Improving housing and health for underserved residents

Walter Moreau, Executive Director, Foundation Communities

Challenge: Almost every day, medical emergencies brought ambulances to housing communities for formerly homeless single adults and families. Many residents were struggling with chronic diseases, obesity and substance abuse. A fundamental disconnect between health and housing needed to be addressed.



Foundation Communities, a nonprofit affordable housing provider based in Austin, Texas, noticed a disturbing pattern. Almost every day, medical emergencies brought ambulances to their supportive housing communities for formerly homeless single adults. At their family communities, many residents were struggling with chronic diseases and obesity. Faced with similar and increasing health needs of both client groups, Foundation Communities began a systematic effort to improve the health of its residents.

Foundation Communities owns and operates 19 affordable housing communities in Austin and North Texas, providing homes to over 5,000 residents. In 2008, Foundation Communities' supportive housing properties, home to 345 formerly homeless men and women, accounted for 338 emergency calls in Austin. That year, 65 percent of formerly homeless move-outs were because of behavior-related issues, often the result of substance abuse and ineffectively managed mental health conditions. While staff worked to connect residents with health and medical services, barriers existed. Formerly homeless, non-suicidal and non-homicidal resident patients reported having to wait three months to see a psychiatrist.

Residents at Foundation Communities' supportive housing properties were not the only ones facing significant health challenges. At our family communities, chronic conditions such as hypertension, diabetes and obesity were preeminent health concerns, a common problem across Texas, which has the 10th highest obesity rate and the seventh highest adolescent obesity rate in the nation. In Austin, approximately 35 percent of students in grades 3 to 12 are overweight or obese. In Travis County, where Austin is located, 37 percent of adults are overweight. Chronic disease is another concern in Travis County, where three out of four deaths are attributed to chronic diseases such as cancer, heart disease, stroke, lung disease and diabetes.

Foundation Communities concluded that a fundamental disconnect between the health and housing sectors was undermining its mission and preventing some of its residents from thriving.

Over the next seven years, we developed a holistic strategy to incorporate health into our onsite support services. Today, a corps of 18 resident "Health Champions," similar to the "community health worker" model common in health settings, organizes health and wellness classes for more than 2,000 residents and community members per year. Community gardens, walking paths and new fitness ‘caminos' at our communities make healthy choices easier. We also tested, implemented and refined new strategies to increase physical activity in our after-school program. At our communities serving formerly homeless adults, integration of behavioral and physical health services improved health, reduced housing insecurity and reduced ambulance visits. Ultimately, we were able to support a culture of health through key partnerships, financial resources and resident leadership.

In 2010, Bianca Enriquez, one of our success stories, lost her home and needed a job. As a mother of two young boys, the stress of finding a sense of stability weighed on her health. To her surprise, Foundation Communities had more to offer than simply a place to live.

"I'm so thankful for all of the programs they offer. There is no other apartment complex that is going to offer health classes, free childcare and financial classes," says Enriquez. "My kids are at the point in their life that they are really active. I want to be able to be active with them."
A year after moving in, Enriquez landed a part-time job as a pre-literacy teacher at one of Foundation Communities' Learning Centers, a springboard to a full-time position at the City of Austin Health and Human Services Department as a neighborhood services unit administrator.

Enriquez took the newly introduced Zumba classes at her apartment complex to get active and relieve stress and was asked to become a Health Champion, a resident leader to coordinate health activities for their community. Enriquez's experience working at Foundation Communities, her interest in health and wellness and her motivation to be an example for her two young boys made her a perfect candidate.

Enriquez organizes weekly exercise and nutrition classes for her community, plans a yearly health fair and organizes special health programming every three months such as a diabetes awareness course. To engage her neighbors effectively, she delivers fliers, goes door-to-door to ask if people are interested in attending a health class, invites people to classes whenever she sees them and frequently asks her neighbors what they want to get out of each class to make sure the classes are meeting their needs. Enriquez loves being able to exercise at her property and to learning new things.

Foundation Communities learned that healthy living is intricately involved with housing and affordable housing communities can succeed by developing onsite wellness programs.