Healthy Diagnosis: New Developments Strengthen the Connection Between Health and Housing

Cristina Tone needed a new place to live when her son became ill.

Her one-bedroom apartment was not nearly big enough for her family when Christopher, 23, had to move back home after contracting a rare form of encephalitis that’s often referred to as “brain on fire,” she says.

Many landlords were charging around $3,000 per month for a three-bedroom apartment, a level that’s out of reach for Tone and many others. After months of searching and worrying, she and her family moved into Barclay Place, a new 56-unit affordable housing development designed to serve individuals or families with chronic health conditions, in July.

Located on the grounds of St. Joseph’s Health in Paterson, New Jersey, the property was developed by the New Jersey Community Development Corp. (NJCDC) in collaboration with the hospital.

Tone, her husband, stepson, and Christopher, a graduate of the University of Pennsylvania, share a new three-bedroom apartment.

“From the moment you walk into the place, you feel good,” she says. “It’s a beautiful place. Just the amenities make you feel good emotionally, mentally.”

Tone reports that Christopher’s health has improved since moving into the new development, which offers a gym, a rooftop garden, and different programs. The community features ground-floor space for St. Joseph’s Health to provide clinical services and for NJCDC to provide other programs. One of the amenities is a community kitchen to host health and nutrition workshops.

In addition, Barclay Place is a stone’s throw away from St. Joseph’s hospital.

“Every day is just better,” says Tone, who happens to work at NJCDC’s Neighborhood Help Center.

The approximately $26 million Barclay Place is the first permanent supportive housing development created and financed under the New Jersey Housing and Mortgage Finance Agency’s (NJHMFA’s) Hospital Partnership Subsidy Program. It’s a new model for integrating housing and health care.

The program is based on the idea that quality housing is critical to maintaining good health and that hospitals are important anchor institutions uniquely positioned to advance housing in conjunction with health care. NJHMFA matches funding contributions from participating hospitals to provide affordable rental apartments for low- and moderate-income families, as well as apartments with access to supportive services for residents with special needs.

“The hospital program starts from the notion that at its core housing is health care,” says Melanie R. Walter, executive director of NJHMFA. “When you combine experts in those spaces, you can have optimized outcomes by making sure there is high-quality housing and high-quality health care. With support services on site, it creates a level of comfort and helps people move past basic needs to be able to address their higher-order needs to help them thrive.”

Several more developments are being created under the initiative, with each project designed to meet local needs. For example, a development in Newark will offer radiology services in the building.

NJHMFA is leveraging the financing from the Hospital Partnership Subsidy Program with 4% low-income housing tax credits and funds from the state’s recently recapitalized Special Needs Housing Trust Fund, which now receives $20 million every year, to ensure permanent supportive housing units are set aside for residents in need of wraparound services.

At Barclay Place, there are 10 of these units set aside for individuals who have chronic mental health issues.

The partnership produces not only support for residents but also a continuing lifeline and relationship with the hospital and its community, according to Walter.

“We’re proud that hospitals are seeing this as a worthwhile investment,” she says.

A New Alliance

Over the years, St. Joseph’s Health had assembled several smaller lots into one large tract of land. Officials recognized an opportunity to utilize the site under the new state program.

Barclay Place helps address the chronic health care needs of residents, but there are other reasons the hospital became involved, says Kenneth Morris Jr., vice president, external affairs, at St. Joseph’s Health.

“We’re an anchor institution within the city of Paterson, and we’re also the master developer of the area, an area of about 244 acres around the hospital campus,” he says. “We took on that role several years ago, recognizing that we needed to make investments within our whole community.”

Leaders at St. Joseph’s Health are hoping Barclay Place will lead to positive results, including a reduction in the overutilization of its emergency rooms while at the same time improving people’s health through other channels such as relationships with a primary-care physicians.

“Our hope is that as we address the social determinants of health, that we can improve health outcomes, increase health equity, but also reduce health care costs,” Morris says.

St. Joseph’s Health holds key roles in the Paterson community, but it’s not an affordable housing developer. It needed NJCDC, a local community development and social services agency that assists more than 4,000 children and families each day. Its work has included building more than 200 affordable housing units.

“We believe the individuals who are living in this new safe, decent, and affordable housing will be able to improve their health as the result of living at Barclay Place,” says Robert F. Guarasci, CEO and founder of NJCDC.

Asthma, heart disease, and diabetes are a few of the main health conditions that residents are facing.

Like Morris, Guarasci says his hope is that residents won’t have to access the hospital despite its proximity to the housing. Instead, the goal is for residents to use on-site services that will help them manage their chronic health conditions and see medical professionals in a way that will empower them and prevent them from cycling in and out of the hospital.

Barclay Place would not have happened without the Hospital Partnership Subsidy Program, according to Guarasci.

It incentivized St. Joseph’s Health to provide land as well as significant equity, which was matched by NJHMFA. Other project partners include LIHTC syndicator Enterprise Housing Credit Investments and investor TD Bank.

“In New Jersey, it’s the first time that an anchor health institution came to a community organization and said, ‘Let’s partner to build housing for chronic health conditions because we understand that housing is the key social determinant of health,’” says Guarasci. “True community health is much more than what happens inside a hospital or a doctor’s office. True community health is realized when things like safe, decent, and affordable housing are available.”

Breaking New Ground

In New Orleans, residents are expected to begin moving into H3C, a groundbreaking project by Gulf Coast Housing Partnership (GCHP) and Alembic Community Development, this winter.

The development features 192 affordable homes—100 workforce housing units and 92 units for seniors. In addition, there will be an on-site Federally Qualified Health Center (FQHC) operated by DePaul Community Health Centers that will provide primary and pediatric care, mental and behavioral health services, a pharmacy, and Medicaid enrollment assistance.

In addition, H3C will be the first Fitwel-certified development in Louisiana, a building-rating system created by the Centers for Disease Control and Prevention to guide building design and operations to improve the health of occupants.

The approximately $84 million project gets its name from the neighborhood’s three Cs—culture, commerce, and community—plus health care, and is part of GCHP’s bold Health + Housing initiative, which aims to bring together affordable housing with accessible medical care.
The development reimagines the former site of the Brown’s Dairy milk processing plant, which closed in 2016.

“The idea that housing and health are connected is not a GCHP idea,” says Kathy Laborde, president and CEO of GCHP. “Housing is considered to have an impact, whether positive or negative, on health outcomes. GCHP embarked on this journey because we hope that if we can quantify through our Health + Housing pilots that better housing results in better health outcomes, healthcare payors will be more inclined to invest in affordable housing.”

GHCP has laid the groundwork by securing financing from two of the largest Medicaid managed care organizations in the country—Aetna and UnitedHealthcare. Aetna is investing about $25 million in 4% LIHTCs for the development.

Additional financing for H3C includes HOME funds from the city of New Orleans and Community Development Block Grant–Disaster Relief funds. State and federal New Markets Tax Credits were used to finance the commercial component of the project.

While connecting health and housing may not be a new concept, GCHP is taking the idea into new territory.

The second project under the Health + Housing initiative from GCHP and the Pearl Street Community Development Corp. also is nearing completion in Jackson, Mississippi. The Pearl will feature 76 affordable units for seniors and will have a FQHC run by Jackson-Hinds Comprehensive Health Center that will serve residents and the larger community.

The approximately $28 million development will replace an abandoned Holiday Inn, providing an additional boost to the neighborhood. The financing includes a $3 million loan from UnitedHealthcare.

Both H3C and The Pearl will have a community health worker on-site. These workers are critical because low-income populations often face multiple barriers to accessing care, including limited understanding of the health care system, language barriers, and lack of transportation.

In addition to increasing access to direct health care, community health workers also connect individuals to resources associated with the social determinants of health, such as stable housing, nutritious food, educational resources, job opportunities, transportation, and social support.

Startup Helps to Deliver Services

New partnerships are coming in other forms as well. Ounce, a company bridging the gap between health and housing, recently raised $5.2 million in seed funding.

It is working with AmeriHealth Caritas District of Columbia, a Medicaid managed care plan, and the National Housing Trust (NHT) to deliver health care coordination and services to more than 2,000 residents at nine NHT affordable housing communities in the District of Columbia.

Ounce embeds teams of trained community health workers within properties to evaluate gaps in care, host on-site clinics and programs, and help residents access other wellness programs. They can also assist residents with enrolling in and navigating complex public health benefits like Medicaid and SNAP (Supplemental Nutrition Assistance Program). There is no cost to residents for Ounce services.

The team’s early work at NHT communities has ranged from providing “well child” or annual pediatric visits and preventive health screenings to organizing fresh food distributions and other community events, says Rachel Munsie, CEO and co-founder of Ounce, noting that the programs vary at each development.

“It’s not the same in every building,” she says. “Neighborhoods are very different. … We try to listen to residents in the communities about what they are most interested in.”

The firm has plans to expand to more properties by the end of the year.

“As we think about where this model makes sense, there are so many cities across America that have forward-thinking affordable housing developers and owners and operators who could be potential partners as well as Medicaid plans who I think make great partners on the health care side,” says Munsie. “They’re funding a lot of the health and increasingly some social services programs as well across their jurisdictions, their states, and the places they cover.”

Ounce’s recent funding round was co-led by Meridian Street Capital and Flare Capital, with participation from Chelsea Clinton’s Metrodora Ventures, Wilshire Lane Capital, Hilton CEO Chris Nassetta, Unite Us co-founder Taylor Justice, and others.