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New Housing and Healthcare for the Homeless in Denver

Photograph of the front façade of a five-story building with a health center on the first two floors and apartments on the top three floors.CCH’s 78-unit Renaissance Stout Street Lofts, co-located with the Stout Street Health Center, provide affordable and supportive housing to residents with chronic health concerns. Credit: CCH

By 2013, the Stout Street Clinic had served the low-income and homeless populations of Denver, Colorado, for nearly 30 years. The clinic, owned by the nonprofit Colorado Coalition for the Homeless (CCH), had become crowded and could not accommodate a full range of services. In addition, Colorado’s planned expansion of Medicaid eligibility under the Affordable Care Act (ACA) was projected to substantially increase the number of patients the clinic could accept. The ACA also introduced new funding to serve individuals experiencing homelessness, which CCH saw as an opportunity to expand its healthcare capacity. In March 2014, CCH replaced the clinic with the new Stout Street Health Center in a mixed-use building. The five-story building includes the Renaissance Stout Street Lofts, affordable and supportive housing that occupies the building’s top three floors. By including both housing and health care in one building, the $35 million project enhances CCH’s ability to provide integrated services to persons experiencing homelessness. The health center is expected to serve up to 18,000 patients per year, and Renaissance Lofts will shelter 78 households.

Treating the Whole Person with Integrated Services

The 53,200-square-foot Stout Street Health Center is the largest and newest of CCH’s 5 facilities that provide healthcare, respite care, substance abuse treatment, employment counseling, childcare, and other assistance for persons experiencing or transitioning out of homelessness. The federally qualified health center operates on an integrated services model, in which all of a client’s needs are addressed at a single location. The model is ideal for people experiencing homelessness because it minimizes barriers to care such as travel, wait times, and insufficient communication among treatment teams. To provide comprehensive care, the center offers primary care, ophthalmology, dental care, behavioral health services, pediatric care, social services, and pharmacy services, all working in tandem.

The $19 million health center was funded by new markets tax credit (NMTC) equity and Affordable Care Act capital funding through the federal Health Resources and Services Administration. The center has large waiting rooms and a sheltered exterior courtyard so patients do not have to stand in long lines on the street. The floor plan includes private interview rooms to preserve patient confidentiality, and architectural details avoid an institutional feel. An offstreet access bay for emergency vehicles avoids the traffic obstructions that plagued the old clinic. The center has four suites, each staffed by an interdisciplinary team to provide a holistic range of care. In its first 4 months, the center saw 13,231 patients in 37,000 general health visits, 6,000 dental visits, and 1,150 vision care visits.

Photograph of a waiting area with seating.The Stout Street Health Center was designed with four treatment suites to facilitate integrated care. Credit: CCH

Stout Street Renaissance Lofts

The 17th of CCH’s 19 housing projects, the Renaissance Stout Street Lofts provide its residents with easy access to the services on the building’s first 2 floors. Of the 78 permanent housing apartments, 50 are supportive housing units reserved for households with members who have experienced chronic homelessness and have ongoing health needs, and 28 are standard affordable housing units for individuals and families participating in CCH programs. All the units are income-restricted, with 26 units reserved for households earning no more than 30 percent of the area median income (AMI), 45 units for households earning no more than 50 percent of AMI, and 6 units for households earning no more than 60 percent of AMI. The units for each income group are mixed to create an economically integrated community and reduce the stigma of homelessness. The apartments were fully occupied as of July 2016 with an extensive waiting list.

Nine units are accessible in compliance with the Americans with Disabilities Act, and all other units are adaptable for people with disabilities. Residential amenities include a laundry, a community room with a kitchen, a courtyard with container gardening space, counseling rooms, a business center, and underground parking with 50 spaces. The 59 one-bedroom and 19 two-bedroom apartments feature ENERGY STAR® appliances and windows designed to reduce sound from the street. The entire complex was built to Green Communities guidelines established by Enterprise Communities, with energy-efficient lighting, heating, and cooling systems. Water-conserving plumbing, a reflective roof, and materials selected for high recycled content and local availability enhance the structure’s environmental friendliness.

The development costs for the residential portion of the complex totaled $16 million. Most of the funding consisted of $12.7 million in low-income housing tax credit equity. The HOME Investment Partnerships Program funded a $2.2 million loan, and the project received an additional $850,000 loan from the Federal Home Loan Bank. CCH privately financed the remaining $250,000.

Moving Forward

CCH gives tours of the building three times a week to other service providers, elected officials, government representatives, and researchers interested in the Stout Street facility, its integrated services model, and the resulting cost savings. A review of healthcare records covering two years before and two years after receiving housing and integrated care at Stout Street showed that residents needed fewer detoxification treatments and in-patient healthcare and emergency services and had reduced number of incarcerations and temporary shelter stays. The cost savings achieved by providing stable housing and improved and less expensive care averaged $4,745 per person per year. The novel use of NMTCs, which hinged on conceptualizing the health center as an economic redevelopment project providing 400 local jobs during construction and 70 new permanent healthcare jobs, has also received attention from service providers. With an estimated 87,000 cost-burdened households at risk of homelessness in 2016 in the Denver area, CCH continues to expand its facilities. CCH’s 18th residential building was completed in February 2016, and the 19th, which will contain 100 units for the chronically homeless, is expected to be completed in fall 2017.

Source:

Interview with Cathy Alderman, vice president of communications and public policy, Colorado Coalition for the Homeless, 21 July 2016; Colorado Coalition for the Homeless. 2016. “What We Do: Healthcare.” Accessed 8 July 2016; Humphries Poli Architects. n.d. “Stout Street Residences and Clinic.” Accessed 17 November 2016; U.S. Interagency Council on Homelessness. 2016. “The Affordable Care Act’s Role in Preventing and Ending Homelessness.” Accessed 17 November 2016.

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Source:

Colorado Coalition for the Homeless. 2016. “What We Do: Housing.” Accessed 8 July 2016; Colorado Coalition for the Homeless. 2014. “Developing an Integrated Health Care Model for Homeless and Other Vulnerable Populations in Colorado: A Report from the Colorado Coalition for the Homeless,” 51. Accessed 15 September 2016; Sarah Klein. 2014. “Colorado Coalition for the Homeless: A Model of Supportive Housing,” Quality Matters: Innovations in Health Care Quality Improvement (October/November). Accessed 16 September 2016; Interview with Cathy Alderman, vice president of communications and public policy, Colorado Coalition for the Homeless, 21 July 2016.

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Source:

Colorado Coalition for the Homeless. 2016. “What We Do: Healthcare.” Accessed 8 July 2016; Colorado Coalition for the Homeless. 2013. “Developing an Integrated Health Care Model for Homeless and Other Vulnerable Populations in Colorado: A Report from the Colorado Coalition for the Homeless,” 54. Accessed 15 September 2016; Sarah Klein. 2014. “Colorado Coalition for the Homeless: A Model of Supportive Housing,” Quality Matters: Innovations in Health Care Quality Improvement (October/November). Accessed 16 September 2016; Colorado Coalition for the Homeless. 2013. “Stout Street Health Center and Renaissance Stout Street Lofts: Groundbreaking Celebration.” Accessed 11 July 2016.

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Source:

Interview with Cathy Alderman, vice president of communications and public policy, Colorado Coalition for the Homeless, 21 July 2016; Colorado Coalition for the Homeless. 2013. “Stout Street Health Center and Renaissance Stout Street Lofts: Groundbreaking Celebration.” Accessed 11 July 2016; Colorado Coalition for the Homeless. 2013. “Developing an Integrated Health Care Model for Homeless and Other Vulnerable Populations in Colorado: A Report from the Colorado Coalition for the Homeless,” 54. Accessed 15 September 2016.

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Source:

Interview with Cathy Alderman, vice president of communications and public policy, Colorado Coalition for the Homeless, 21 July 2016; Correspondence from Cathy Alderman, 1 November 2016; Colorado Coalition for the Homeless. 2013. “Stout Street Health Center and Renaissance Stout Street Lofts: Groundbreaking Celebration.” Accessed 11 July 2016; Colorado Coalition for the Homeless. 2013. “Developing an Integrated Health Care Model for Homeless and Other Vulnerable Populations in Colorado: A Report from the Colorado Coalition for the Homeless,” 51–3. Accessed 15 September 2016.

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Source:

Interview with Cathy Alderman, vice president of communications and public policy, Colorado Coalition for the Homeless, 21 July 2016; Correspondence from Cathy Alderman, 13 October 2016.

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Source:

Interview with Cathy Alderman, vice president of communications and public policy, Colorado Coalition for the Homeless, 21 July 2016; Building America Community Development Entity. 2013. “Building America Allocates $8.5 Million in Tax Credits for Stout Street Health Center in Denver: $35.3 Million Project to Expand Access to Healthcare and Housing for City’s Homeless Population.” Accessed 4 November 2016; Correspondence from Cathy Alderman, 1 November 2016.

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