Presentation at NCSHA September 2016 Housing and Health Presentation at NCSHA September 2016

Mission Driven / Community Focus SAHF is a collaborative of eleven multistate nonprofit affordable housing providers. SAHF’s Mission: To lead policy innovation and advance excellence in the delivery of affordable rental homes that expand opportunity and promote dignity for residents. Members’ Missions Build quality, healthy affordable housing Create vibrant, healthy communities Use housing as a platform to help residents improve their quality of life

How is Housing and Health Linked? Housing is a social determinant of health Physical nature of buildings – quality, sanitary, designed to promote wellness, internet access Mental health – from isolation to trauma and stress Safe and easy access to supports for good health – healthy and sufficient food, quality health care services, jobs, good schools, recreation On site and accessible quality services and service coordination to help residents enjoy a good quality of life, live independently and with dignity Enable Health Sector to better locate and serve their clients

What can we do? Increase Supply of Affordable Housing Expanded Vouchers and Project Based Rental Assistance Senior Housing Production Program Flexibility in utilizing resources to allow for multiple financings Encouraging the Health Sector to think creatively about land and capital resources Supporting local land use and permitting policies for affordable housing Work creatively with CMS and State Medicaid Directors to leverage resources and flexibility

Physical Nature of Buildings and Communities Building Materials – respiratory, supportive of physical use of space Air Quality – asthma, respiratory Cleanliness and Maintenance – disease prevention, mental health Accessibility and Safety – walkability, mobility, disabled access, isolation, stress Light Access and Lighting – mental and physical health Water and Sewage – lead, water quality and safety, sufficient water, functioning sewage systems Digital Divide – internet access to reduce isolation and stress and expand access to information and wellness Transit Oriented – expand access to jobs, services and recreation

What can we do? Green building and rehabs – building materials, systems, lighting – encourage through QAPs; provide additional funding to subsidize, encourage philanthropy and corporate support Sufficient maintenance budgets and support for periodic audits of air, water and systems quality Support well designed new construction and retrofits that optimize safety, security, aging in place, recreational opportunities and access to open space Enforce building codes and provide appropriate financing tools and mechanisms for small multifamily and single family retrofits

Mental and Behavioral Health Isolation and Loneliness Chronic Stress and Trauma poverty housing costs safety and security ongoing violence adverse childhood experience Access to and Acceptance of Mental and Behavioral Health Services

What can we do? Home is a sanctuary – use design, furnishings, landscaping Make it easier to access social services and assistance (philanthropic and government) available that help reduce stress and effects of poverty (food banks, job services, child care…) Partner with mental health providers that can provide easy access, have cultural competence and consider onsite support groups Proactively use assessments for isolation and sponsor a resident services program that prioritizes reducing isolation Explore technology solutions and address digital divide

What can we do - access to support? Good health requires healthy and sufficient food, quality health care services, jobs, good schools, recreation, transit Location – invest in distressed neighborhoods and also invest in housing in opportunity neighborhoods Facilitate increased enrollment in health insurance through tenant recertification Create partnerships for quality medical referrals & health care access On site or easy access to food banks Invest in security in the property and surrounding neighborhood to reduce trauma and make community supports more accessible

Resident Services Improve Health Outcomes http://mms.businesswire.com/media/20151120005126/en/497727/5/LeadingAge_Infographic_506x253_final.jpg?download=1

On site and accessible quality services On site and accessible quality services and service coordination help residents enjoy a good quality of life, live independently and with dignity Quality service coordination should focus on collecting data to assess residents’ health challenges and opportunities and then prioritize services Encourage primary care practitioners and use of health insurance Programs include fall prevention, chronic disease management, nutrition, smoking cessation… Potential for telemedicine and on site health access Provision of services is not sufficient; have to engage residents

Access to Personal Doctor/Usual Place of Care This chart indicates that rates of SAHF residents with a usual place to go for medical care are substantially lower than the overall U.S. rates for people aged 0-44 years old, but begin to approach the U.S. rates for ages 45-64 years old and are almost the same as U.S. rates for ages 65+ years old. Presumably Medicare makes it easier for seniors to access regular medical care. The larger disparity between SAHF and U.S. rates is for children ages 0-17, with a difference of 26.3 percentage points. The SAHF data point is more broadly defined than the U.S. data point (taken from the CDC National Health Interview Survey), in that it asks whether the resident has a “personal doctor, health provider, or usual place of care.” -26 pct. pts -3 pct. pts -13 pct. pts -20 pct. pts -24 pct. pts N = 2,660 N = 734 N = 2,075 N = 2,853 N = 8,001 SAHF N = 10,715 Member A residents (collection rate: 31%), 5,641 Member B residents (collection rate: 24%). SAHF specific indicator is “resident has a personal doctor/health provider/usual place of care.” Data source for U.S. rates is the CDC National Center for Health Statistics “Early Release of Selected Estimates on Data from the National Health Interview Survey, 2014” (page 17).

Routine Doctors Visits and Demographics Do rates of routine, preventive care vary by gender, race, or age? The charts below show the percentages of SAHF Member A’s residents in certain demographic groups who visited a doctor for a routine check-up in the past year. For example, 24% of all female residents had a check-up, compared to 23% of all male residents. As such, rates of preventive care do not vary much by gender. Rate of preventive care do vary by race and age, with Asian-Americans having the highest rate of routine visits with a doctor (34% visited a doctor in past year), compared to only 21% of African-Americans. Unsurprisingly, seniors had a highest rates of routine visits with a doctor out of any age group. N=15,544 N=12,531 N=11,300 N=8,104 N=4,310 N=3,044 N=4,636 N=5,801 N=6,125 N=7,589 N=6,445 N=2,985 N=10,498 N for gender chart = 28,075 Member A residents (collection rate 80%), N for race/ethnicity chart = 37,197 Member A residents (collection rate 99%), N for age chart = 33,640 Member A residents (collection rate 96%).

Thank You efitzgerald@sahfnet.org