Rural Housing, with David Lipsetz

Organizations and resources mentioned in this episode:

• Housing Assistance Council (HAC)
  • Rural Data Central
  • Taking Stock: Rural People, Poverty, and Housing in the 21st Century, 2012 report
  • National Rural Housing Conference
• Worst-Case Housing Needs: 2023 Report to Congress - Executive Summary, U.S. Department of Housing and Urban Development
• Multifamily Housing Programs, U.S. Department of Agriculture (USDA) Rural Development
• Community Action Commission of Fayette County
• Rural Alaska Community Action Program
• Clearfield County Area Agency on Aging
• Mature Resources

Transcript

Andrew Nelson: Welcome to Exploring Rural Health, a podcast from the Rural Health Information Hub. My name is Andrew Nelson. In this podcast, we'll be talking with a variety of experts about providing rural healthcare, problems they've encountered, and ways in which those problems can be solved. This is an episode about rural housing. Today I'm talking to David Lipsetz, who's the president and CEO of the Housing Assistance Council. Thank you for joining us, David.

David Lipsetz: Great to be here, Andrew.

Andrew Nelson: To start off here, can you tell me a little bit about the Housing Assistance Council and what its mission is and how it got started?

David Lipsetz: Love to. We've been working hard to help small towns and rural places for over 50 years. We're a national organization, and we work with local community groups to help them build and maintain and preserve affordable housing. But if you're paying attention to rural, you know that you do more than just your basic task whenever you go at it, right? You're always wearing many hats. And at the Housing Assistance Council, we do more than just build or support the building of the housing. We do a lot of community development activity as well.

Andrew Nelson: Can you tell me about some of the trends you might've been seeing recently as far as affordable, safe, healthy housing options in rural communities?

David Lipsetz: You'll likely know that housing is one of the main social determinants of health. The quality and safety of the places we live, they have direct impacts on the people who live there and their health outcomes. And this goes beyond the ideas of a trip-and-fall hazard or the makeup of materials that they use to build the house. The safety and security a family gets by raising their kids in a safe and secure place that gets them to school on time, it gets a meal on the table, it gets the family themselves to work and all those things — those things all determine your life outcomes around health. In May, the U.S. Department of Housing and Urban Development put out a report that shows the worst-case housing needs around the country are at their highest levels ever.

We've got 8.5 million people living in substandard housing. That's not okay, right? And that's leading exactly to the kinds of health outcomes we're going to talk about. Broadly speaking, there are two reasons that happens. You can't afford the place you live, and the place you live is lower physical quality. We got great news of late. We're on a roll. We're getting a lot better at addressing quality issues as a country. It's down to like 5% of the worst-case needs are driven by quality. But guess what, that leaves a big category out there of affordability and the financial stability of the home and the family living in it has a huge impact on what you can do in life.

Andrew Nelson: Yeah, absolutely. Can you tell me about some of the ways in which HAC works to help address those housing conditions in rural America?

David Lipsetz: When we go about our business, what we want to happen at the end of the day is for a local organization to have gotten stronger and be prepared to create and sustain housing and community the day after we're gone. I'm not going to say we're trying to put ourselves out of business, but we make that joke a lot around the office, that if we lived in a world where nobody needed help getting affordable housing, then that would be a fantastic thing. You know, wash my hands, “See you later,” off to the next task. But that clearly isn't the world we live in. And so when we're working in community, we're working with local organizations so that they can stay at those tasks every day, day in, day out, for years to come. And having done this work for 53 years, our organization has seen some groups come and go.

But we really hope and believe that we've helped a number of them sustain their work and grow their local areas. We do it with four things.

So, we are spread out around the country. We have staff in 15 states, but we serve all 50 states, and we're providing everyday technical assistance and training. “How do I run my community development organization at a local level?”

We do research on the conditions in rural America. So we're looking at not just housing affordability and quality issues, but we look at the opioid epidemic. We've looked at seniors in housing. We've looked at community placemaking activities. We're always stretching our research to find housing-adjacent things to inform the broader world of what we're really trying to do here.

Thirdly, we lend money. So over the years, we've piled up a modest stack of cash that if you come to me, Andrew, tomorrow and say, “My organization's trying to build a small apartment building in a rural town, and we need some help. We don't have a local bank that either exists or can lend to us. We're not going to be able to afford to do this. How can you help me?” My staff is awesome at this. We have funds to get you that are very low-cost loans. We have technical assistance. We're going to help you develop that housing every step of the way. And if you're talking to us, I guarantee you we're the nicest lender you've ever met because our rates are way below market, and our desire is for you to succeed in building and maintaining that housing. And we want to partner with you again after you get it done, because you're going to have learned a whole lot of lessons trying to get that done.

Lastly, we have a policy shop, and that's why we're here in the lovely nation's capital, which is decidedly not a rural environment. But when we're out there lending, doing training and technical assistance and our research, we're learning a lot of lessons that we believe pretty strongly the folks here in D.C. ought to hear and see. And so, if we can bring knowledge about what works and doesn't, what's impacting rural places into policy conversations, that's yet one more way we feel we can have an impact of growing the prosperity of small towns and the families that live in them.

Andrew Nelson: You folks also help people who have proposals or have ideas for creating housing options in their communities. You also help them evaluate whether or not something might be feasible, right? Maybe they want to build a big complex or something and, and you folks can kind of look at their community or their situation, and say, “Well, let's start with something a little more modest and try to build up from that.”

David Lipsetz: Yes, we do evaluation of projects, of organizations. Our goal is for you to succeed. We may be a bank of sorts, a lender, a community development financial institution, but we put the “non” in “nonprofit.” We're going to deliver our goods for the success of the local organization and the families they serve, and our desire to build profit or anything into that doesn't exist in a way that you'll experience when you're working with commercial lenders.

And we want you to succeed time and again. So doing that requires us delivering a whole bunch more than a loan, a mortgage that you're going to be paying back every month, as an organization working on affordable and often rental housing. Every one of the federal programs out there that runs in small towns needs attention. Well, there's one called 515 Multifamily Rural Housing that we think demands tremendous attention. It's one of the only stocks of affordable housing in small towns that get federal support. It was a big investment.

They built over a half a million houses, community groups built over a half a million houses 40 and 50 years ago. And everybody washed their hands, “Hot diggity, you know, we've solved it, here we go, our affordable housing issues are over.” And in the years since then, it's helped countless families. It's fantastic. We love that people have had good days inside, under a solid roof, getting to school, having a meal in that house they can afford. But now, after all these years, the program is losing funding from the federal government, and it's losing units out of the program. It's down to 380,000 units. They have lost more than 20% of the units out there. And if that's one of the only places you can get an affordable apartment in this country, we're going to get in deep trouble in these towns if we keep losing it.

My great aunt lived in a tiny town in western New York State, lived in a 515 apartment building, and it was the only way she could afford to stay in the town she lived in, be near her family and the community she had enjoyed her whole life. We're in desperate need to help it. So what do we do about it? We put out a couple of reports. We did some deep analysis of why units are staying, why they're being pushed out of the program. We go up to Capitol Hill, we share that experience or that knowledge with them to try to get policy changed. And at the same time, we're over here in our lending shop trying to find people who own 515 apartment buildings and help them get new resources into the property. They call us. We provide them technical assistance, we provide them grants, low-cost loans, you name it. We're going to try to keep that building alive because my great aunt and so many other of our moms and dads and friends and folks who are just starting out, young families are in these apartments. We need them.

Andrew Nelson: You said you were losing units. Did it have to do with the condition of the buildings, or what was happening there?

David Lipsetz: It's either affordability or quality, right? And there are some buildings who have not been kept up over time and have, have literally left the program because they're not a place where people should be living anymore. Most if not all of the properties, because they've been well kept by USDA's help, and organizations like ours over the years, are leaving because of affordability. Because of a quirk in the way the 515 program is run, once those organizations finish up their first agreement with USDA, and that could be 30 or 40 years, they're immediately ineligible to continue to get support. So they have to establish a new agreement somehow. And that's a very hard thing to do in this program, to get a new mortgage on the property basically, that allows you to keep getting the federal resource that makes the apartment affordable.

If you can't get that, and you own the building, you're going to go elsewhere. You're going to stop serving people in need, you're going to go to market rate, or are you going to sell the building off and let somebody redevelop it into something else? Housing is a quirky world. There are lots of financial structures within this industry that really have an impact on outcomes. Most of that work is being done on Capitol Hill and at USDA and the department to try to make sure that we can save the units, and not let them leave the program.

Andrew Nelson: Okay. Gotcha. Can you go into a little more depth about some of the obstacles that face people that are trying to find housing in rural areas?

David Lipsetz: The reality in a lot of rural places is there are depressed wages, there is entrenched poverty. There are oftentimes not enough affordable homes to move into, and certainly the quality and construction challenges. The USDA put out that the median worker with a high school diploma is making $2,000 more if they live in an urban area. I'm going to take my high school diploma and move off to a higher wage. For workers with a bachelor's degree, that gap is $10,000. So I'm going to take my bachelor's degree and I'm going to go off somewhere where I get a better wage. If your income is not at a point where you can afford a unit, even if the whole rest of the country's like, “Gosh, that housing out there is inexpensive, I could go grab myself an apartment for 400 or 500 bucks a month,” $200 a month, $1,000, whatever it is, your region would look affordable to you from the region you live in.

Well, if your wages are that far below the other places that you could earn money, then you can't afford the housing that even exists in that small town, right? So, if you are 2,000 bucks shy of your income, if you just moved off to a suburban area outside a big city, then you're going to have moved out of your community. You're going to take in the resource that you are, as a kid that earned that degree, and that can work in that small town, and you're going to go chase a few more bucks, because that's what the economy is pushing you to do. If we can address wage disparities, then we would have a much better opportunity to retain the kids that are getting degrees, attract them back to keep folks living and spending those wages in the communities in which they work.

A bunch of my family work in construction and home building and home repair. They're driving, they're getting in their pickup truck at 4:00 AM and driving into a work site by 6:30 or so that's in a place where the wages are going to be much higher, and then they're driving all the way home. That is not a safe, healthy, or good way to live your life. If you could be able to get that kind of work close to your home at a wage that's livable, I bet they put a whole lot less miles on those pickup trucks. So we have identified at the Housing Assistance Council a group of communities in which poverty has persisted.

20 plus years ago, we started drawing this map every year called the Persistent Poverty County Map. And we have identified roughly 400 counties across the US where 20% of the population has been below the poverty line for 30 plus years. Poverty is there to stay, it's not going anywhere. By identifying those, we've been trying to draw attention to the fact that we need different answers. We need different approaches both in the public and private sector to break that cycle of poverty. 81% of those are located in rural places. You know, those of us who are probably in this conversation today, we're thinking about rural places all the time. But, you know, big city folk are not picturing poverty nationally in rural places the way they maybe do in an urban center. And so drawing people's attention to that is also a big important part of our work. Living in that entrenched persistent poverty is truly an obstacle to getting yourself an affordable quality house and place to live.

I would also draw folks attention to what is called Rural Data Central. So we have stood up a data-specific website that folks can get into and punch in just a little bit of information about their own hometown. And they're going to get a whole raft of statistics back. Now we use that for a whole variety of reasons. I'm hopeful that some of the folks who are listening to your show are working on, with, or around programs that they're having to apply for. And they know you've always got to pull together a bunch of data, right? To make your application and put it in. And we've tried to design this website so that it will produce the kind of data you need to make those reports and those applications. I definitely invite folks to get on there, and if you see that you need another data point or another way to use it, we can add stuff to the website. Folks should find an interactive approach there to understanding their own community.

Andrew Nelson: What are some of the organizations and partners that you often see working to address housing shortages and quality issues on a local level?

David Lipsetz: We see everybody, and we work with everybody. There's a lot you have to do when you're working in a smaller community that goes beyond the task. You start at the beginning of that day, right? If you are helping local organizations and local partners address housing shortages, there's a lot you need to do to help them out. If I were listening to the podcast, I'd be thinking, “How can that organization give me a hand trying to get done what we're doing?” The nice part about Housing Assistance Council is our front doors are wide open. We don't have members, we don't have associations, we don't limit our activity to some groups for-profit or nonprofit. Anybody who wants to put up an affordable house in a small town is going to find a friend with us.

So if you're a hospital administrator and you're having a tough time keeping your staff well housed in that small town, you're always having to recruit folks from everywhere else. I mean, it's literally down to the micro level like that. We want to make sure that every organization out there has somebody they can call that can help them along the journey of getting some affordable housing in their small town. One of my favorite loans that we recently did, this guy owns a steak restaurant in the mountains of southern Colorado. It's a town of I think like 1,200, Fort Garland. He couldn't get folks working in the kitchen because they were having to drive over the other mountain to get to his shop to be able to work in the kitchen.

And so he called us and we're trying to sort some of this out, and it ended up, with the help of his son, we built a little 10-unit building, little nice little apartment building on the back of his parking lot. And all of a sudden, this little town in Colorado had 10 more units and a whole lot better place for folks who were going to work in the restaurant and in the surrounding community, a better place to live that's safer, cleaner, closer than where they were. So if you're in a place like that and an organization like that, and you need some help and want to move your projects forward, give us a call. We're happy to chat.

Andrew Nelson: You said you kind of work with everybody, or everybody kind of needs to work together. Can you talk about the place that healthcare organizations or community coalitions might have?

David Lipsetz: We see a lot of work with CAP [Community Action Partnership] agencies. They're also working to address a number of the economic and health issues in their communities. Thinking about Community Action Commission of Fayette County, Ohio, my home state, where those guys are out there training and building the capacity of new staff to continue to operate housing programs. We were just on a call the other day, Rural Alaska Community Action Program. They're doing business modeling or planning for organizations for homeless prevention, and they're developing an assistance support hub for their community in rural Alaska. Another one of my favorite ones is the Clearfield County Council on Aging in central Pennsylvania called us up and said, “We have a bunch of grandmas and grandpas who are trying to raise kids.

This opioid epidemic has wiped out that middle generation, and we don't have housing that can do that, right? Like all our senior specific housing and healthcare-supportive housing doesn't let little kids live there. What, you know, what are we going to do with this population?” And so we worked with those folks to start developing housing that you can have multi-generational residents in. So the 45% of grandparents in the county that were raising their grandkids now have a little bit more option to go in. And we did that through a partner of theirs called Mature Resources Foundation. It's a subsidiary of that area agency. But a partner nonetheless to an organization that works in the healthcare space to develop the kind of housing that we need to address a real, concrete, you're seeing it every day kind of social problem. They are, by the way, not a housing organization. So if any of this, the details and specifics and crazy language that U.S. housing folks use, puts you off a little bit, know that we try to take the time to walk healthcare organizations and others through the process of addressing what they're trying to do, what the mission they're trying to serve is through housing as a component.

Andrew Nelson: A few minutes ago, I asked you about some of the obstacles that face individuals that are in need of housing. Can you talk about some of the challenges that providers of housing often face in rural areas?

David Lipsetz: If you are a three-person municipality, you're not going to have a person whose specialization is in the HUD 202 senior housing program. I'm sorry, you can't afford that kind of specialization yet. USDA's 515 that I talked about before, that can be a complex program.

Housing can be complex, but it doesn't have to. You work with an intermediary like us. We'll learn HUD and USDA and all the private lenders' language; we'll figure it out. We'll translate it for you, and we'll try to get the project done with you on the ground, because that as an organization itself, maintaining that technical specialization is really hard. Getting affordable capital becomes an extraordinarily hard thing to do. If you're in a 10,000, 20,000 person town, and you've got a bank branch, hallelujah, right?

We've seen enough bank branches close over the last 20 years to fill a big, big room. If you've got that bank branch, you're going to go and start talking to them about, “Hey, I need to be able to borrow some money to go buy the land, to get my construction equipment over there, do all those things that it takes to get the housing.” Very few of those small-town banks or bank branches have the resources to help you. So you're going to start pulling funding from every corner you can find, from state programs, and hopefully you got a rich uncle and everything else, and you're going to layer up the resources to try to build the housing there. That becomes complex. It's a long road to do that. How are you going to be able to sustain your organization when you're not a big city place that's building 100-unit apartment buildings every time they turn around? You've got to be able to take that expertise over a long period of time and sustain it; not an easy thing to do. And then you've got to be able to afford to pay those loans back. And if you borrowed it from your small-town bank or one of the big national banks to go buy that piece of land that you're going to build the apartment building on, they're probably going to charge you 7% or 8%. So whatever you borrowed plus that interest rate, you have to pay them back. And if the rents are low and the incomes are low, you're not going to be able to afford to do that. So you need to go find a lender that's going to get you the money at 2%, 3%, 4%, someone like us. Well, I wish we could help absolutely everybody and solve the problem today, be done, but we're not that big. And it's because there just aren't enough resources in the kind of work we do of trying to get affordable houses built to actually meet the need that's out there in the country.

Andrew Nelson: Yeah. It seems like so many of the issues that especially face rural communities, there isn't necessarily a lack of problems to be overcome. It kind of comes down to availability of funds. Can you tell us about how you focus your lending outreach to make sure that you're helping the people that need it the most?

David Lipsetz: I remember my predecessor Moises Loza. Born a migrant farm worker in Mexico, moved here when he was really young as a kid, rose up through the ranks, ran this place for 27 years. And one of the very first things he told me when I took this job a couple years ago: “No margin, no mission.” You can carry your heart out every single day, but if you don't have the resources here to be able to execute on that mission, it's going to prove to be pretty challenging. So, we do think about having the ability to get a little bit of resource coming in, and whether that's from grants or federal programs or our own lending, that kind of thing is a necessary part of what we have to do as well. And so for anybody out there who's running a nonprofit, I get you, I hear you. It's hard to maintain enough resources to get your mission served.

Our mission is to focus on the poorest of the poor and the most rural places. And we talked a little earlier about how we've identified those persistent poverty counties. It's true. We work everywhere. Every single rural community out there and be it wealthy or not, our heart and our concentration is on those smallest and poorest places in the country. And so we feel, unlike all the kind of housing finance talk that I've been doing so far, we feel that it is an essential part of what we're doing, that we have technical assistance and training on hand to help folks in those regions succeed. If you haven't done this work before, you're not going to walk into the bank and convince them to give you half a million bucks to start building an apartment building to house the couple of grandmas and young families in your town. It's just not going to happen.

And so you need, you need someone to be able to call and say, “What does the city mean when they ask me to do this certain element, or what's the bank need for security? What do they mean by that? How can I work on it? Or the state or federal government says, ‘Fill out this form,’ and it's got a fancy number and a big long bunch of boxes, and I've never done that and I don't know where to get this data.” Well, we have technical assistance available that says we can get you the data. We know how to fill out that form. We know the crazy words the bank is using. Here's what they mean. Here's how we can respond together.

We're trying to build the capacity of those organizations in the smallest and poorest places, because they are not going to have the capacity immediately when they get to the people that they need to help them build this housing. And so our work wouldn't go half as far as it does if it wasn't for the fact that we provide more than just loan capital or some research or data. We've got to provide that technical assistance if people are going to succeed.

The highest need regions in the country, suburban, urban, or rural, are in Indian country. The lower Mississippi Delta all across the southern Black Belt, into the border colonias, around our southern border, and throughout central Appalachia. And the reason that I want to take a minute and go back and name those places is that if you are coming up with solutions to try to help these communities, you're a fellow traveler of ours. We're all trying to fill that mission, whether it's through healthcare services or housing or other. If that's where you're working, you have got to recognize that there's nothing in close proximity that is going to help you.

It's not like you can just say, “Hey, here's a voucher. Drive this thing over to a big town with a bunch of good housing and you'll be fine.” Or, “Here's your prescription. Go fill it.” Oh, well, there's not a drugstore anywhere close. “Here's the procedure I just gave you telemedicine. Great. Here's the procedure you need.” Well, you know, I'm a pregnant mom eight and a half months in, and there isn't OB service within three and a half hours drive of me. Like, thanks for the telehealth visit, but what on earth am I going to do to get there when the moment is right? And, and so if you're thinking of programs and ways to serve these communities, you've got to put in there elements that address that distance or they just don't work. It's like, “Thank you very much for the service. Can't help me here. And I've got to find a way.” And rural folks have always shown extraordinary resilience and creativity and strength for doing those things. We shouldn't be putting a society together that makes the hurdles higher.

Andrew Nelson: I suppose there are a lot of different scales at which you're working. There can kind of be the relatively immediate problems for individual communities that you're trying to address, but you also want to build towards a better future. Something where these problems are not as widespread. If you think ahead a few years, what are some of the biggest concerns about the future availability of affordable and safe rural housing?

David Lipsetz: Well, the problem is twofold. I mean, we're not keeping up with preserving what we got, and we're not building as much as we need. And if we're not solving either of those, then we're not going to be able to house folks affordably or safely. You know, and it goes back to a lot that we've talked about of making sure you got the right tradespeople who can work close by to home, or the right bank that can lend you a couple bucks to build the housing. All those things weigh into it. The federal assistance for renting an affordable apartment has also been at risk. It's never met the need. And that which we have is at risk as well. So, if my great-aunt back at that funny-numbered 515 apartment building in western New York State hadn't gotten some rental assistance, a few bucks every month to make sure that she was only taking 30% of her Social Security check to pay the rent, then she would've started digging into the money she needed to drive over to the grocery store or pick up her meds or heaven forbid, keep the grandkids over for an evening and have some fun with them. If we're not doing what we can as a public to keep folks' rent at those levels, then they're going to start digging into other resources they need.

And if those funds are at risk as they're coming in now, then we're going to see a whole lot of families making a whole lot more of those hard choices. Last year, the number of new houses financed by USDA's guaranteed mortgage program fell by 40%. I mean, there are a lot of impacts right now in just the last few years of what happened to the housing markets. And a lot of it's the effects of COVID. The impacts that that had on the different markets, whether it was for your healthcare, or your housing, or a car, or whatever, have really roiled a lot of these industries.

And this is for modest-income folks to buy oftentimes their very first house. These are not homes filled with granite countertops and, and, you know, swimming pool out back. They have to be really nice quality, but this is, on average, a $140,000 house in a small town. And if we're losing half of those opportunities, that's a whole bunch of folks not in the market, not able to afford a place. And we're seeing the impact of that post-COVID now, but there's good stuff out there too. We could take the whole hour talking about the stuff that keeps us up at night, but there's also a whole hour's worth of talking about the things that make me hopeful.

I've been doing this for work for a while, working in DC, coming back and forth from my Midwestern roots. And throughout that time, I haven't seen nearly as much attention as I do right now to the challenges in rural communities. People are starting to pay attention. We work with any and all folks across every corner of the political spectrum. We've seen great ideas come from every direction, and we're always happy to help.

But lifting up rural by definition as a group of communities that are not well served by federal policy and private markets is going to really help us address poverty, and I'm sure by definition, then health outcomes across the country. I'm also really hopeful for my own organization. Things are pretty good at the moment. We are growing really fast.

We've got a bunch of organizations coming to partner with us to provide that housing capital that I talked about, so that we're getting it out at really good rates to folks who really need it, helping them build housing. We've doubled the amount of capital we've had in that period of time, so we've got investors coming in, people who see a real need to be able to do this kind of work. And we have some of our big reports coming out soon that we do every year to keep the conversation going about rural. So you'll see in the next month or so “Taking Stock,” which is a report that we've written. But we've written it every 10 years for 50 years.

This will be our fifth publication. And we basically are taking stock of what's happening in rural American affordable housing. And by being able to do that decade after decade we can trace some pretty important stories for what's succeeding and what isn't. So, you know, there's just a lot of fun stuff. So whether it's housing, or you've got to get a new firehouse or community facility in your town, our team can't even keep up with the amount of demand right now, and we got a bunch of partners coming in. So that's pretty exciting.

Once every two years, we bring a whole bunch of folks together here in D.C., just two blocks from the White House with all the different kinds of partners I just described for a National Rural Housing Conference. And folks come by and speak. Our last conference, we had the head of the Federal Reserve came by and gave us a speech and told us what they were planning to do. A local practitioner from Hale County, Alabama got up, and described how they were doing their work. And it's a whole week with hundreds of people in D.C. together trading their secrets and figuring out how to work with programs and getting a chance to talk to the federal public staff that work on them. And we have found that it's our single best tool for helping local folks figure out all this craziness that we've been talking about for the last hour, take that knowledge back to their community, have a big network of folks now that they can call for help and get things done at a local level.

You don't have to know the language of housing. You don't have to have done this before. If you are a hospital administrator and you're a nonprofit hospital, and you pulled up your 990H, and you're filling it out to justify your nonprofit status, and it says you can do community development and housing work, call me and I will put you in touch with another hospital system that said, “We aren't going to just do some public service announcements and maybe have a health fair day. The resources we spend on that, we're going to use that to develop the kind of housing that our patient population needs to thrive and survive.”

If you're a healthcare provider, or in a public office that does healthcare work, come talk to our research guys. We'll map out places in your community that are generating the highest costs and most demand on the healthcare system. If you're serving an area that has, I don't know, 10,000 homes, I guarantee you I can come in and pinpoint 500 of them that created the most asthma exacerbation, trip and fall hazard, inability to access, the cold windows… We know that that unit and its poor condition is going to produce a patient in your hospital or your healthcare clinic or your system or demand work out of your public program that you're supporting through healthcare. If we can identify those, we step in and do something about it. That is right straight off the prescription pad. Write down good housing, hand it to us, we'll take it out there, get it done, and that person will be healthier. And the person who moves in after them healthier; after them, healthier. These effects grow and accumulate over time because we're investing in the structure that people live in that produces their health outcomes.

Andrew Nelson: You've been listening to Exploring Rural Health, a podcast from RHIhub. In this episode, we spoke with David Lipsetz, President and CEO of the Housing Assistance Council. Look in our show notes for more information about their work and visit ruralhealthinfo.org for all things pertaining to rural health.