increasingly considered as an essential element of health, and healthcare organizations could do more to improve housing with government incentives and financial support from Medicare and Medicaid.
Housing impacts health, and healthcare organizations have opportunities to improve housing in their communities.
Housing problems are a key determinant of health for individuals and families, Stuart Butler, PhD, wrote in an article published this month in the Journal of the American Medical Association.
"Poor living conditions can trigger such developments as respiratory problems and stress-related illness, and many falls and hospitalizations among elderly individuals result directly from unsafe housing," he wrote.
Healthcare providers are increasingly partnering with local groups and housing advocates to tackle problems such as homelessness that impact health. Butler makes four recommendations to foster and finance these partnerships.
1. Tax and other incentives
A daunting hurdle for housing partnerships that involve healthcare providers is the "wrong pocket" problem. In these partnerships, investments in housing generate savings that are allotted to healthcare budgets rather than the housing sector's bottom line.
For nonprofit hospitals, one solution to the "wrong pocket" problem is investing in housing as part of the federal community benefit tax reduction, Butler wrote.
"Partly in response to this requirement, as well as to pursue their philanthropic goals, several health systems have invested significantly in housing, such as Bon Secours in Baltimore. The treasury requirement thus serves as a partial antidote to the wrong-pocket problem by encouraging hospitals to invest in the community."
Promotion of housing investment by healthcare organizations also could be achieved through changes to the Community Health Needs Assessment for hospitals under the Patient Protection and Affordable Care Act, Butler wrote.
"Today many hospitals are unsure if they will receive CHNA credit for innovative housing investments."
2. Medicaid managed care waivers
Butler calls on the federal government to increase health-related housing spending through Medicaid managed care's Home and Community Based Services waivers.
"These waivers from federal rules allow communities to use paid social workers more broadly to provide home-based care and so avoid expensive nursing home care," he wrote.
He says federal, state, and local government could also improve safety in the homes of seniors and the infirm by supporting senior villages—nonprofit membership groups that use volunteers and staff to provide a range of home services.
3. More from Medicaid
The federal government should ease restrictions on the use of Medicaid funding for health-related housing spending, Butler says.
Particularly when there are opportunities to improve health and achieve savings, Congress should allow Medicaid spending for room, board, and capital expenses, he wrote.
4. Medicare flexibility
He says Congress should build on passage of the CHRONIC Act of 2017, which gives some Medicare Advantage health plans authority to use money for nonmedical services that boost health such as housing.
Congress could also allow Medicare managed care organizations to pay for home alterations, Butler wrote.
Christopher Cheney is the senior clinical care editor at HealthLeaders.