A Hospital Helps Revitalize the Community Outside Its Walls: Q&A with George Kleb and Christine Madigan
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of more than 40 organizations, including 36 non-profit health systems that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One Stakeholder Health member is the Bon Secours Baltimore Health System in Maryland, whose Community Works initiative helps improve the lives of the people in one of the poorest neighborhoods in the city. Bon Secours Baltimore is part of a national health system founded by the Sisters of the Order of Bon Secours.
Bon Secours engaged the community before embarking on projects and have created programs aimed at improving the community’s health through services that include the hospital, community clinics and visiting nurse programs, as well as housing, GED and financial literacy programs and revitalization programs.
The ambitious housing program will ultimately provide more than 1,000 units of affordable housing in the streets just around the hospital.
Bon Secours’ partner in its housing program is Enterprise Community Partners Inc., which builds affordable housing throughout the United States. NewPublicHealth recently visited the Bon Secours housing and services sites in Baltimore and spoke with George Kleb, executive director Bon Secours Health System, and Christine Madigan, senior vice president of development at Enterprise Homes.
NewPublicHealth: When did the housing program begin?
George Kleb: Bon Secours here in Baltimore has been developing and operating housing since 1988. We started by developing a couple of senior buildings through a U.S. Department of Housing and Urban Development (HUD) program. Both buildings had been schools that were part of the surplus capacity in Baltimore. The HUD program serves people who are elderly, disabled, or very low income. There was a clear need and so we pursued that, and that was the start of our reach into housing. Then in the ‘90s we began work on housing really in line with a neighborhood revitalization strategy attached to our presence in the neighborhood of Southwest Baltimore. There was an area of West Baltimore Street, which is the street the hospital is on, that had become largely vacant. Two-thirds of the units in the three blocks leading up to the hospital were empty and we acquired 31 of those buildings and started a project we now call Bon Secours Apartments. We renovated three-story Victorian row homes into affordable apartments, and that’s when we started working with Enterprise. That’s a relationship that goes back to the mid-1990s.
NPH: What is Enterprise’s role?
Christine Madigan: Enterprise Homes is an affordable housing and workforce housing developer. We were particularly interested in opportunities with Bon Secours because it is located in an area of real need and provided us with a partner that shares similar values and mission. Our role has changed over time, but when Bon Secours first came to us, Enterprise assisted with everything from getting the properties and titles and permits to structuring the financing to overseeing design and construction. Over time, that has changed as Bon Secours has built its own development capacity. So now Bon Secours handles the engagement with the local community, all of the local support requirements with local government and financing applications, and also participates in the entire design/development process with us. When the developments are completed, they own and operate the properties, so they provide ongoing asset management once the lease—which they also oversee—is complete. Our primary functions are the financial structuring and negotiations, construction and design oversight, and accounting as the construction moves through the process.
NPH: How many units does Bon Secours now have in Baltimore and what are the future housing goals?
Kleb: We have 648 units of housing in operation. There are six senior disabled apartment buildings and 59 that are row homes that we’ve renovated for apartments for families, so 119 units of the housing is family housing and 530 units are senior/disabled. We’re also working on an apartment building for families that will hopefully start construction around this time next year.
We’d like to approximately double the number of units that we have to about 1,100 to 1,200 units.
NPH: What support have you gotten from the city of Baltimore and the State of Maryland?
Kleb: The city and the state have been strong partners on the financing side as well as zoning approvals and overall support. They’re very supportive because we already have a strong presence in the neighborhoods we serve because of the hospital. And from a neighborhood stabilization/revitalization standpoint, we provide millions of dollars of capital investment. Every single one of our projects, whether it’s been a renovation or a new construction, has been reuse of a formerly vacant space. For example, one of our senior buildings is a former site of a potato chip factory that closed in the early ‘90s. That was a vacant factory and now it’s a living facility.
From the financing side, the city and state play key roles. Through the state is how you access the low-income housing tax credit financing, but they also provide loans that they’re willing to subordinate and not have to repay other than through residual receipts or surplus cash. The city does the same kind of thing. They have loan products that are federal home funds that they administer. Both the city and the state have competitive processes that also create a framework for putting development teams and projects together. In terms of planning and zoning, the city has different areas that are classified as being part of a revitalization plan.
NPH: What services are you coupling with the housing to help improve the health of the community?
Kleb: For most of our units and for all our senior and disabled units, we have on-site service coordinators. These folks are like case managers who develop relationships with all the residents and connect them with services that they need. That’s their main portal to accessing services at the hospital, and nurses from Bon Secours come in and do health education and connecting to health screenings and other services. And the service coordinators on site also link residents to other services available in the community.
Madigan: On the design side, in virtually all of the senior buildings we build in gathering spaces for the residents and those typically include one large community space for large gatherings that would fit all of the residents for social events. We also have smaller gathering spaces for crafts or television or computer work or reading, games and craft classes. One of the things that we hear over and over again is that residents who may have been reluctant to move out of the homes, once they move into a communal setting where they have their own independent apartment but the opportunity to socialize and have neighbors they really do have a new lease on life.
Just having literally physical structure with a kind of embedded social structure where people, including the property manager and service coordinator, are looking out for each other and for the residents is really important. We also make sure that there’s transportation for residents to get to the services they need, whether it’s shopping or health care or entertainment. That can take the form of a shuttle bus sponsored by the building or some other form of access that’s offered to the residents.
NPH: How are you tracking success?
Kleb: What we’re tracking for in the senior building is for folks to be able to successfully age in place by making sure they have the support they need. The family buildings happen to be very closely located to the community support center which provides services including financial guidance and literacy and workforce assistance. Participation in the programs isn’t a condition of their lease in the apartments. It’s really more about trying to offer things such as home-buying classes and tax preparation and making sure that folks know about this stuff. When tenants fall behind on their rent we automatically offer a referral to financial counseling and eviction prevention programs.
Madigan: One of the key measures of success even before we conclude that people stay or don’t stay—and for the most part they do stay successfully—is leasing up our buildings, and that’s important for a number of reasons. We have financial obligations to our funders to lease up the buildings, but what it says to us is that we’re meeting a huge need, and most of our properties have long waiting lists. And so, from a health perspective, what that translates into is obviously the stability of the residents having a roof over their heads, but in addition there’s the elimination of the stress that comes with the burden of high housing costs. So, the fact that our buildings do lease up and stay full and people tend to stay tells us we’re continuing to meet a real need.
NPH: Have you looked to other communities to model the buildings and its services?
Madigan: Every time we develop a new community, we look at what was most successful in prior communities, what gets used, what doesn’t get used, and that evaluation covers everything from the unit mix—meaning the number of one-bedroom units versus two-bedroom units—to the common area spaces that get used and don’t get used, to the services provided.
Kleb: That’s how we got the service coordinators, for example, which is a staff position we’ve had for the last three or four years. We first started funding the positions through HUD grants, and now we’re working toward more and more including that cost as part of the actual operating budget, which is something we’ve learned from seeing what was successful in other properties.
NPH: And how are you using what you have learned to help other communities?
Madigan: Everything that we have done to date comes in to play when we look at the next community. That being said, every community and every set of needs and every site is different, so we tailor each solution to whatever the particulars are of that site or that opportunity. But if you were to look at our work in other parts of the region, you would see some similar themes, particularly on the senior side in terms of the structure of the housing and the access to services and transportation, and the services that are built in.
Kleb: For us, I see it within a context of a Healthy Communities initiative for a hospital. Like Enterprise, we are also part of a multi-state organization. Bon Secours has facilities in several states and each hospital has a Healthy Communities initiative. They’re not all building housing but the concept is based on engaging the community around what the needs and desires are.