Man walking through CAMBA Gardens affordable housing

Co-Locating Housing with Healthcare for Transformative Outcomes

EXECUTIVE SUMMARY

Executive Summary

America’s affordable housing crisis continues to worsen. The numbers tell a distressing story:

Approximately 771,480 people experienced homelessness in 2024, per the U.S. Department of Housing and Urban Development (HUD), up from 653,100 in 2023.
The U.S. has a shortage of 7.3 million rental homes available and affordable to renters with extremely low incomes, per the National Low Income Housing Coalition.
Over 40 percent of persons experiencing homelessness are Black/African American, despite that group being just over 12 percent of the U.S. population, per HUD.

The lack of affordable housing correlates directly with poor health. Those without stable housing typically experience higher rates of complex and long-term health conditions, including diabetes, HIV/AIDS, mental illness, and substance use disorders. They can struggle to access healthcare and follow through on treatments. They increasingly rely on hospitals for primary care and shelter, which drives up taxpayer costs.

A Proven Solution Exists

Co-locating affordable, supportive housing with healthcare can end the cycle of homelessness and uplift entire communities. This model has proven effective in New York City. It’s now gaining traction in other states, as the viability of smaller hospitals continues to decline while the need grows for creative off-market sites for affordable and supportive housing.

Cross-sector partnerships make the co-location model possible. Collaborations involving affordable housing developers, healthcare providers, supportive service providers, city agencies, community leaders, and financial institutions generate transformative results. Vulnerable populations receive a stable home with reliable services to support their physical, mental, and economic wellbeing.

When people without stable homes move into supportive housing, they experience:

A 58 percent reduction in ER visits
An 85 percent reduction in emergency detox services
A 50 percent decrease in incarceration
A 50 percent increase in earned income

Meanwhile, neighborhoods gain attractive assets that enhance safety, create jobs, and revitalize their economies. Hospitals generate additional revenue by offloading unused property, reducing operating liability, and increasing their pool of insured patients. Funders see returns on a secure, long-term investment while fulfilling mandates and achieving their social goals.

Ready to Replicate

As of 2025, CAMBA Housing Ventures, Inc. (CHV) has 17 affordable and supportive housing developments completed or in progress throughout New York City. These include developments on underutilized hospital and City property. CHV’s affiliate, CAMBA, Inc., provides comprehensive supportive services in CHV developments. Tenants have access to a comprehensive array of services, including:

Intensive case management
Health benefits advocacy
Financial literacy and computer training
Education and youth development
Nutrition workshops
Connections to job training
Mental health and wellbeing groups

CHV brings equity to low-income communities through beautiful, sustainable homes, environmentally friendly building materials, contextual architecture, landscaped gathering spaces, and curated original artwork. CHV and CAMBA pursue partnerships with health providers for access to essential resources that move tenants from survival to stability and success. We hope our developments, processes and partnerships will serve as models for others pursuing housing as healthcare.

1
INTRODUCTION:

The Housing and Healthcare Connection

The Intertwined Challenges of Health and Housing

Health and housing are inextricably linked.

A healthy, thriving life is not possible without a safe and stable home. Conversely, poor health can be the tipping point toward homelessness for vulnerably housed individuals. Think of the tenant whose rent is late again but cannot maintain employment due to an untreated mental illness. Or the homeless patient who is discharged from the hospital with bed rest orders, but there may not be beds available.

People without stable or permanent housing can struggle to be healthy, and people with health issues can face difficulties maintaining housing. The American Journal of Public Health found 67 percent of all bankruptcies resulted from medical issues, either due to high medical bills or time spent away from work. In terms of maintaining housing, the National Alliance to End Homelessness reported that people experiencing chronic homelessness typically have complex, long-term health conditions, such as mental illness, substance use disorders, and physical disabilities. Homelessness and chronic poverty also increase the risk of poor health outcomes and diseases, including diabetes, HIV/AIDS, hypertension, respiratory diseases, and other conditions.¹

Housing instability or substandard housing conditions can complicate treatments and jeopardize health, due to patients not having permanent places to recuperate, lacking proper storage for medications, or breathing unhealthy air. These factors make it nearly impossible to take care of one’s health without a stable environment to follow a doctor’s recommended treatment plan. Hazardous and unsafe homes also increase poor health outcomes, including chronic diseases and injuries, and can have harmful developmental impacts on children.² Dangerous substances like lead, arsenic, mold, and asbestos threaten tenants’ health and can lead to Legionnaire’s disease, asthma, cancer, neurological diseases, and other life-threatening conditions.

“The intersection of housing and healthcare is where the safety net for the most vulnerable is giving way. The lack of safe, permanent, affordable housing can undermine a healthy life, and major medical issues can cause housing instability.”
VALERIE BARTON-RICHARDSON, President & CEO,
CAMBA Housing Ventures, Inc./CAMBA, Inc.

High use of hospitals for emergency shelter

Over 70 percent of all hospitalizations of homeless patients resulted in either an inpatient readmission, observation status stay, or emergency department visit within 30 days of hospital discharge.

Patients Experiencing Homelessness Relying on Hospitals for Shelter

There are inefficient and costly trends born from the lack of affordable housing and insufficient access to healthcare. Among them is the high use of emergency rooms by homeless individuals and hospitals being used as shelters.

A 2013 study published by the National Library of Medicine found that patients who were homeless had alarmingly high 30-day hospital readmission rates. Per the study, “Half (50.8 percent) of all hospitalizations resulted in a 30-day hospital inpatient readmission and 70.3 percent resulted in either an inpatient readmission, observation status stay, or emergency department visit within 30 days of hospital discharge.” The study found discharge to the streets or shelter versus other living situations—such as stable housing—was associated with increased risk for readmission.

In the years since, others have reported a similar pattern across the country. For instance, a 2022 study in the American Journal of Preventive Medicine showed that 30-day readmission rates among homeless patients (42.8 percent) more than doubled that of non-homeless patients (19.9 percent). A 2023 study from the Annals of Family Medicine found that “homeless patients were 30 percent more likely to be readmitted to the hospital within 30 days” compared to non-homeless patients.

This high use of hospitals and emergency
departments indicates the clear need for prevention measures in the community and referral pathways between health, housing, and supportive services.

Such integration is especially needed in New York City, where the majority of unsheltered homeless individuals live with a mental illness or other severe health problems.³ One of CHV’s hospital partners, NYC Health + Hospitals, the largest municipal healthcare system in the country, reported nearly six percent of its patients, or approximately 50,000 New Yorkers annually, are unstably housed and experiencing homelessness.⁴ These homeless patients are often discharged to shelters; however, shelters are not always available, safe, or stable places to recover from illness. Hospitals need more options and coordination for supportive housing so they can safely discharge patients, provide follow-up care, reduce emergency visits, and improve long-term outcomes.

Housing as a Social Determinant of Health

Housing is one of the most impactful social determinants of health (SDH), which the World Health Organization defines as the non-medical factors that influence health outcomes (in positive and negative ways) and contribute to health inequities.⁵ These factors, including housing, can impact health outcomes even more than healthcare access or lifestyle choices.

Examples of the SDH include:

Income and social protection
Education
Unemployment and job insecurity
Working life conditions
Food insecurity
Housing, basic amenities, and local environment
Early childhood development
Social inclusion and non-discrimination
Access to affordable health services of decent quality

New York State’s Vital Brooklyn Initiative highlights that approximately 90% of an individual’s health is due to nonclinical aspects such as socio-economic and environmental factors.⁶

“Unequivocally, housing is fundamental to good health. Our patients experiencing homelessness have complex medical conditions, and as a health care provider the first prescription is for housing. Patients need a safe affordable home to thrive and lead a healthy and happy life. NYC Health + Hospitals strives to support our most vulnerable patients on their journey to permanent housing on our land and throughout New York City.”
LEORA JONTEF, Senior Assistant Vice President,
Housing and Real Estate, NYC Health + Hospitals

Housing functions as an SDH in several ways:

Physical Health Impact: Poor housing conditions—such as mold, lead paint, inadequate ventilation, pest infestations, and insufficient heating and cooling—can lead to respiratory problems, allergies, and other physical health concerns.

Mental Health Effects: Housing instability, overcrowding, and concerns about safety in certain neighborhoods can contribute to heightened stress, anxiety, and depression.

Access to Healthcare: Having stable housing with a fixed address is essential for accessing healthcare services and ensuring continuous medical care.

Vulnerable Populations: Low-income individuals, people experiencing homelessness, and minority groups are especially at risk of poor housing conditions and the associated health hazards.

Neighborhood Environment: The quality of a neighborhood—including access to nutritious food, safe recreational spaces, and community support—plays a key role in overall health.

“In the early 1990s, CAMBA began providing emergency housing, followed by transitional housing with supportive services, to stabilize individuals and families for future permanent housing. Created in 2005, CAMBA Housing Ventures expands that initiative holistically with a proven solution. As of 2025, CHV has leveraged over $1.3 billion in public and private dollars to create long-lasting assets for residents, communities, and investors. Developing permanent affordable housing with on-site supportive services is one of the most comprehensive and efficient investments to address homelessness.”
DAVID A. ROWE, Chief Administrative Officer,
CAMBA Housing Ventures, Inc./CAMBA, Inc.

mother and woman smiling while young boy gives a fist bump

Housing and Health Inequities

Homelessness, poverty, and lack of affordable housing opportunities are critical issues in the U.S. right now. The U.S. Department of Housing and Urban Development (HUD) found approximately 653,100 people experienced homelessness in 2023, while the National Low Income Housing Coalition reports the U.S. has a shortage of 7.3 million rental homes available and affordable to renters with extremely low incomes.

Higher rates of poor health outcomes and homelessness persist for people of color in America. People who are Black or African American, American Indian or Alaska Native, and Latine experience more chronic illness and higher disease mortality rates than people who are white. This racial disparity extends to housing status. A 2023 study from HUD reported that 37 percent of all persons experiencing homelessness are Black/African American, despite making up just 12 percent of the U.S. population.

Extremely low-income renters—defined as households with income at or below the poverty guideline or 30 percent of Area Median Income (AMI)—are most impacted by the low supply of affordable rental housing. According to a 2023 report by the National Low Income Housing Coalition, only 33 available and affordable homes exist for every 100 extremely low-income renter households. Black or African American, Latine, and Indigenous households are disproportionately extremely low-income renters and are therefore unevenly impacted by this shortage.

Disproportionate rates of Homelessness across BIPOC communities

A 2023 study from HUD reported that over 40 percent of all persons experiencing homelessness are Black/African American, despite making up just 12.7 percent of the U.S. population.

Chart of Disproportionate Rates of Homelessness

A Sound Investment with a Community-Wide Impact

Affordable and supportive housing offers a win-win solution to the complicated issues of homelessness and poor healthcare outcomes. Affordable housing has historically enjoyed bipartisan support, which is expected to continue. For financial partners, it represents a sound investment that’s proven cost- effective with multiple layers of oversight. Nonprofit developers that own and operate the properties are accountable to their city, state, federal, and private funders for a minimum of 15 years, with most regulatory agreements in place for over 30 years. Developments create jobs in both construction and operations phases, provide workforce housing, keep tenants stably housed, and increase tax revenue for communities. Workforce housing is needed now more than ever, as workers continue to be priced out of neighborhoods where they provide essential services. The impact of construction and the resulting addition of more taxpayers provide a boost to neighborhoods and local economies.

According to a large and comprehensive study, affordable and supportive housing does not depress neighboring property values; it actually leads to a slight increase in value for properties closest to new residences.⁷ Supportive housing often makes way for new neighborhood development, serving as an anchor for the block where they are built. A beautiful new construction building complete with new sidewalks, landscaping, lighting, and architecture contextual to the area serves to improve the neighborhood. Security guards, daily maintenance, increased activity of people coming and going, lighting, and other visibility features help to increase the neighborhood’s safety.

Affordable and supportive developments are also strong job creators. According to the New York City Department of Housing Preservation and Development (NYC HPD), a 100-unit supportive housing development creates 133 jobs during construction and 12 ongoing permanent positions.

There are also significant upsides for hospitals and healthcare providers interested in participating or investing in affordable and supportive housing. Following a 40-year construction surge sparked by the Hill-Buton Act of 1946, many hospital systems now find themselves with sprawling campuses that include underutilized land or vacant sites and buildings. Whether they became obsolete due to new care delivery models or financial pressures, these sites now present huge annual carrying costs and can create a burden for a hospital’s bottom line. Repurposing these sites into affordable and supportive housing creates a sound investment for the hospital, offers potential homes for patients, and transforms a vacant lot into a well-maintained, community asset.

In terms of benefits to improving health outcomes, according to the Supportive Housing Network of New York (The Network), supportive housing drastically reduces the use of the costliest systems of care, including hospital emergency rooms, acute care, and inpatient psychiatric services. In New York, a study of tenants’ use of services before and after entering supportive housing found that an unhoused person living with mental illness costs taxpayers over $78,000* a year, while a supportive apartment in the City, on average, saves more than $31,000* per housing unit across seven systems.⁸

*adjusted for inflation

2
KEY SOLUTIONS:

Partnering for Better Outcomes

Co-Locating Affordable Housing,
Supportive Services, and Healthcare

Given the relationship between health and housing, partnerships involving affordable and supportive housing developers and healthcare providers can have transformative impacts for tenants, patients, and entire communities.

Adding Onsite Services to Create Supportive Housing

The need for affordable and supportive housing continues to grow throughout the country. In 2013, extremely low-income households faced a shortage of 3.9 million affordable homes.⁹ In 2025, that shortage has surpassed 7 million.¹⁰

While it is imperative that we increase the supply, additional layers of services and amenities must also be considered to help address the many complex issues facing homeless and vulnerably housed populations. Incorporating onsite supportive services into affordable housing developments provides tenants with customized care to meet their individual needs. Tailored case management and supportive services such as those provided by CAMBA, Inc. help to ensure tenants maintain their health and wellbeing and remain stably housed. Beneficial onsite services CHV developments offer include:

Mental health and wellbeing groups
Access to and coordination with healthcare services and health benefits advocacy
Teaching kitchens to learn about healthy cooking skills and eating habits
CAMBA Food-Choice Pantries to access quality food
Nutrition workshops
Indoor and outdoor spaces for recreation and exercise
Community rooms for gatherings, events, and socialization

“When housing and healthcare systems collaborate, everyone benefits. Hospitals gain a cost-effective way of serving people with complex health needs, supportive housing providers expand access to quality care, and communities benefit from healthier, more stable residents. These partnerships show that integrating housing and health creates cost-effective, sustainable solutions that help people reach their highest level of health and independence.”
DEBORAH DE SANTIS, President and CEO,
Corporation for Supportive Housing

“The Federal Home Loan Bank of New York is proud to support partners that do the critical work of creating safe and affordable housing every day. Through our Affordable Housing Program, funded directly through our earnings, we and our members have supported nearly 2,200 projects with more than $1.1 billion in grants focused on housing and community development—including $10.5 million for CAMBA initiatives. Altogether, we have helped create or preserve nearly 110,000 units of housing.”
Randolph C. Snook, President and CEO,
Federal Home Loan Bank of New York

The affordable and supportive housing model has proven particularly impactful for improving health outcomes and streamlining access to care. An evaluation report from a Massachusetts supportive development that housed 766 chronically homeless individuals found that in the six months prior to housing, tenants accumulated 1,812 emergency department visits, 3,163 overnight hospital stays, 847 ambulance rides, and 2,494 detox stays.

The estimated total cost per person for measured services—including Medicaid, shelter, and incarceration—totaled $33,190 per year. After one year in the supportive housing program, the total per-person cost for these same services fell to $8,603.¹¹

The benefits of including onsite supportive services in affordable housing extend beyond healthcare, creating more stable lives and brighter futures. When formerly homeless people or people at risk of homelessness move into supportive housing, they experience a:

58 percent reduction in ER visits
85 percent reduction in emergency detox services
50 percent decrease in incarceration
50 percent increase in earned income
40 percent rise in rate of employment when workforce training and economic development services are provided

In addition, more than 80 percent stay housed for at least one year.¹² In CHV developments, over 98 percent of tenants maintain housing for at least one year, a feat that may not be feasible for a formerly homeless tenant without access to supportive services and healthcare.

Designing and Building a Proven Solution

A comprehensive approach to improving health outcomes and housing access is as essential as designing and constructing a building with the most durable and appropriate materials and methods. Co-located healthcare, supportive services and safe, affordable housing creates a proven foundation and formula for a stable future.

Affordable Housing, Supportive Services, Access to Healthcare Services

Foundational Research: The Corporation for Supportive Housing White Paper

Affordable and supportive housing can transform communities when co-located with healthcare services. The concept of building housing for vulnerable populations on surplus or underutilized hospital property was first conceived by the Corporation for Supportive Housing (CSH) and then implemented by CHV with two innovative developments, CAMBA Gardens I (CGI) and CAMBA Gardens II (CGII) at NYC Health + Hospitals/Kings County Campus.

Supportive housing developers and nonprofit or public hospitals share a mission to serve the most vulnerable in their communities. Investing in or partnering to create supportive housing can also provide opportunities for hospitals to expand their patient bases, increase their services to the community, and improve their financials. The formerly homeless tenant population typically has not had access to regular and preventative healthcare services, but they are Medicaid-eligible. Their tenancy in a supportive housing development provides hospitals with new patients and the guaranteed revenue of fully insured care cases. This will become especially valuable to safety-net hospitals who treat larger numbers of low-income and Medicaid patients. Anticipated 2026 Medicaid cuts could reduce their operating margins by 56 percent, with higher numbers expected for certain states and rural areas.¹³

Another benefit of hospitals partnering with developers to build supportive housing: the opportunity to discharge a patient to a safe and stable home where they can fully recuperate.

The CSH report noted, “The current shortage of affordable housing forces many nonprofit and public hospital systems to make the difficult choice between discharging homeless patients back to shelters or the street, and thus compromising their health conditions, or keeping them hospitalized longer than medically appropriate.” Formal links to supportive housing provide hospitals with dedicated out-placement opportunities, increasing patients’ chances of improved health outcomes.¹⁴

CSH’s report also recognized the benefits for developers. In addition to expanded access to quality healthcare for tenants, advantages include financial sponsorship from a large institution with sophisticated fiscal management systems, access to suitable development sites, and positive community perception.

Map of Hospital-Owned Properties in New York City

Aerial view of CAMBA Gardens construction

Strengthening a Financial Investment

Other stakeholders in the development of affordable and supportive housing also stand to benefit from co-locating housing with healthcare. Financial institutions and Low-Income Housing Tax Credit (LIHTC) syndicators are essential and valued partners in building affordable housing. For some, like members of the Federal Home Loan Bank system, there is a Congressional requirement to contribute 10 percent of their net income to Affordable Housing Programs (AHP) each year. Others have mission-oriented initiatives aimed at community reinvestment. When nonprofit affordable housing developers secure a partnership with a healthcare provider, whether through the use of a development site or as a commercial tenant providing services, the feasibility of the deal only increases, creating a sound investment strategy.

Beyond developing on hospital property, other co-location strategies and partnerships include establishing primary care, behavioral health, ambulatory care, or other health facilities within housing developments, serving both as commercial tenants and as community health providers. This model promotes aligned services at supportive housing developments to further expand immediate access for tenants’ healthcare.

NYU Furman Center’s Tool for Tracking Hospital Owned Land

Those looking to develop affordable and supportive housing on hospital-owned land in New York City have access to an extremely useful tool from New York University’s Furman Center: a website that tracks hospital-owned properties in the City. The tool includes data about whether the properties are open or closed, zoning district, and lot area or square footage, as well as overlays such as community districts, flood zones, median rent, and demographics. This tool, as well as the other extensive research and datasets compiled and offered by the Furman Center, can help potential developers begin to assess a site’s feasibility for future supportive housing.

“Once formerly homeless and low-income individuals and families can call a CHV building their home, working with on-site supportive services greatly enhances their stability, health, and integration into the community. CAMBA’s supportive services teams not only provide essential case management and access to benefits but also programming to support residents’ health and life goals. CHV’s variety of flexible interior and exterior spaces—including gardening beds, teaching kitchens, fitness facilities, and playrooms – enable diverse programming opportunities for residents.”
Sharon R. Browne, Chief Administrative Officer, CAMBA, Inc.

Further Collaborations for Health and Wellbeing

Creating wellness activities, services, and programs together is another way health and housing providers can collaborate for the holistic benefit of tenants.

CHV designs affordable and supportive housing developments with amenities aimed at improving health, and CAMBA’s onsite services offer multiple wellness opportunities for tenants. For example, through a partnership with The Horticultural Society of New York, we provide a Community Supported Agriculture program along with therapeutic gardening activities to support tenants’ mental health, maintain their buildings’ garden beds and green spaces, increase the availability of fresh foods, and promote environmental stewardship.

In many CHV buildings, onsite pantries help to ensure tenants have ready access to nutritious food options, including the produce they harvest from their community gardens. Meanwhile, teaching kitchens provide cooking and nutrition classes to empower tenants with the information they need to make healthy dietary choices.

Other amenities developers and their partners can pursue include:

Designated fitness rooms that host exercise classes and make workout equipment available for tenant use
Health screening centers and mobile clinics that offer tenants convenient access to routine and preventative medical care
Wellness programs for tenants of all ages that focus on yoga, therapeutic arts, parental skills training, job training, and more
Onsite childcare facilities that give parents peace of mind while they work
Walking loops and exercise class spaces that encourage physical activity, especially among seniors
Dedicated case managers who work with tenants to promote independent living, long-term housing stability, and community integration

CHV developments often feature numerous spaces for community connection, such as multipurpose activity rooms, libraries, computer rooms, kitchens, courtyards, and patios—all to help combat poor health outcomes that stem from loneliness or isolation. We also work with galleries to curate permanent art installations from local artists throughout our buildings, which help to spark joy and a sense of pride among tenants.

Solving for Multiple Issues at Once

Environmental Design Principles for Healthier Communities

The interconnection between a healthy home and a healthy life is foundational to CHV’s approach. We make sustainable design choices to improve tenants’ health in tandem with their surroundings. CHV’s developments:

Meet the highest feasible energy and sustainability guidelines such as Energy Star, Enterprise Green Communities, LEED, and Passive House
Are transit-oriented, for the convenience of daily life and to reduce tenants’ environmental impact
Use high-quality and sustainable building materials for long-lasting buildings and the health of tenants and the community
Incorporate landscaped indoor and outdoor recreation spaces, roof terraces, and community gardens for enjoying nature and socializing
Ensure healthy air quality through non-toxic finishes, ventilation, and non-smoking policies
Foster a sense of community to create social connections and reduce isolation

There is extensive research on the benefits of green spaces in urban areas improving health and wellness, such as reductions in obesity as a result of proximity to parks, and improved mental health due to access to nature. However, low-income communities typically have less access to green spaces and fewer trees in their neighborhoods. CHV is working to reverse this trend. Our CGI and CGII developments have community gardens where tenants grow fresh produce and beautiful flowers. Landscaped spaces are densely planted with trees, shrubs and grasses to give a sense of being immersed in nature. Plantings are chosen to provide year-round color. This fosters a sense of shared purpose, provides hyperlocal and healthy food, and allows residents to enjoy the therapeutic benefits of nature.

“Enterprise launched Green Communities 20 years ago to demonstrate that housing could be affordable, healthy, and energy-efficient for anyone, including people with low incomes and those who’ve been homeless. More than 230,000 households have benefited nationwide, including over 2,000 in CHV developments.”
Krista Egger, Vice President, National Initiatives, Enterprise Green Communities

“Passive House creates quiet, thermally enhanced, resilient environments that sharply reduce energy demand. High-performance envelopes and balanced ventilation systems lower utility costs while easing operations and maintenance. By delivering carbon reductions, Passive House supports both community health and climate goals.”
Kevin Nasello, AIA, LEED AP BD+C, Director of Sustainability, CetraRuddy

“Active design is more than an architectural strategy—it’s a pathway to holistic wellbeing. By integrating features that encourage movement, social interaction, and access to natural light and green spaces, we create environments that reduce isolation, alleviate stress, and foster dignity. These design principles improve health and strengthen resilience, helping residents thrive.”
Catherine Selby, AIA LEED NCIDQ IIDA,
Partner, Dattner Architects

Active Design Principles for Healthy Lives

When developing affordable and supportive housing, it is imperative to think beyond meeting the basic need of shelter. The place we call home is as critical to our wellbeing as healthy food, movement, and access to nature. CHV’s developments focus on design excellence in order to elevate the standards of affordable and supportive housing. For instance, we employ active design principles, such as putting windows and inviting colors in stairwells to encourage using the stairs over the elevator. Whenever possible, we incorporate:

Gardening beds and programs to promote activity, foster new and shared hobbies with other tenants, and focus on healthy foods
Walking tracks and indoor fitness centers for tenants to conveniently exercise
Heavily landscaped outdoor recreation space for tenant gatherings and time in nature
Children’s playrooms for our youngest residents to have fun and build community in a safe space
Indoor bicycle parking for convenience and to protect tenants’ property
Teaching kitchens with cooking classes to learn about food preparation and healthy eating habits

Clarkson Estates, CHV’s second Vital Brooklyn development (discussed further on page 34) will feature a basketball court open to the community, inviting the neighborhood to use the facility for fitness and fun.

Design Principles Addressing Mental Health

Affordable and supportive housing design principles can create positive outcomes around mental health. Addressing social isolation and creating a sense of community is imperative to mitigating the negative impacts of loneliness and its effects on all aspects of one’s health. Research shows that people with weak social connections carry a 50 percent higher risk of death—a mortality effect as strong as smoking 15 cigarettes a day. Social connection is one of the key antidotes; it reduces stress, enhances immune function, and is linked to longevity and disease prevention. CHV’s developments offer:

Community rooms where tenants and neighbors can gather for workshops, events, socializing, and more
Interiors filled with natural light offering direct sight lines to green spaces
Outdoor recreation areas for socializing opportunities and access to nature, such as rooftop terraces, courtyards, grilling areas, and sculpture gardens

Incorporating curated artwork and sculptures by local artists is another way to build community connection, increase aesthetic value, and support local artists. Viewing these carefully selected pieces next to elevators, in the lobby, in community rooms, and outside their apartments encourages tenants to feel proud of the place they call home. Moreover, access to visual art promotes health and wellness and fosters adaptive responses to stress. CHV also recognizes that low-income communities have less access to art, which is why we make certain to incorporate art into our developments. CHV’s use of beautifully landscaped outdoor spaces and curated artwork throughout our buildings reflects our commitment to tenants’ health and wellbeing.

3
CASE STUDIES:

Housing as Healthcare

Overview

CAMBA Housing Ventures creates flourishing, healthy communities with permanently affordable housing. Our developments, coupled with CAMBA’s impactful onsite supportive services and programming, offer tenants opportunities to build healthy, stable, and thriving lives.

We have seen time and again how our developments empower tenants to take control of their own care and choose lifestyles that lead to better health outcomes. When we co-locate our developments with healthcare, the positive effects on tenants, the community, and the local economy are even greater. Our financial and development partners also benefit from the streamlined health and housing model, which provides a stable revenue source and secure long-term investment. Tenants at CAMBA Gardens I and CAMBA Gardens II, and soon at Clarkson Estates, all benefit from living next door to public hospitals. Tenants of The Hart live above a mental health and primary care outpatient center. Additional amenities throughout all our developments, such as landscaped outdoor spaces, rooftop terraces, and community gardens, provide tenants with the connection to nature and community that is so critical to mental health. High-quality building materials, non-toxic finishes, and healthy indoor air quality improve the health and wellbeing of our tenants. Our developments are built with a foundation of services and amenities that support families as they transition from survival to stability and success. CHV firmly believes that housing is healthcare.

Over the past two decades, we have secured many of our development sites through one of the following three categories, and we hope these case studies provide a replicable model for other groups to follow:

Underutilized public hospital property

CAMBA Gardens I
CAMBA Gardens II

New York State’s Vital Brooklyn Initiative

The Hart
Clarkson Estates

Underutilized City-Owned Property

Morris Manor
Van Dyke
Hegeman
Kingsborough Seniors

Research

Understanding Areas of Need and Identifying Partners

The need to increase the affordable and supportive housing supply, improve health outcomes, and deliver results for partners are pervasive trends throughout every community. Understanding the proven benefits of co-locating supportive housing and healthcare services, it is time to research the organizations and industries that may be facing challenges, like public and/or nonprofit hospitals, and determine how a partnership could help. Another important step in this process: developing relationships with local public agencies charged with improving community housing opportunities and health outcomes. They often have shared missions but take different approaches. It is essential to identify the right partners, and those in the public sphere are critical to making progress. They may also have public funding resources that can jumpstart a new housing initiative.

Connecting Shared Needs

After identifying potential collaborations, the next step becomes solidifying shared needs. Many organizations have similar goals, and identifying how they can combine strengths results in opportunities. For example, a public hospital has surplus land, and a public sister agency needs land to fulfill housing production or preservation goals. Another example speaks to cross-sector solutions, where the affordable housing industry is helping to mitigate climate issues with sustainable, energy-efficient practices. The buildings themselves are leading to better health and environmental outcomes with improved indoor air quality, low-VOC paints, energy-efficient windows, and rooftop solar panels. Developers are building affordable and supportive housing to LEED and Passive House certifications and Enterprise Green Communities Criteria, which are sustainability standards that ensure new construction has a low ecological impact.

Site Feasibility

Determining site feasibility requires a great deal of time, due diligence, and staff expertise. Below is a sample of the questions CHV’s team uses for this process.

Have we identified the right partners?
Where does it make sense to build?
Is the site’s size feasible to develop?
Are any zoning actions needed?
What size building will the available square footage allow?
Is the site transit oriented?
What partners are in this area?
What partners have the resources to help us acquire this land?
Who owns vacant land?
What are the benefits to the city and the neighborhood of building on this site?

Create a proposal (like a mini RFP) that sets out a vision for the property (include architects and attorneys in this process). Architects can analyze how many units and the total square footage the site can support. There are many stakeholders and understand their priorities. Ask why the project makes sense for these stakeholders and how the proposed development can benefit everybody.

Taking a Successful Model to Scale

It takes dedicated leadership, collaboration, and innovation to scale a successful model. For CHV, the process began with the vision laid out in CSH’s white paper, then moved to discussions among various partners, including the NYC Health + Hospitals, the local campus of Kings County Hospital Center, NYC Department of Housing Preservation and Development, and the community. This working group identified the shared goal of serving low-income New Yorkers. Site selection started by identifying one site based on the local hospital’s operating capacity and liabilities, which then shifted to two adjacent sites with nearly identical vacant hospital buildings, as the initial site was repurposed for another use.

Once the final site (comprising two separate buildings) was identified, other ancillary concerns had to be vetted and resolved. Parking was the main component of these discussions, in addition to a network of campus utilities that the design and construction team had to account for. Holding regular meetings with hospital facilities staff before, during, and after completion was integral to ensuring that CHV’s developments were advancing without interrupting day-to-day hospital operations, particularly in the adjacent emergency department. Regular communication protocols led to positive working relationships that facilitated the replication of CAMBA Gardens Phase I into Phase II. Once the model proved successful, other stakeholders and partners began promoting the concept to City and State officials. From this success, a working group of hospital leaders formed to discuss how this model could work at other City and private nonprofit hospital campuses. The Vital Brooklyn initiative was born, which has since spurred the development of nearly 4,000 units of housing across a dozen sites.¹⁵

Developments Built On Underutilized Hospital Property

Our Process

Planning for Cross-Sector Collaborations

Co-locating supportive housing and healthcare services on underutilized hospital property is a complicated endeavor—one that’s achievable by planning correctly for cross-sector collaboration.

This planning includes the essential step of aligning the interests of all stakeholders. It also requires open, regular communication between all partners—from the beginning discussions around site feasibility to the final agreements for operations—to keep the development on track.

CHV has found success forming working groups with stakeholders, giving frequent presentations on the development’s progress and status, and looping in elected officials and community leaders early on to ensure the development addresses the neighborhood’s concerns throughout the planning process.

Prior to any collaboration, conduct research to understand potential mission-aligned partners. Look for opportunities to build upon existing initiatives or to learn from what worked or failed in the past.

“Unhoused individuals are disproportionately affected by confounding social issues, including food insecurity and lack of access to affordable healthcare. Kings County Hospital is proud to have collaborated with CHV in a public-private partnership to co-locate affordable and supportive housing on hospital property. This initiative has proven to be an effective, sustainable solution. A stable home environment is foundational to improving lives, and CAMBA’s supportive services work in tandem to heal the whole person.”
Sheldon P. McLeod, CEO, NYC Health + Hospitals/Kings County

Forging Partnerships

Initiating and sustaining partnerships are keys to successfully developing on hospital property. Network with those involved, meet with community members, and engage any players who could influence progress, including:

Public and nonprofit hospitals
Developer teams
Elected officials
Community leaders
City and state housing agencies

CHV recommends these best practices to build productive relationships:

Share solidified plans promptly. Highlight key milestones and objectives.
Be transparent about progress. Send regular communications and meet often about updates, next steps, setbacks, and other information.
Follow through on promises. Failure to do so can quickly erode confidence.
Enable all partners to share success through press releases, groundbreakings, ribbon cuttings, tours, and community meetings.

“Housing is central to fostering thriving communities. This is why the FHLBNY seeks out partners like CAMBA Housing Ventures, local institutions that know the needs of their neighbors and are committed to the communities they serve.”
Randolph C. Snook, President and CEO, FHLBNY

CAMBA Gardens I

TOTAL HOMES
209 homes

DEVELOPMENT COST
$67 million

BUILDING SIZE
193,150 SF

ADDRESS
690-738 Albany Avenue, Brooklyn, NY 11203

DEVELOPER
CAMBA Housing Ventures, Inc.

ARCHITECT
EQ Architecture & Design (formerly Harden Van Arnam Architects, PLLC)

CONTRACTOR
Bruno Frustaci Contracting, Inc.

SUPPORTIVE SERVICES PROVIDER
CAMBA, Inc.

PROJECT CONSULTANT
Ametrine Group

PREDEVELOPMENT FINANCING
Corporation for Supportive Housing, Enterprise Community Loan Fund

CAPITAL FINANCING
Brooklyn Borough President, FHLBNY
AHP/HSBC, Goldman Sachs, 4% LIHTC, NYC Council, NYC HPD SHLP, NYS HFA Bonds, NYS HHAP, NYSERDA, TD Bank

OPERATIONS FINANCING
New York/New York III, NYC DHS SRO
Support Subsidy, NYC DOHMH, Shelter
Plus Care

SYNDICATOR
Enterprise Housing Credit Investments

COMPLETION
2013

CGI is a $67 million public-private investment in Wingate, Brooklyn, located on underutilized public hospital property. CHV implemented a national model for co-locating housing and healthcare by developing affordable and supportive housing on the NYC Health + Hospitals/Kings County. CGI consists of two buildings with 209 homes, providing affordable housing for households earning under 60 percent of Area Median Income (AMI), and families and individuals with special needs.

Health-Centric Services and Amenities

By building on the KCHC campus, CGI improves health outcomes for tenants by connecting low-income and formerly homeless households to CAMBA’s onsite supportive services and KCHC’s preventative healthcare resources. The development reduces public costs by decreasing the use of homeless shelters and emergency rooms. By locating affordable and supportive housing on the same campus as a community health provider, we tripled the potential to address housing as a social determinant of health.¹⁶

“The Homeless Housing and Assistance Program and CAMBA Housing Ventures have partnered for over 20 years, investing more than $70 million in 10 projects to develop nearly 1,000 units of supportive housing. This includes the successful investments in CAMBA Gardens Phase I and II, which together created 502 units of permanent housing at Kings County Hospital.”
Barbara C. Guinn, Commissioner, New York State Office of Temporary and Disability Assistance

“Goldman Sachs sees the value of investing in innovative, replicable national models like CAMBA Gardens I that leverage public-private partnerships, revitalize neighborhoods, and combine housing and essential services to drive better outcomes for residents and communities.”
Dan Alger, Managing Director, Urban Investment Group, Goldman Sachs

Sustainability Measures

CGI is a transit-oriented development built to LEED-Platinum certification, Enterprise Green Communities Criteria, and NYSERDA’s Multifamily Performance Program. As such, the development requires less energy and produces fewer greenhouse gas emissions, and it provides for greater occupant comfort and health. To reduce the development’s carbon footprint and operating costs, CHV invested in an 86 kW rooftop solar array providing 104,000 kWh of electricity per year and powering approximately 45 percent of common areas

CAMBA Gardens II

TOTAL HOMES
293 homes

DEVELOPMENT COST
$100 million

BUILDING SIZE
257,873 SF

ADDRESS
560 Winthrop Street, Brooklyn, NY 11203

DEVELOPER
CAMBA Housing Ventures, Inc.

ARCHITECT
Dattner Architects

CONTRACTOR
Bruno Frustaci Contracting, Inc.

SUPPORTIVE SERVICES PROVIDER
CAMBA, Inc.

PROJECT CONSULTANT
Ametrine Group

PREDEVELOPMENT FINANCING
Corporation for Supportive Housing,
Enterprise Community Loan Fund

CAPITAL FINANCING
Bank of America, Brooklyn Borough
President, FHLBNY AHP/HSBC, 4% LIHTC, NYC Council, NYC HPD SHLP, NYS HFA Bonds, NYS HHAP, NYS MRT, NYSERDA,
TD Bank

OPERATIONS FINANCING
NYC DOHMH, NYC HPD PBV, NYC HRA,
NYS OMH, Shelter Plus Care

SYNDICATOR
Enterprise Housing Credit Investments

COMPLETION
2016

Development Overview

CGII is a continuation of the award-winning model for collaboration among a public hospital, a nonprofit developer, and a supportive services provider. CHV, CAMBA, NYC Health + Hospitals/Kings County continued their unique partnership, creating a $100 million development that represents 293 affordable homes for formerly homeless families and individuals.

Over 60 percent of the building’s apartments are set aside for formerly homeless/special needs individuals and families, including those living with HIV/AIDS or a serious and persistent mental illness and/or substance abuse disorder.

Health-Centric Services and Amenities

CGII provides onsite supportive services and streamlined healthcare services for tenants, while continuing established relationships with the hospital and community. Co-locating housing with healthcare and CAMBA’s uplifting supportive services creates a critical connection for special needs tenants to lead healthy, full lives.

Health-centric features include a recreational room, two community rooms, outdoor landscaped areas for active and passive uses, resident gardening beds, daylit stairwells to promote walking, and original artwork by local artists for community connection and mental wellbeing.

“NYSAFAH is a strong advocate for forging creative partnerships and expanding public funding that increases affordable housing and provides lasting impacts to tenants. CAMBA Gardens I and II are a national model.”
Carlina Rivera, President and CEO, New York State Association for Affordable Housing

“Every family deserves a healthy start, and that begins with a safe home. At Bank of America, we’re committed to partnering with local organizations and developers to create opportunities that help families thrive and neighborhoods grow.”
Maria Barry, Managing Director, Bank of America Community Development Banking

Sustainability Measures

CGII is a transit-oriented development that has achieved LEED-Gold certification and Enterprise Green Communities Criteria, and met ENERGY STAR and NYSERDA standards. CGII requires less energy and produces fewer greenhouse gas emissions due to CHV’s investment in a 96 kW rooftop solar array, healthy indoor air quality, non-toxic finishes, and a variety of green spaces for all ages.