Hospital investments in housing-Banner of change or red flag

Departing from their traditional roles, hospital-based health systems are investing in social services for patients. Four of 5 US hospitals report a commitment to addressing patients’ social needs. The American Hospital Association now offers guidance for how hospitals can address transportation barriers, nutritional assistance, and housing instability.

To date, most hospital spending on social needs has focused on housing. From 2017 to 2019, health systems spent $2.5 billion to address social determinants of health, of which $1.6 billion was for housing interventions. Some hospitals provide rent support or lease apartments for transitional housing, while others build new, stable housing units for patients who are homeless.

Many have welcomed these investments, as homelessness has risen nationally for 3 consecutive years (most recently by 3% from 2018 to 2019) and may accelerate with the economic fallout from COVID-19. Yet, the deployment of hospital resources to house patients marks a conspicuous shift in the purview of the health care system. As hospital spending on housing increases, a careful examination of motivations and implications is warranted. Why are health systems using their dollars to address housing instability? We consider 2 possible reasons—the prospect of financial gain and mission-driven spending of surplus—and the broader significance of hospitals allocating societal resources.