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A growing body of research on the social determinants of health has highlighted the importance of stable, safe, and healthy affordable housing to health outcomes. At the same time, many housing providers have come to appreciate the importance of quality, affordable health care to residents' ability to remain stably housed, particularly those residents who are elderly or have disabilities. Recent federal efforts to address health care spending and insurance through the Patient Protection and Affordable Care Act (ACA) have made this a fertile time for innovation and experimentation, particularly as the U.S. population is aging and health care needs and costs are growing. Housing providers and health care stakeholders have new opportunities for collaboration to improve health and housing outcomes both by expanding access to quality, healthy affordable homes and by creatively delivering and expanding access to services and supports in homes. This Article will provide an overview of the landscape and examples of partnerships between housing providers and health care stakeholders and will outline certain legal issues that may constrain what housing providers can do.
Background
An Expanding View of Health
A growing body of research around the impacts of housing and the surrounding neighborhood on life outcomes increasingly has led academics, policy makers, practitioners, and lay people to recognize that the place one calls home significantly impacts physical, emotional, and economic well-being. Housing has been recognized as one of the "social determinants of health"-the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness, shaped by economics, social policies, and politics,1 all of which impact individual and communal health outcomes. Particularly within the context of chronic homelessness, research has demonstrated that providing housing and services to individuals who are high users of public services produces both improved outcomes for the individuals and a reduction in expenditures on health care and emergency public services. Legal directives to serve persons with disabilities in the most integrated setting appropriate to their needs2 have resulted in a policy shift toward community-based care, requiring more creative approaches to health services. Missionoriented housing providers serving elderly and disabled residents have recognized their residents' need for enhanced services, particularly as elderly residents age in place.3 Growing costs and...