Restoring Waters is a 60-unit multifamily housing development under construction in the new neighborhood development – Highland Bridge (Ford Site) in St. Paul.
The development, a partnership between Emma Norton Services and Project for Pride in Living, is specifically designed to serve the needs of homeless women with histories of trauma, including often co-occurring chemical dependence, mental health, and/or other chronic health conditions. Emma Norton Services, established in 1917, has a mission of providing transformational housing to women and families on their journey of recovery. All the units in Restoring Waters provide Permanent Supportive Housing (PSH) that is shown to not only address homelessness, but successfully serve populations with challenging – sometimes debilitating – health challenges. For residents of permanent supportive housing, research shows there is an 18% reduction in emergency room visits, 20% increase in primary care visits, and a 12% reduction in healthcare expenses for Medicaid recipients (based on research by Enterprise Community Partners).
One would think this is the sort of development where direct partnership with healthcare providers might make sense. But in fact, Emma Norton Services and most developments which include PSH must raise ongoing support to provide health services with their staff or contracts for visiting nurses to the facility. One of the biggest challenges, often experienced in maintaining this essential housing, is the ability to continue raising operational resources to provide core services that enable residents to remain stably housed and in good health.
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First, including PSH in an affordable housing project is an additional challenge in developing needed partners, financing, and operations once completed. The capacity of a non-profit to establish the necessary partners is a challenge due to capacity. It is also a challenge to know where to enter and who to talk to within a healthcare system to build such a partnership. It requires a sustained relationship that continues through the 3 or 5 years it takes to bring a complex project to fruition.
There is hesitancy because the project, while making progress, is not always a sure thing. There are many points where the Restoring Waters development looked like it might not go forward. There is a sense of fear the healthcare partner will be upset if their time involved with the project goes to waste, but the touch and go nature of development is a norm for many housing projects, especially those serving people with multiple barriers to overcome to be capable of staying in their housing.
Now that the project is under construction, with an estimated completion date of April 2024, Emma Norton Services seeks to establish housing and healthcare partnerships to fill the clinical space in the building with enriched services supports that serve not only the residents in the building, but also residents without access to healthcare in nearby buildings and neighborhoods with proximity to the Highland Bridge development. For mental health support, they are looking specifically at a unique “Living Room” model that provides an alternative to emergency rooms and offers peer assisted mental health support in a calm, trauma-informed environment.
The nature of the partnership can improve and be built around a sustainable relationship with a healthcare partner to enable the properties to succeed in delivering housing stability for our community’s most challenged neighbors. Here are a few basic rules of engagement which can help build more units of PSH and more sustainable services:
- Establish a housing & healthcare partnership in the earlier stages of a project to build a sustainable integrated model in the provision of support to residents.
- Healthcare should make clear where to enter its system to discuss such a housing/healthcare partnership. It should also establish one contact point with the connection and authority internally to advance partnership discussions.
- The partnership cannot add work or cost to the operations of the building, which runs on such a tight budget that it cannot support additional costs.
- Any service offerings need to be consistent and recuring, allowing time for residents and the community to be knowledgeable about what is available and when.
- The source of funds should be from a sustainable business relationship that is not based on Emma Norton Services’ ability to raise funds, but on a healthcare institution’s ability to support operations as a line of business that reduces costs of care for hospitals and clinics.
- The model established should consider future replication that can be used on not just one project, like Restoring Waters, but similar projects that are in a pipeline of development that can offer similar enriched services.
- Finally, Medicaid reimbursement could provide a sustainable source of funds and grow the partnerships and number of PSH units that are created by developers. However, significant changes in how reimbursement occurs and in the reliability of the Medicaid resources connected to those units will be the only way to expand this critical resource in our communities.
If you are interested in exploring a partnership that provides health services at Restoring Waters, you should contact Tonya Brownlow, Executive Director, at tbrownlow@emmanorton.org or 651-251-2624 to discuss the opportunity to partner.
GMHF worked with PPL and Emma Norton Services to finance this development with a construction/bridge loan and first mortgage. Other partners included The City of Saint Paul, Ramsey County, the Met Council, and Minnesota Housing Finance Agency.
