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Relationship Building Key to Success for Health and Housing Initiatives

Analysis  |  By Christopher Cheney  
   August 20, 2019

Initiatives involving healthcare organizations, housing groups, and government agencies require trust and communication across diverse industries.

Developing organizational relationships is a key element in addressing housing as a social determinant of health, a recent report from the National Housing Conference says.

Research has shown that access to affordable housing has a powerful impact on health outcomes. For example, homelessness hinders management of chronic diseases such as diabetes, and many patients face financial struggles balancing housing costs and medication expenses.

To bolster housing at community scale, establishing trust and effective communication across industries is crucial, the National Housing Conference report says. "Successful projects often bring together partners from various government agencies, nonprofit and for-profit housing providers as well as healthcare organizations like hospitals and health insurers. No single entity can tackle the challenges around health and housing alone but through their shared strengths and resources, progress is being made."

The report highlights three housing development initiatives that involve relationship building efforts.

1. Housing is Health Initiative, Portland, Oregon: Central City Concern, which is a Portland-based nonprofit group focused on homelessness, built relationships with six healthcare organizations including Kaiser Permanente Northwest to help finance nearly 400 new housing units. The effort generated a $21.5 million investment from the healthcare partners.

Central City Concern conducted boardroom sessions with its healthcare partners to emphasize the importance of affordable housing to population health. The nonprofit also enlisted representatives from healthcare organizations to serve on the group's board of directors.

2. Creating Homes Initiative, Tennessee: For the past two decades, the Tennessee Department of Mental Health and Substance Abuse Services has developed affordable housing opportunities across the state, including independent living arrangements at rental properties and private homes. From 2001 to 2016, the agency's Creating Home Initiative developed more than 15,000 affordable housing options.

The Tennessee Department of Mental Health and Substance Abuse Services employs seven regional housing facilitators, who have developed relationships with several other state agencies and community partners. Agencies that have provided financial support for the Creating Home Initiative include the Tennessee Housing Development Authority, Federal Home Loan Banks, the federal department of Housing and Urban Development, and the U.S. Department of Agriculture.

3. Massachusetts housing and health pilot program: LeadingAge Massachusetts—a trade association of nonprofit providers of aging services—and the Long-Term Quality Alliance are leading an initiative to provide coordinated services to residents of affordable senior housing communities in The Bay State. The pilot program is drawing funds from health insurers to finance on-site service providers in affordable housing such as resident service coordinators and wellness nurses. The health insurers are hoping to reduce hospitalizations and emergency room visits.

The University of Massachusetts-Boston is a key partner in the pilot program, monitoring costs and health outcomes.

Managing health and housing collaborations effectively

There are several factors to consider when building health-oriented housing development partnerships, David Dworkin, president and CEO of the National Housing Conference, told HealthLeaders. "The primary elements are understanding the business model of your prospective partner, building trust, data sharing, financial alliances, and strong leadership."

Relationship building in health and housing collaborations can be challenging, he said. "These are necessary partnerships between extraordinarily diverse entities, from government agencies to healthcare providers, and housing developers to health insurers."

Harnessing a blend of nonprofit and for-profit organizations can be difficult because they have different business models and accounting practices, Dworkin said. "Many of these organizations may be significantly siloed, so understanding who the decisionmakers are and who the substantive experts are is also critical as they will ultimately have to come together to close a partnership arrangement."

Teamwork on community assessments is pivotal when healthcare organizations participate in affording housing projects, he said.

"Hospitals can use their community benefit dollars toward financing affordable housing, but affordable housing must first be identified as a community health need. For this reason, it's important for affordable housing advocates and providers to be at the table when community health needs assessments are being conducted to raise the importance of affordable housing for healthy outcomes and develop impactful strategies that can be measured and financially accounted for."

Christopher Cheney is the CMO editor at HealthLeaders.


Affordable housing has a significant impact on health such as the ability to manage chronic illnesses.

No single organization has the resources to rise to the challenge of supporting health through housing opportunities.

Affordable housing advocates and healthcare providers should collaborate when community health needs assessments are being conducted.

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