When A Hospital Plays Housing Developer

[M II A II R II K]

When A Hospital Plays Housing Developer


SEP 21, 2018

By LAURA BLISS

Read More: https://www.citylab.com/equity/2018/...eloper/569800/

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About a decade ago, Nationwide Children’s Hospital embarked on a project to transform the adjacent area. The medical institution pumped investments into housing improvements in the surrounding community as part of an audacious effort to create a healthier environment for residents. The idea, as a recent article in Pediatrics journal explained, was in part an effort to treat a “neighborhood as a patient”—improve the overall public-health profile of the community by reducing the stressors of a high-poverty environment.

- So far, Nationwide Children’s experimental cure for a sick neighborhood seems to be working housing values are ticking up, the vacancy rate is down, and several other indicators are showing positive results. But as gentrification pressures mount on the downtown-adjacent neighborhood, some locals worry that the most vulnerable among them and most at risk for health problems won’t be able to stick around for the full course of treatment. — Urban hospitals have been major players in community redevelopment since community redevelopment was conceived in the 20th century. These are anchor institutions with big footprints, lots of employees, and vast amounts of economic leverage to throw around.

- The “urban renewal” projects of the 1960s, in which local authorities used eminent domain to raze entire neighborhoods—usually brown, black, and poor—to make way for massive new constructions frequently featured large hospitals. They displaced thousands of households, and left traumatizing scars. Today, 20 percent of the country’s 1,250 large, nonprofit hospitals are located in high-poverty neighborhoods in urban cores, according to a 2015 report by the Institute for Competitive Inner Cities, partly a vestige of this past. — That wasn’t quite the story of Nationwide Children’s, which started life in 1892 as Columbus Children’s Hospital. But the fraught legacy of urban renewal is part of the story in Southern Orchards, a neighborhood that today counts about 4,300 residents, about a quarter of them children.

- As Southern Orchards was in decline, the children’s hospital next door was booming, adding new wings and buildings and expanding into a campus of clinical and research facilities. It’s now one of largest children’s hospitals in the U.S. and it’s getting bigger. In 2016, it announced a $730 million expansion that includes 11 building projects, including an eight-story Behavioral Health Pavilion, due to be completed in 2020. — But Nationwide Children’s rising fortunes did little to lift Southern Orchards. In the early 2000s, the hospital was buying up neighborhood blocks in preparation for an $80 million, 160,000-square-foot addition. As it went, “they built a parking lot with a back fence on it that separated the neighborhood, and sent security guards on patrol a block further out, making circles around the hospital,” said Kelly Kelleher, the director of the Center for Innovation in Pediatric Practice at Nationwide Children’s.

- This is a familiar pattern for urban hospitals, whose security and parking needs can make them poor neighbors to the residents who live nearby. But then a few things happened that nudged Nationwide Children’s to think about its neighborhood differently. First, around 2008, hospital leaders came to the city looking for tax incentives they wanted to improve public roads, sidewalks, and parking areas, according to Steven Schoeny, the city’s director of development. The city agreed, but they made a requirement: The hospital had to put some money into stabilizing the neighborhood, too. — That tit-for-tat marked the first stages of what came to be the Healthy Neighborhoods, Healthy Families initiative. Partnering with a local faith-based nonprofit developer called Community Development For All People that was already rehabilitating homes across the greater South Side area, Nationwide Children’s backed about $1 million in home repair grants for 74 homeowners in Southern Orchards.

- It was a modest investment, but it had a big effect on the aesthetics of the neighborhood, and it “felt exhilarating” for hospital leaders to get active in the neighborhood, said Kelleher. So they did: The following year, Nationwide Children’s formally entered the real estate development business. It began to buy and flip vacant and abandoned homes, selling them to buyers just over the neighborhood’s median income range. Special incentives were extended to low-wage employees who worked at Nationwide Children’s. — It continued to back the nonprofit as it invested further in neighborhood homes, selling about 10 houses every year. In 2012, the initiative expanded beyond the immediate 31-block area Southern Orchards to a 52-block area farther south.

- The hospital also began to watch what For All People was doing with its rental housing. Between 2012 and 2015, the nonprofit and a private developer had built nearly 100 rental units in the area with federal low-income housing tax credits. After that, the hospital joined with For All People and a commercial developer to win a $11.7 million LIHTC grant to build a 58-unit apartment and townhouse building where an abandoned elementary school had once sat near its campus. — Over the past nine years, Nationwide Children’s put $6 million into this combined effort, joining the city and other donors to Healthy Neighborhoods, Healthy Families; all told, what began as holding up its end of a tax deal became a nearly $23 million investment in 272 single-family homes and dozens of rental units around the South Side.

- Hospitals, like many anchor institutions, expect returns on their community investments. A more attractive neighborhood is undoubtedly an employee benefit, said Jason Reece, an assistant professor of city and regional planning at the Ohio State University who co-authored the report in Pediatrics with Kelleher. But the advantages of improving quality of life in Columbus go beyond that: After the Affordable Care Act, Nationwide Children’s became what is called an accountable care organization. That means it gets reimbursed by the state for each Medicaid and Medicare patient it treats, rather than each service it delivers. This is designed to incentivize the hospital to cut down on redundancies and suppress readmission rates.


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[JManc]

There is a plan to build a new hospital downtown in my hometown...an area that has seen better days. The idea pushed hard by local officials who hope a new hospital will revitalize the area. It has fail written all over it...other than a downtown overshadowed by a hospital.

[Pedestrian]

Since 2001, Johns Hopkins has been collaborating with the City (of Baltimore), the State, the Annie E. Casey Foundation, private developers and community organizations in the redevelopment of an 88-acre area adjacent to Johns Hopkins’ East Baltimore campus. As revised in 2012, the master plan for the area provides for the development of more than 1,200 units of new and rehabilitated housing, a 6-acre park, a school, a 1.5 million square-foot Science + Technology Park and 144,000 square feet of retail space.

Although the redevelopment of the area has been slowed by the financial crisis of 2008 and by a depressed real estate market, much has already been accomplished.
• Forest City Science and Technology completed the first building in the Science + Technology Park – the 300,000 square-foot Rangos Research Building – in 2009. Johns Hopkins was the anchor tenant of the building which includes
lab and office space for Johns Hopkins, other not-for-profit biomedical research organizations and life sciences technology companies, as well as 30,000 square feet of retail and restaurant space.
• In 2011 Johns Hopkins completed the renovation of a landmark former police station at 1809 Ashland Avenue; the building now houses the University’s Berman Institute of Bioethics.
• 929 Apartments, a privately-developed, 321-unit residential building at 929 North Wolfe available to the general public as well as Johns Hopkins graduate students and employees, was completed in 2012.
• A total of 249 other units of new housing have also been built, including approximately 200 low-income units.
• A 10-story, 1,450-space parking garage with a Walgreen’s pharmacy on the building’s first floor, located at the corner of Ashland Avenue and Washington Street, was completed in 2012.
• The Henderson-Hopkins School, a 90,000 square-foot K-8 school with space for 540 stu- dents, was completed in 2013. It was built by East Baltimore Development Inc. (EBDI), and is managed by the Johns Hopkins School of Education in collaboration with Morgan State University. The seven acre site was developed at a cost of $43 million through a onetime capital contribution from Johns Hopkins of $21 million and funds raised from the Casey and Weinberg foundations and other local and national philanthropies. This was accomplished without state or city school capital funds which are in short supply.
• The 30,000 square-foot Harry and Jeanette Weinberg Early Childhood Center, with space to serve 174 pre-school children, opened in September 2014. It was built by East Balti- more Development Inc. and is managed by the School of Education in partnership with the Greater Baltimore YMCA.
• The second building in the Science + Tech- nology Park, the Maryland Department of Health and Mental Hygiene’s $171 million, 235,000-square-foot Public Health Labora- tory, located in the Eager Park area in part to increase potential collaboration with Johns Hopkins researchers, was completed in June 2014.

Other projects now in various stages of development include:
• The development of 250 additional units of new and rehabilitated housing
• A 182-room extended-stay hotel
• A 167,000 square-foot research facility, the Science + Technology Park’s third building, to be developed at 1812 Ashland Avenue; the University will be the building’s anchor tenant operating under a contract with Baltimore City Public Schools, Henderson-Hopkins K-8 elementary/middle school is operated by the Johns Hopkins University School of Education in partnership with Morgan State University's School of Education and Urban Studies.
• Eager Park, a three-block-long, six-acre public park that will include a 30,000 square-foot lawn, a playground, a community garden, ex- ercise facilities, a performance venue and other amenities

The Johns Hopkins Institutions’ commitments to the redevelopment of the project area have been substantial. Johns Hopkins estimates that from 2003 through 2013 it has invested more than $50 million in the redevelopment of the 88-acre project area, including $21 million for property acquisition and relocation, and $21 million toward the cost of construction and ongoing operations of the Henderson-Hopkins School and the Weinberg Early Childhood Center . . . .

In addition to its investments in the projects described above, Johns Hopkins has also sought to strengthen Baltimore neighborhoods through its Live Near Your Work (LNYW) program, which provides grants to employees as an incentive to purchase homes in Baltimore. Grants range from $5,000 in many parts of the City to $23,000 in neighborhoods near the Homewood campus to $36,000 in East Baltimore. Recipients may also be eligible for a small matching grant from the City.

In fiscal year 2014, LNYW grants totaling $1,411,000 were awarded to 84 homebuyers employed by Johns Hopkins. Of this total about $756,500 was contributed by Johns Hopkins, with another $654,500 contributed by other supporters of the program, such as the Annie E. Casey Founda- tion. Since the program was launched in 1997, LNYW has supported Johns Hopkins employees’ purchases of 418 homes in Baltimore.

http://web.jhu.edu/administration/gc...ommunities.pdf

[Pedestrian]

It should be mentioned that academic and research hospitals were often originally located in their city's poorest neighborhoods for a reason. In return for free or low cost medical care, the people of the neighborhood were used as teaching examples for students. This does not necessarily mean they were "guinea pigs": The way it worked and still works to some degree and in some places is that these patients were taken care of in the hospital by a team consisting of medical students, interns, resident physicians (licensed doctrs getting specialty training) and senior staff doctors supervising the care. So the trade off really was about being poked and proded ("examined") by 3 or 4 people of various levels of training in return for the bargain care. Ultimately decisions about what to do for you were made by senior academic physicians who often were national or global experts in their field (especially at a place like Johns Hopkins, mentioned above). And it should be said that without this opportunity for (literally) "hands on" learning, it would be hard to teach new generations of doctors.