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Healthy Housing On the Horizon

4 min read

Insufficient ventilation and insanitary surroundings reduce the vital resisting power of individuals exposed to such conditions; overcrowding causes closer contact with the infected individuals, and the absence of sunlight prevents the destruction of disease germs by nature’s principal disinfecting agent.

After a pandemic always follows a sea change in approaches to public health, especially in housing.  The pandemic’s onset triggers rapid advances in biological understanding and biotech. Its eventual retreat enables a space of political urgency that leads to remaking the urban palimpsest to remove obvious-in-hindsight health hazards, such as the 1666 demolition of tenement warrens built on London Bridge itself or closing the urban wells that spread cholera in 1858.

As we emerge from our work-at-home sheltering places, Americans—people, markets, and policy makers—will rethink cities to make them health secure. We will start by changing the proximity dynamics of human interaction in places with a high Kevin Bacon Coefficient, including multifamily dwellings. Further, those who live in affordable housing will be incontrovertibly demonstrated to be particularly vulnerable, through the combination of pre-existing risk profiles and then by definition living in close quarters with many others. These hard-won insights will coalesce into a national health reinvestment strategy that focuses on making sure those most susceptible to this disease are able to live in health-secure housing (HSH).

In health-secure housing (which you can easily remember as Home Sweet Home), the owner’s implied promise will be “once you’re inside the front door, you’re health-safe.” Owners will deliver on this implicit warranty across five reinvention dimensions:

  • Medical. Within a few months, there will be consensus modalities around prevention (e.g. mask and hand-washing protocols) and testing/treatment. Soon thereafter will arrive vaccines or post-virus antibody certifications. Health status checking may be further facilitated by a wearable (entirely voluntary) app-based gadget that tracks wellness indicators and reports them in real time.
  • Physical. Multifamily dwellings4 will retrofit into having a ‘health mud room,’ a double-door vestibule in which you enter from the outside, undergo the basic health-check protocol (possibly with a brief waiting interval), and then when through it enter the property itself. Likewise, somewhere in the property’s common areas will be the wellness check-in station for one-on-one staff-resident consultations.
  • Operational. The whole infrastructure of resident services will be rethought with health and wellness at the core. All on-site staff will be trained in health awareness and certified by one of several owner-manager trade associations. Residents in HSH will have access to daily or weekly protocols of prevention, treatment and cure. Like current resident services, they’ll be voluntary, based on informed opt-in consent, either with a minimal resident co-payment or free and funded off existing streams.
  • Procedural. Privacy-respectful and HIPAA-compliant disclosure, data aggregation, and data use standards or safe harbors will be developed, possibly by state HFAs allocating tax credits or volume-cap bonds, possibly through overlay guidance from Fannie/Freddie/FHA or in concert between HUD and Health and Human Services. Use of the safe harbor standards will be important to provide insulation from the class-action or mass-tort virus risk.
  • Financial. The capital costs of these retrofits will be funded without disturbing the existing mortgage lien collateral, possibly through net leases, possibly through chattel mortgages on the capital improvements retrofitted. Either way, the ultimate funding source may be some new or repurposed version of tax-exempt bonds, or possibly Social Impact Bonds with payment-protection credit enhancement.

Despite being on par with most members of Congress in not having read the CARES Act, I can confidently assert that within it lies latent or explicit authority to approve every one of these elements now as a demonstration or pilot. The HSH demonstrations will start in senior housing, and over time the practices will migrate to family.

Who will invent HSH? We will.

In affordable housing, properties follow from financial and subsidy products. Products follow from housing programs, which follow from pilots. Pilots follow from singular paradigms. And paradigms are invented by private actors who become fearless when fired by urgent visions of better futures. The quote with which I opened this column comes from 1907 and General George Miller Sternberg, a Civil War veteran who became Surgeon General in the Spanish-American War and founded the Army Medical School. He is considered the first U.S. bacteriologist, with milestone work in malaria, lobar pneumonia, typhoid and tuberculosis. Recognizing that these conditions flourished in overcrowded and unsanitary housing, he founded the Washington Sanitary Housing Company. Authorized by an Act of Congress in 1904 at his urging, it was the nation’s first housing authority, and as such is the ancestor of every housing authority in America today.

David A. Smith is founder and CEO of the Affordable Housing Institute, a Boston-based global nonprofit consultancy that works around the world (60 countries so far) accelerating affordable housing impact via program design, entity development and financial product innovations. Write him at dsmith@affordablehousinginstitute.org.