The United States has the most expensive healthcare system in the world, and yet in terms of actual health outcomes the United States is ranked near the bottom compared to other developed (OECD) countries. Why is this the case? While there are many problems with our healthcare system, one of the major culprits is lack of spending on social services, according to Elizabeth Bradley and Lauren Taylor authors of The American Healthcare Paradox. On average, other developed countries spend $2 on social services for every $1 spent on healthcare. The United States, by contrast, spends only 55 cents on social services for every $1 spent on healthcare. Additionally, the authors found that increased spending on social services was positively correlated with better health outcomes among all the OECD countries (http://academyhealth.org/files/2013/sunday/bradley.pdf).

Thankfully, both health policymakers and healthcare administrators are beginning to embrace that health is ensured not by only pills and procedures but also by access to safe and stable housing, living wage employment opportunities, financial stability and safe neighborhoods.  They are beginning to find ways to redirect their resources in order to address the structural inequities of communities that lead to poor health. Here are three examples:

1.Community Benefits Plans- The Affordable Care Act now requires all non-profit hospitals to conduct community health needs assessments and come up with community health improvement plans to address health needs in surrounding communities. Some hospitals are using those plans creatively to meet community needs. For instance, Dignity health a network of nonprofit hospitals serving California, Arizona and Nevada has created a $100 million loan fund to develop affordable housing, provide job training, assist neighborhood revitalization and build wealth in neighboring communities. However, there are no strict guidelines for the kinds of activities that can be funded by these community benefits plans, and therefore there is wide variation among hospitals.

All Massachusetts nonprofit hospitals publicize their community benefits plans in the Annual Reports section of the Massachusetts attorney general’s website. Community organizations can explore these reports to see what their local hospitals are currently doing and use them to advocate for more creative and impactful programs.

2.Anchor Institution Models- Some hospitals and healthcare systems are realizing that as nonprofit institutions whose missions are to improve health and wellbeing, they have to go above and beyond the IRS community benefits mandate to adequately address the root cause of poor health in their local communities. Kaiser Permanente, the nation’s largest nonprofit integrated health system with operating revenues over $56 billion dollars, is using a concept called “total health” to guide all its non-clinical practices towards promoting health broadly including physical, mental and spiritual well-being, that account for “resilience” factors not traditionally considered by medicine such as people having a sense of purpose, belonging and self-efficacy.  They are intentionally hiring from low income census tracks in their service area, sourcing their food from local farmers, purchasing supplies from woman and minority owned businesses and are also using their investment capital to invest in local housing and economic development. As a leading healthcare system, Kaiser is setting an example for the whole country for how nonprofit hospitals can most effectively and holistically deliver on their mission to promote health and save lives.

3.Accountable Care Organizations-  As a part of Medicaid reforms, some states are authorizing Accountable Care Organizations (ACOs) as new Medicaid delivery systems. ACOs are integrated health delivery organizations that receive a standard payment per member, and then use the combined funding to both pay for healthcare services and coordinate the prevention services for the members. ACOs can keep a share of any money saved, so they are incentivized to invest in creative solutions that improve health and reduce costly treatments.  In Hennepin County, Minnesota, the Hennepin Health ACO found that 30% to 50% of its members were unstably housed or homeless, leading to serious health problems. The ACO worked with local supportive housing providers to pay for room and board in supportive housing units for some of their members. Using savings from the ACO as a result of this program, Hennepin Health was able to invest in social service navigators who help members with housing and other needs.

Five Pioneer Accountable Care Organizations were set up in Massachusetts in 2012-13, and four of five were able to use the model to cut spending.  Learn more about states that have supported social services through their ACOs in this report.

4. Determination of Need Community Health Initiative- Here in Massachusetts, any hospital expanding their services, undergoing extensive capital expenditure or starting a large solicitation process must undergo a Determination of Need process (DoN) process through the state in order to prevent excessive spending on healthcare. Approved projects must allocate at least 5% of the funds to “provision of primary and preventive health care services necessary for underserved populations in the project’s service area” through the Community Health Initiative. As a part of their CHI, Brigham and Women’s hospital (BWH) has released an RFP for 10 Health Equity grants of $20,000 to $100,000 to promote community psychological health and wellbeing, strengthening employment and job skills opportunity as well as addressing health inequity issues with a racial equity lens. Through these grants, BWH is setting an innovative standard for how hospitals can use community health funds from a DoN process.

All of these hospital and healthcare organizations rely heavily on partnerships with community organizations to identify needs and support investments in the housing, workforce development, local businesses and local neighborhoods. Community organizations in Massachusetts have the opportunity to identify and reach out to the community engagement coordinator at their local hospital to find out how they can better partner to improve health and wellbeing in communities.

The Massachusetts Office of Consumer Affairs and Business Regulation’s Division of Banks (DOB) announced recently that it has awarded $1.3 Million in grants to 11 regional foreclosure prevention centers and 8 individual first-time homeownership education centers across Massachusetts.  For a list of the grantees and the awards, see the Office of Consumer Affairs website.

The awards are made under Chapter 206 of the Acts of 2007, a law enacted as the foreclosure crisis was gaining steam, with MACDC and its Members instrumental in drafting and passing the legislation. Among other things, it regulates non-bank mortgage lenders for the first time, and uses the licensing fees from mortgage originators to fund the foreclosure prevention counseling and homeownership education awards.  Over the past three years, DOB has provided more than $4 Million for foreclosure prevention counseling and homebuyer education.

Thirteen of the 19 awards were made to MACDC Members or to coalitions including MACDC Members. In fact, over a five year period ending in December, 2015, MACDC Members have helped close to 6,700 households facing foreclosure secure a loan modification or other positive outcome.

Unfortunately, foreclosures continue unabated.  Foreclosure petitions in the Bay State, the first step in the foreclosure process, continued to climb, according to a report from The Warren Group, publisher of Banker & Tradesman.  In the first three months of 2016, lenders filed 3,367 petitions to foreclose statewide, a 30% increase from the 2,594 petitions filed in the first three months of 2015. During the same time period, completed foreclosures increased by 60% from the first three months of 2015.

MACDC will continue to support our Members, as they strive to help current homeowners preserve their homes and provide future homeowners with the tools for enjoying sustainable homeownership.  MACDC is currently advocating with the Legislature to increase in the amount of revenue from mortgage originator fees the DOB is allowed to retain, so DOB can increase the awards to fully fund the counseling agencies at $2 million in 2017. This would enable DOB to provide the funding level originally authorized in the 2007 legislation.

For more information on this, please contact Don Bianchi at donb@macdc.org.

MACDC Members Come Together for Annual Lobby Day at the State House

MACDC Members from across the state traveled to the State House on Tuesday, May 3 for our annual Lobby Day, urging legislators to support funding for small business development, foreclosure prevention counseling and housing programs, while also pressing for passage of strong economic development legislation.  This year’s event was a bit different than in the past, with the Luncheon Program dedicated to briefing legislators on the success of the Community Investment Tax Credit Program.  Senator O’Conner Ives, co-chair of the Jt. Committee on Community Development and Small Business, hosted the CITC briefing, which included remarks by Chrystal Kornegay, Undersecretary of the Department of Housing and Community Development, Joanne Campbell of Valley CDC and Jess Andors of Lawrence Community Works. 

Lobby Day also provided an opportunity for the MACDC Board to meet directly with Governor Charlie Baker.  The meeting provided MACDC with an opportunity thank the Governor for his support of many MACDC priorities and to briefing him about the success of CITC.  Our discussion also focused on his economic development legislation, the Massachusetts Food Trust program, and the need to support both community scale rental housing and new homeownership development.

Residents at Harborlight House in Beverly resoundingly said, “we want to stay,” as the facility faced increasingly difficult financial circumstances and the need for significant rehabilitation.  Harborlight Community Partners set out to not only preserve the affordability of Harborlight House, but also improve it to better accommodate the needs of an increasingly frail population. Last year, Harborlight House received a $4 million tax-exempt bond to renovate the House’s 30 units as well as ensure each unit’s affordability for another 30 years.  But the CDC is trying to provide more than just an affordable home.

Harborlight Community Partners developed an integrated services and housing model that ensures seniors are able to age in place, maintaining their independence as long as possible while accessing needed medical services.  Thanks to the renovations at Harborlight House, seniors will now have better and more accessible units, with the addition of their own kitchenettes.  At the heart of Harborlight House, common areas and a porch allow for people to gather, and the dining room is being expanded to safely accommodate the mobility equipment of residents.  Seniors also have in-house care service, thanks to a partnership with Element Care and Associated Home Care.
 
Furthermore, Harborlight Community Partners supports a newly formed residential advisory council that can provide feedback on program operations as well as advocating for affordable housing across Harborlight’s service area, which spans from Lynn to Rockport.  The goal is to build relationships and partnerships that will lead to a more holistic approach to low-income elder housing on the North Shore.

Fundamentally, what unites Harborlight Community Partners’ work is a deep commitment to dignified and well maintained housing that engages elders and creates meaningful and sustainable opportunities for low-income people.  In fact, they are looking to expand their affordable housing model across their service area.  As affordable housing for our communities’ elderly becomes an increasingly critical issue, Harborlight Community Partners plans to work with MACDC and others to spread this model across the Commonwealth and beyond. 

Check out the complete 2016 GOALs Report and past GOALs Reports

From its beginning nearly 50 years ago, a core goal of the community development field was to attract investment capital into places and for people historically excluded, or worse, harmed by traditional capital streams and financial products. Over the years, CDCs developed the expertise to put capital to use in low-income neighborhoods to build housing, to start local businesses, to help first-time homebuyers secure safe mortgages, and to help low-income families begin to save money and build assets that can propel them forward. To do these things well, of course, CDCs need capital and investment to establish the professional expertise necessary to wisely attract and deploy capital in the neighborhoods and towns across the Commonwealth.

In 2012, the Community Investment Tax Credit (CITC) was enacted to do just that, by spurring more private support for CDCs.  The CITC, which offers donors a 50% refundable state tax credit for donations made to participating CDCs, was launched in 2014 and has already resulted in significant new funding for CDCs, which is building capacity and increasing our impact.

In 2014, the CITC program generated $4.7 million and last year the number grew to $8.3 million, making it the largest CDC capacity building program in Massachusetts history.  Last year, over 1,500 donations were made to 48 organizations, with more than 1,000 of them coming from individual donors. Indeed, individuals gave $3.2 million to CDCs in 2015.  Prior to the CITC, most CDCs received very few donations from individuals, relying instead on earned revenue, along with government, foundation, and corporate funding.  CITC is enabling us to diversify our funding, build new partnerships with individuals and local businesses, and leverage greater impact for the community. 

The program has been a win-win for donors and CDCs alike. For Joanne Campbell, Executive Director of Valley CDC in Northampton, “The CITC Program has been a great success in building our capacity as a CDC.”  And in the words of one donor, “It was 
very enticing, and I have to say I feel great about how far the dollars for an individual donor can get stretched.”  Said another, “it made sense to invest locally!”

We could not agree more. 

Check out the complete 2016 GOALs Report and past GOALs Reports

When Linda and her two sons finally connected with Community Teamwork, they had been homeless and moved among shelters in Boston, Bedford, and Leominster. In Lowell, Linda found a way to turn things around and received the inspiration, motivation, and wrap-around services she needed.

What Linda and her family needed first was permanent housing.  Once Community Teamwork was able to get Linda’s family settled in a home, the housing specialist visited Linda regularly to help her adjust.  In Community Teamwork-fashion, Linda and her housing specialist had a conversation that led to connecting Linda with a Secure Jobs caseworker. At Community Teamwork’s Resource Center, the caseworker helped Linda identify her own interests and skills that could lead to gainful employment. It was clear that Linda had the education and experience, but she needed the connections, confidence, and direction to make it all work. After their conversation, it was Linda’s choice to apply for a position in the Fuel Assistance department at Community Teamwork.  She did and was hired for the job!

Linda’s success story is one of many to have emerged from Community Teamwork’s participation in the Secure Jobs program, a new statewide program to link housing, social service, and workforce development agencies together in an effort to help low-income individuals find and sustain employment. Community Teamwork now has partnerships with five vocational schools and the Lowell Career Center in order to provide high quality education and training opportunities.  The combination of stable housing and employment services is proving to be a powerful formula for transforming the lives of people like Linda.

But Community Teamwork does not stop there.  They also provide students with office-appropriate attire via their SuitAbility program and administer 
a flexible fund that is available for unforeseeable, one-time expenses, like a parking ticket or supplies for work, which might otherwise halt a client’s progress. Finally, Community Teamwork helps their clients to navigate the various government agencies in order to obtain food stamps, childcare vouchers, or other needed resources. 

In the end, Linda remembers that it was the human connections at Community Teamwork that made her feel ready to take steps forward in her life. Community Teamwork has been more than influential - Linda now feels “there’s nothing I can’t accomplish.”

Check out the complete 2016 GOALs Report and past GOALs Reports

While the Greater Boston region has one of our nation’s strongest economies, the same cannot be said for the entire state. Unemployment is higher in Western Massachusetts and incomes are lower as the region struggles to adapt to the new economy. Thankfully, the Franklin County CDC has developed a flexible and customized array of services to support the long-term economic vitality of Western Mass by helping locally-owned businesses start, grow, and thrive. 

Each year, Franklin County CDC (FCCDC) works with over 300 entrepreneurs to help develop and grow their businesses, and they are continually expanding and adapting their programs to meet the needs of their region.  More than 20 years ago, they established the Venture Center in Greenfield as a small business incubator.  A few years later, the CDC established the Western Massachusetts Food Processing Center, which provides the facilities and equipment for culinary businesses to not only prepare their products, but also to package and prepare them for distribution.  More recently, thanks to funding from the Massachusetts Growth Capital Corporation, the CDC formed a regional partnership with MACDC Members, Valley CDC and Hilltown CDC, to provide small business technical assistance and lending to the broader region, from Northampton, to the Hilltowns, to the Northern Berkshires.  

And just this year, the CDC established the Pioneer Valley Grows Investment Fund to enable local residents to invest in local businesses.  So far, the CDC has raised $650,000 from dozens of local investors and those dollars have been reinvested in four local companies – with six more in the pipeline. 

The CDC also has a new program to help their clients reach new and larger markets. Expanding on the Western Massachusetts Food Processing Center’s work, FCCDC encouraged many local growers and processors to connect to the recently opened Boston Public Market. Eight Franklin County CDC-supported businesses now either have a booth or sell their goods through other vendors in the new market. They also hope to encourage more regional sales through the market, or develop a way to rotate in producers and collaboratively use the space.  Helping businesses in Western Massachusetts to access the Boston market will help lessen the economic inequities between the Eastern and Western parts of our Commonwealth.

Each year, the CDC strives to find new and creative ways to build their local economy.  It’s not easy, but, as John Waite, Franklin County CDC’s Executive Director says, “This is what we do.”

Check out the complete 2016 GOALs Report and past GOALs Reports

Long before Kendall Square’s emergence as the center of the Biomedical Industry in Greater Boston, Just-A-Start (JAS) was an engine of its own. JAS’s Biomedical Careers Program has prepared 25-30 low-income students annually since 1992. With over 500 graduates placed in industry jobs and a 77% in-industry placement rate, JAS’s success has not gone unnoticed. In 2015, the Biomedical Careers Program received a $200K grant from J.P. Morgan Chase and JAS acquired new equipment for the program.

Even though the industry is filled with young people, most of JAS’s students are in their 30s, 40s, and 50s. Some found the program through Cambridge Housing Authority outreach and others are unemployed individuals with training vouchers. Many are immigrants, some have college degrees, and all of them make a commitment to participate in the program five hours a day, Monday through Friday, for nine months. They cover subjects like genetics, immunology, human anatomy, and chemistry, in addition to hearing from guest speakers and going on facility tours. For Sajan, after emigrating from Nepal in 2009, the program offered a way to build his skills and familiarity with the latest technology, so that he could get a job in a cancer research position. As a cancer survivor himself and former pharmaceuticals researcher in Nepal, Sajan says he is now much more optimistic about establishing a career here. 

According to Program Manager Felipe Gomez, it is not uncommon for students to emerge with a transformed sense of self. They are more confident and knowledgeable when it comes to their abilities in math and science. But more than that, Gomez remarks that students feel respected, empowered, and proud of their work. For Jennifer O’Donnell, one of the program’s teachers, the strength of the program lies in the connections that students make with each other, alums, staff, and industry leaders. O’Donnell knows that the family atmosphere JAS creates is one of the reasons the students feel ready to persevere despite the challenging curriculum. Students know that there is a place for them at JAS and in the industry.

With rents rising and unspent funds set aside to help with housing, we knew we had to act,” says Daria Gere, Executive Director at Waltham Alliance to Create Housing (WATCH).  The city of Waltham passed its Community Preservation Act (CPA) in 2005.  In the past 10 years, between the local property tax surcharge and state distributions, Waltham’s CPA generated $30 million, at least 10% of which is for affordable housing. WATCH and its Tenant Action Group (TAG) decided it was time to organize to create the political will and pressure to spend CPA funds to help low-income tenants living in Waltham. 

TAG and WATCH wrote a proposal for a CPA-funded Tenant-Based Rental Voucher Program. With almost 6,000 households income-eligible for the voucher and 5% of the City’s residents living in overcrowded or substandard housing, the need in Waltham is pressing. Fueled by their own experiences, tenant leaders organized phone banks and a letter writing campaign. WATCH sent hundreds of letters to the Waltham City Council from residents, allies, and 15 organizations. On 3 different occasions, WATCH brought over 20 tenants and allies to testify to City Council.

One resident to testify was Getty, a mother of a 9-year-old child with special needs who wanted to help the City Council understand the difficult choices she faces. “I work 20 hours a day to support my son and myself. Right now, I am about to be homeless because I couldn’t find [a new] place to live,” she said, noting that she was unable to pay her rent after her roommate moved out. Because her son has special needs, she can’t move to another town and put him in a new school environment. Other residents, like Getty, also shared their stories.  And the City Council listened. 

On January 26th, 2016, the City Council passed the CPA Voucher program. Upon approval of the contract between the City and the Waltham Housing Authority, Waltham will provide a 3-year rental voucher to 50 of the City’s lowest income households. The voucher will ensure that tenants’ rents are only 30% of their income. While more permanent low-income housing options are needed, this was a huge step forward that only happened because of the community organizing efforts of WATCH, and the residents of Waltham.

Check out the complete 2016 GOALs Report and past GOALs Reports

The nonprofit executive director as "heroic martyr"—committed, overworked, trying to do ever more with the same or shrinking resources—doesn't serve the organization and may dissuade new generations of potential leaders from taking over, attendees at a panel discussion in Boston were told earlier this week.

Articulating the sentiment was Hez Norton, director of partnership and leadership initiatives at Third Sector New England (TSNE), speaking on "The Future of Nonprofit Leadership" at Boston University's Questrom School of Business, who presented key findings from a TSNE nonprofit leadership survey completed last year.

Other panelists, as well as many among the 50 attendees, agreed with Norton.

Said Danny LeBlanc, chief executive officer of the Somerville Community Corporation for the last 15 years, "We role model things I wouldn't want to emulate if I were 30."

Shirronda Almeida, director of the Mel King Institute for Community Building in Boston, concurred, observing that because Millennials, those born from 1982 through 2002, are looking to make an impact and less interested in functioning within traditional organizational hierarchies, current nonprofit leaders need to reduce stress from the top job and focus more on what type of organization they want to leave behind.

While the event was organized to stimulate discussion on a key survey finding—that 64% of nonprofit leaders across New England, and 78% in Boston, said they intend to retire within five years—panelists acknowledged that numerous regional and national surveys for at least the past 15 years have developed similar projections, which have yet to materialize.

Jennifer Aronson, senior director of program and nonprofit effectiveness at The Boston Foundation, said nonprofits have not yet seen a massive leadership turnover, because many Baby Boomer nonprofit leaders are not ready to retire. 

"They feel they're on the side of good and push themselves," she said, which results in leaders protecting the organization as it is today instead of thinking about the best way to make an organizational impact. She added, "We say we can do more with less, but that's not realistic."

One possible response, Aronson suggested, is for nonprofits to practice leadership sharing, which helps more people within the organization more fully understanding how it functions.

Another response is for nonprofits to learn to say "no" to funders who underfund projects. 

"Nonprofits need to be realistic regarding what it costs to do programs, and reject funding if it is not enough," said Norton, himself a former nonprofit executive director who changed the direction of his career because "the work takes its toll."

Key findings from the TSNE Leadership New England report included the following:

• 58% of nonprofit leaders and 62% of nonprofit board members said their organizations do not have any type of succession plan in place. 
   
• Two-thirds of leaders (64%) and half of board members (52%) said they do not believe there is someone on the staff who could succeed the executive.
   
• One-third (32%) of all leader and board respondents said they believe there is enough “bench strength” in their organizations, that is, “people who can step into leadership/management roles if and when needed.”
   
• 35% of Massachusetts nonprofit leaders said it is essential to have support for developing succession plans, and slightly more (37%) said it is essential to provide funds for developing professional staff.
   
• 60% of Massachusetts nonprofit leaders earn $99,000 per year or less.

Republished from www.massnonprofit.org