National Overview of Nonprofit Hospitals' Community Benefit Programs to Address Housing

Abstract

Background: Housing is a critical social determinant of health that can be addressed through hospital-supported community benefit programming.

Objectives: To explore the prevalence of hospital-based programs that address housing-related needs, categorize the specific actions taken to address housing, and determine organizational and community-level factors associated with investing in housing.

Research design: This retrospective, cross-sectional study examined a nationally representative dataset of administrative documents from nonprofit hospitals that addressed social determinants of health in their federally mandated community benefit implementation plans. We conducted descriptive statistics and bivariate analyses to examine hospital and community characteristics associated with whether a hospital invested in housing programs. Using an inductive approach, we categorized housing investments into distinct categories.

Measures: The main outcome measure was a dichotomous variable representing whether a hospital invested in one or more housing programs in their community.

Results: Twenty percent of hospitals invested in one or more housing programs. Hospitals that addressed housing in their implementation strategies were larger on average, less likely to be in rural communities, and more likely to be serving populations with greater housing needs. Housing programs fell into 1 of 7 categories: community partner collaboration (34%), social determinants of health screening (9%), medical respite centers (4%), community social determinants of health liaison (11%), addressing specific needs of homeless populations (16%), financial assistance (21%), and targeting high-risk populations (5%).

Conclusions: Currently, a small subset of hospitals nationally are addressing housing. Hospitals may need additional policy support, external partnerships, and technical assistance to address housing in their communities.

FIGURE 1

Distribution of housing strategy categories from housing strategy dataset. Pie graph distribution of how hospitals are addressing housing needs of homeless populations. Community partner collaboration was the most common approach to addressing housing needs, followed by financial assistance and addressing nonhousing needs. Of the 302 specific strategies, 103 were related to “Community Partner Collaboration,” 26 were related to “SDOH Screenings,” 12 were related to “Respite Centers,” 33 were related to “Community SDOH Liaison,” 47 were related to “Address Nonhousing Needs,” 65 were related to “Financial Assistance,” and 16 were related to “Targeting High-risk Populations.” SDOH indicates social determinants of health.