Critical Connections: Coordinating Health and Housing Needs during COVID-19

As we approach the sixth month of New York’s COVID-19 crisis, the inextricable link between health and housing has never been clearer. Coronavirus took its toll on the most vulnerable communities, especially those at greater risk for contracting the virus due to the conditions in which they live and work. In New York City, this means the brunt of COVID-19 is borne by communities of color. At the same time that these communities suffer higher rates of COVID-19 infection and deaths, they also have high rates of housing instability, poor housing quality, and individuals experiencing homelessness. In addition, these hard-hit neighborhoods are home to many frontline workers who cannot work remotely. 

People affected by housing instability—whether homelessness, precarious housing, or overcrowded or low-quality housing—are at a greater risk of COVID-19 infection and mortality; this is above and beyond the poor health outcomes already associated with unstable housing and homelessness. Among homeless individuals living in New York City shelters, the COVID-19 mortality rate was 61% higher than the city’s general population. 

COVID-19’s persistence into late summer adds urgency and complexity to efforts to address New York City’s unprecedented housing affordability and homelessness crisis. Unemployment is still at extraordinary levels, with 735,000 households reporting lost employment due to the pandemic. Critical emergency economic supports like expanded unemployment benefits and moratoria on mortgage payments and evictions have already expired or are about to. Advocates expect that discontinuing these supports, coupled with a projected filing of 50,000 evictions when housing courts fully reopen, will contribute to a boom in evictions and entry into homelessness. Just as the pandemic has had a disproportionate impact on communities of color, the anticipated increase in evictions and entry into homelessness is also racially disparate. Data on COVID-19’s impact on households show clear racial disparities in housing stability that may grow as a result of the pandemic.

Despite the phased reopening of New York State’s economy, the pandemic’s economic fallout continues to increase and is likely to get worse. As the pandemic wears on, New York City health care and community-based organizations face a two-pronged operational crisis: COVID-19 reduces their capacity to serve constituents at the same time as the pandemic’s impacts create an increased, sustained demand for services. This dichotomy hinders organizations’ ability to mitigate the harmful impacts of the pandemic and housing crises.

Ultimately, the pandemic is likely to exacerbate New York City’s already historic homelessness crisis, which will in turn compound the pandemic itself because individuals experiencing homelessness can’t stay home to quarantine. 

Community Innovations to Address Health and Housing in the COVID-19 Era

To prepare for the incoming wave of housing instability and resulting uptick in health care utilization, health and housing stakeholders across the city can look to partnership models that can help assess, address, and communicate the needs of communities to policymakers. Multiple community partnerships together can collectively identify regional priorities and, in turn, influence policymakers. Addressing the impacts of COVID-19 on health and housing will require a population health-informed response that is sufficiently broad to achieve results at scale, but also adaptable to the specific needs and priorities of affected communities. 

Earlier this summer, United Hospital Fund released a framework for developing multi-sector partnerships to address housing-related health care outcomes at the population health level. While the framework was developed prior to the emergence of COVID-19, its lessons are readily applicable. It emphasizes the importance of identifying and mobilizing existing community assets and recognizing the benefits of using a partnership model to frame and align goals, track and evaluate outcomes, and communicate impact across stakeholders. 

The Health and Housing Consortium, Inc., operating housing consortia in the Bronx and in Brooklyn, is one example of a successful multi-sectoral partnership. Throughout the COVID-19 pandemic, health and housing sector partnerships like the Health and Housing Consortium have played a critical role in coordinating health care and housing sector stakeholders’ responses to the crisis. The Consortium’s network leadership model positioned them to act as a convenor, communicator, and facilitator between City agencies, health care systems, and housing and homeless services organizations. Their COVID-19 town-hall style gatherings of frontline staff and stakeholders were a venue for information sharing and real-time problem solving on issues like where to divert patients requiring non-emergency care and long wait times for isolation beds for clients. 

Partnership models have also been instrumental in advocating for, and demonstrating the success and value of, important health and housing policy and program initiatives like medical respite. During the COVID-19 pandemic, medical respite models emerged across the country as both a response for isolating homeless and housing-insecure individuals with active COVID-19, as well as a preventive measure for limiting the spread of COVID-19 among the homeless population. 

The Road Forward

New York City and State face an uphill battle in addressing health and housing challenges in the age of COVID-19, but there are some promising practices on the horizon, especially for individuals experiencing homelessness:

  • As part of the Fiscal Year 2021 enacted budget, New York State’s Medicaid program will pilot medical respite for individuals experiencing homelessness who need a safe place to stay while recovering but whose needs do not require hospitalization. 
  • State flexibility around off-site services and telehealth (especially during the pandemic) provides opportunities for enhancing access to care via street medicine programs, such as mobile medical units, and drop-in centers to deliver care to unsheltered homeless individuals, as well as through care delivered via transitional housing facilities and virtual visits. As the State considers ongoing flexibility post-pandemic, it should specifically consider the unique needs of homeless and unstably housed populations. 
  • Both New York City and New York State continue to invest in affordable and supportive housing development, and in health and housing partnerships with community-based organizations; these include NYC Health+Hospitals and Comunilife’s planned expansion of the Woodhull Residence as well as Clarkson Estates, a partnership between the State and CAMBA as part of the Vital Brooklyn Initiative.

If successful and sustainable, innovations like these should ease the way for improved coordination of health care and housing needs among the most vulnerable New Yorkers. Such efforts are essential for alleviating suffering and fighting inequity, especially now. 

Kristina Ramos-Callan is a program manager at United Hospital Fund.

United Hospital Fund has a long history of bringing together diverse perspectives to address critical challenges in health care in New York. In the current crisis, it’s more important than ever to hear from all parts of the health care system. Today’s commentary from UHF's Kristina Ramos-Callan looks at the connection between housing and health in the era of COVID-19. – UHF President Tony Shih 

July 30, 2020
Focus Area
Coverage and AccessClinical-Community Partnerships