The guide is informed by Urban Institute’s research examining the current practice as well as the motivations, opportunities, and barriers nonprofit hospitals and health systems face to initiating and broadening investments in housing development. Our findings suggest that while nonprofit hospitals and health systems may be increasingly aware of and involved in addressing housing concerns of their patients and communities, few invest in construction and rehabilitation projects.

This guide presents key concepts and strategies for designing and implementing housing development projects, complemented by examples and supplemental resources. We first guide the readers through steps and considerations when exploring and formulating an appropriate affordable housing investment strategy, including assessing community needs, identifying the target population, engaging community members, examining the policy context, selecting partners and internal champions, and measuring progress. We then describe concrete ways in which nonprofit hospitals and health systems can provide invaluable support and financing for affordable housing projects. These include using their financial position to enhance credit, therefore lowering borrowing risks and costs; providing in-kind resources, such as land and staff time, to help affordable housing development; and providing capital (as a grant or a direct loan) to cover construction or rehabilitation costs.


Author: Kathryn Reynolds, Eva H. Allen, Martha Fedorowicz, and Joycelyn Ovalle