Internet Explorer 11 is not supported

For optimal browsing, we recommend Chrome, Firefox or Safari browsers.

Merging Housing and Health Together Under One Roof

Boulder, Colo., may be the first county to combine the two agencies, but it likely won’t be the last.

By late morning, there’s a buzz on the main floor of Josephine Commons. People in the senior center in Boulder, Colo., are playing games and chatting. Others are taking advantage of the nearby medical checkup desk in the common area. All are eagerly waiting for lunch -- a free, hot meal -- to be served. On today’s menu is a sun-dried tomato and mozzarella egg bake.

This isn’t your ordinary county-run facility. Josephine Commons, which has 72 apartments, is one of Boulder County’s largest and newest affordable housing units geared to those aged 55 and older. The county teamed up with a local Meals on Wheels chapter to ensure that the residents -- all of them low- or moderate-income folks -- get a hot lunch on weekdays. There’s also an onsite resource coordinator to make sure residents are accessing all of the public benefits they need, as well as some health and transportation services.

These amenities may seem over the top for your average affordable housing complex, but not in Boulder County. In January 2009, county officials merged the housing and human services departments in an effort to better and more effectively serve its residents. The premise was simple enough: Create a one-stop shop for people to get all the public benefits they need in one place, with housing as the foundation needed for a healthy life.

The county sees its approach as the wave of the future. “We know that poverty equals poor health outcomes,” says Frank Alexander, director of Boulder County’s Housing and Human Services (HHS) department. He believes the solution is connecting housing with public health. 

Reconfiguring the delivery of housing with health and human services is gaining traction within a number of health and human service organizations throughout the country. While Boulder may have been the first county to combine the two agencies, similar initiatives are popping up in a number of other localities. By merging the two departments, Alexander says, Boulder County has been able to better coordinate to serve those in need. 

But the merger itself was driven by a far more powerful -- albeit negative -- factor: the cost of housing. Average rents in the county have risen 50 percent since 2011, and the median home value has jumped 32 percent since 2010. The annual income needed to rent a two-bedroom apartment in Boulder is $49,280-but the median income for renters sits at $37,000. 

Housing costs were a problem even before the Great Recession. But making matters worse, Alexander, who was working as the housing authority director at the time, learned that people who were eligible for assistance weren’t even applying for it. Community needs assessments revealed a common thread: “Our systems were too complicated, too challenging to navigate for the people who need our services,” says Alexander. 

What occurred next was a bit of a perfect storm. The social services director was retiring, which gave Alexander the opportunity to start a conversation with community leaders about what the county could do to transition to something a bit more functional. With a major economic storm bearing down on them, community leaders were open to talking about an organizational transition. “We just had this idea: What if a combined department between housing and social services could best address the needs of the people of this county?” recalls Cindy Domenico, a Boulder County commissioner. “We already knew there was an overlapping set of clients there.” 

Not only an overlap, but also a growth. “We are really experiencing this new phenomenon of suburbanization of poverty here,” Alexander says. “We have a lot of people dealing with job loss, income loss, housing instability. All of these economic factors begged for a new department that could address all of these issues.” 

It wasn’t a seamless transition. Merging at the height of the recession meant the department suffered funding losses and layoffs at the same time as constituents’ needs skyrocketed. Alexander estimates that it took about a year before the team was able to see the advantages of a combined department.

One major perk was data integration, pulling together all the information from Section 8, Medicaid and the Supplemental Nutrition Assistance Program (SNAP). “With this merger, we’ve had to take the hood off each of these systems and we’ve gotten a better picture of the client that is being served,” says Jason McRoy, director of business operations and systems support division for Boulder County HHS. “We can see where they are and if there’s a gap or something being missed that would benefit them. We work with families as they move through the system.”

This integration of data has been instrumental in building Kestrel, an affordable housing development set to open next spring in the Boulder County town of Louisville. The team working on the project was able to see which services were already available within the town and who was receiving these benefits, in order to decide what sort of programs and services would best benefit residents.

As soon as struggling families are settled into their new homes, they have the option to enroll in the five-year Family Self-Sufficiency program, which helps families meet goals that range from no longer needing SNAP benefits to becoming homeowners. Family self-sufficiency programs are hardly unique to Boulder -- it’s a federally funded program -- but the county’s approach differs in that it offers residents resources, such as financial literacy classes, homeownership training courses and career development workshops, to move toward their goals.

Boulder County may be the first county to undertake such an endeavor, but similar initiatives are slowly picking up steam across the country. Richmond, Va., has started integrating health services in affordable housing units, such as a program that gives comprehensive mental health services to residents with a history of chronic homelessness. Spokane, Wash., merged its housing and human service departments in 2012, though it’s been a rockier ride. While officials say the merger has led to a 10 percent reduction in operating costs because of previously overlapping programs, there have been critical audits pointing to a mishandling of grant money.

Boulder County is working with many of these places, from the urban Allegheny County, Pa., to the more suburban Olmstead County, Minn., to give officials ideas, tips and general technical assistance where they can. But there is still some question over whether a successful merger could be pulled off in a large urban area studded with big cities and with large populations of residents in need of social services -- say Cook County, Ill., or Miami Dade County, Fla. 

“The logic behind it works across the country -- if someone is having trouble with housing, they probably have a lot more need,” says Will Toor, a former Boulder County commissioner. Nevertheless, “it would need be assessed on a case-by-case basis,” he says. “So much depends on having extraordinary leadership that is committed to pulling it off.”

While Boulder County officials are pleased with the merger’s effects, there has been some resistance from the community. Before construction broke ground on Kestrel, there were 24 meetings with the city council to discuss what the development would look like. Residents and city council members felt uncomfortable about the idea of a tall building. An agreement was finally met, and the result will be 191 townhome- and condo-style units in three-story buildings, with one central park and seven pocket parks. 

Looking past the construction site and out toward the Rocky Mountains, Bob Hutchinson, senior project manager for Milender White Construction, praises the department for its vision when creating these projects. “A lot of care goes into these developments to make sure they feel like a home,” Hutchinson said. When finished, the complex will be environmentally sustainable, with community gardens, an artist space and neighborhood walking trails that lead out to regional trails.

Some Boulder County residents are squeamish about the idea of so much affordable housing springing up -- another development is set to break ground in 2018 that has had resistance from nearby residents. Kestrel itself is flanked by an apartment complex where most units rent for $2,000 a month, well above the national average of $1,200. Right now, these apartment dwellers are paying high rents for a view of a construction site of affordable housing. “I can’t tell anyone what I do without hearing an affordable housing predicament story,” says Erin Ganser, development project manager with Boulder County HHS.

Boulder County’s rising home and rental costs are not unique. Many pockets of the country are seeing living costs rise as areas become more desirable and upwardly mobile millennials continue to move into cities. Boulder County’s vacancy rate is so close to zero, says Sarah Buss, housing and emergency services coordinator, that “landlords don’t have to keep people who fall a month or two behind in rent payments.” What that means, she added, is that “people are spiraling into homelessness much more quickly.”

Will Toor may no longer be the county commissioner, but he still keeps his ear to the public policy ground. “Six or seven years ago, job loss was probably the biggest driving factor behind our issues,” he says. “But now and for the foreseeable future, housing is the core issue behind human services.” As more localities merge the two, Toor believes it will “open up more important conversations for how you can make the community work.” 

Mattie covers all things health for Governing.