Nurse Leaders are Housing Advocates

Feb 20, 2020 | Housing is Health |

Housing in Health, A Public Policy Blog from the National Nurse-Led Care Consortium

Housing affordability has markedly worsened over the past 15 years, and more American families than ever are struggling to pay the rent and make ends meet. For those at the bottom of the income scale, the problem is most acute: roughly 10 million households with extremely low incomes are either homeless or pay unaffordable rents that force many of them to make untenable choices between paying the rent and paying for other necessities like nutritious food, transportation, and medications.

Out of over 3,000 counties in the nation, there are only 28 counties where a full-time worker earning minimum wage can afford a modest one-bedroom rental home, and there are none where they can afford a modest two-bedroom. A full-time worker earning the federal minimum wage of $7.25 needs to work approximately 127 hours per week for all 52 weeks of the year to afford a two-bedroom rental home at the national average fair market rent. The number of households with “worst-case housing needs” – that is, households with very low incomes that either pay more than half their income for rent or live in severely substandard housing and receive no aid – has risen by 66% since 2001. Nationally, there are only 37 affordable and available homes for every 100 extremely low-income renter households. According to a recent public opinion poll, 60% of Americans say housing affordability is a “serious problem” where they live, which is up an astounding 21 points since 2016 — and that includes majorities in cities, suburbs, and rural areas.

Decades of research demonstrate that stable, affordable homes are linked with better health outcomes across the lifespan (e.g., fewer child hospitalizations, ER visits, developmental delays, asthma cases, and mental health challenges; more preventative care visits; lower Medicaid costs; etc.). Unfortunately, today, millions of people experience housing circumstances that damage their health and, consequently, increase unnecessary health care utilization. These experiences include living in dilapidated/unsafe homes; residential instability such as “couch surfing” or doubling-up with family or friends; struggling to pay rent; living in housing that is located in low-opportunity neighborhoods that lack resources, job opportunities, and strong schools; and experiencing eviction and homelessness. Children’s HealthWatch found that unstable housing among families with children will cost the nation $111 billion in avoidable health-related expenditures over the next 10 years.

Every day, nurse leaders see first-hand the harmful health impacts of unstable and unaffordable housing on their patients. Therefore, they are uniquely positioned to weigh in on housing policy issues and join in the advocacy to make homes affordable for low-income people. Housing advocates and healthcare professionals must recognize that their fates are intertwined and work shoulder-to-shoulder to advance research-based housing solutions. That is exactly what we are doing through Opportunity Starts at Home, an unprecedented campaign that is bringing together leading organizations from housing, health, education, civil rights, food security, criminal justice, and more to urge Congress to finally tackle the housing crisis. The National Nurse-Led Care Consortium certainly understands that good housing is good health, and we are so pleased that it participates on the campaign’s Roundtable alongside so many other powerhouse organizations.

Failures of both public policy and the private market have contributed to today’s crisis, and many public and private institutions must play a role in developing solutions. But among these institutions, the federal government is key. Federal investments in affordable housing have been declining for decades and, today, only one in four households eligible for federal housing assistance receive it due to chronic underfunding. Without action from the federal government, quality affordable homes for the lowest-income people cannot be consistently built, operated, and maintained. The Opportunity Starts at Home campaign has outlined a set of federal policy strategies that are necessary to solve the affordable housing crisis facing America’s poorest households:

  • Bridge the Gap Between Rent and Income: Because rents are far outpacing wages, a substantial expansion of rental assistance is a necessary element of any successful strategy to solve the affordable housing crisis. The most well-known type of rental assistance is the Housing Choice Voucher program, which helps people with the lowest incomes afford housing in the private market by paying landlords the difference between what a household can afford to pay for rent and the rent itself, up to a reasonable amount. While vouchers are most common, there are other promising policy innovations that could also bridge the gap between rent and income, such as creating a new renter’s tax credit that would focus aid on the lowest income people.
  • Expand the Affordable Housing Stock: In markets where vacancies are scarce, “supply-side” approaches are also vital to build and preserve affordable units. This will require substantially larger investments in production programs, such as the national Housing Trust Fund (HTF), which is a dedicated funding stream that was recently created to efficiently build, rehabilitate, preserve, and operate rental housing specifically for extremely low income people. Additionally, we must preserve the existing affordable housing stock, including the roughly one million public housing units that are currently home to 2.6 million residents. The Public Housing Capital Fund, which pays for upkeep and repairs, has been underfunded for so long that thousands of public housing apartments fall offline each year because they are no longer habitable.
  • Stabilize Households in Crisis Through Emergency Rental Assistance: Most families in poverty who rent spend at least half of their incomes on housing, leaving virtually no margin for an unexpected expense. Whether it is a broken-down car, an unreimbursed medical bill, or an unexpected job loss, these households are one shock away from housing instability, eviction, and even homelessness. By providing a relatively small amount of money and supportive services to household in crisis, emergency rental assistance programs can stabilize families before the situation spirals out of control and save taxpayer money in the long run. The problem is that such flexible, temporary aid is not available at the scale needed.

While the situation is dire, there is reason to be encouraged. In recent months, several of these ambitious policy concepts have been introduced in congressional legislation. In several cases, such as the Eviction Crisis Act and the Family Stability and Opportunity Vouchers Act, the legislation has been bipartisan, which demonstrates the growing recognition in both parties that housing is inextricably linked to nearly every measure of having a quality life. The political momentum is growing, and powerful new constituencies are forming to ensure that everyone has access to stable, affordable homes.



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About The Author

Mike Koprowski is the National Campaign Director, National Low Income Housing Coalition.

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