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

2. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Resident Services Improve Health Outcomes

12. 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

13. 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 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).

14. 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%).

15. Thank You efitzgerald@sahfnet.org