When a 92-year-old is discharged from hospital after a fall, excited to go home, and the only bathroom in his house is up 14 stairs, whose problem is that? The hospital’s? The housing provider’s? His own?

At the 2025 ONPHA Conference, a room full of housing and health leaders sat with that question. The answer, it turns out, is everyone’s.

Housing Providers as Health Partners

Community housing is non-profit rental housing with rents set below market rate, making it the primary option for low-income households, seniors, and people who cannot access the private market. These are also, as it happens, some of the highest-need users of the healthcare system.

Dr. Gina Agarwal, a family doctor and researcher at McMaster University, has spent years studying health outcomes in social housing across Ontario. She found that around half of community housing tenants have high blood pressure. About 30% have diabetes. Cancer screening rates – for colorectal cancer, mammograms, and Pap smears – run 10 to 15% lower than in the general population. They carry a higher burden of chronic disease, and they are less likely to get the screening that catches it early.

This gap exists because housing and health were not designed to work together. Housing providers are often operating at this intersection. Every day, property managers, tenant facing staff, and building superintendents are in contact with people who are managing complex health and social needs, often without adequate support. This has been a reality for years. What is changing now is how providers are responding.

When Housing and Health Work Together

What does it actually look like when housing and health start working as one system? The panelists had no shortage of answers. While their approaches are different, the underlying logic is the same: housing providers have people, assets, and space. Health organizations have clinical expertise and, sometimes, funding. Neither can do this alone.

Matt Bowen, CEO of Haldimand-Norfolk Housing Corporation, works in a small, rural context. More than half of his portfolio is seniors housing, and 50% of those tenants are 70 or older. Partnering with Dr. Agarwal’s lab, his organization implemented a Community Paramedic at Clinic (CP@clinic) program in seniors buildings. Paramedics conduct regular visits, collect health data, check blood pressure and blood sugar levels, and connect tenants who do not have a family doctor to one. The program addresses both social isolation and early health intervention at the same time.

The model works because it started with a question housing providers are uniquely positioned to answer: who lives here, and what do they need?

Nolan Goyette, Chief Tenant Services Officer at Windsor Essex Community Housing Corporation (WECHC), came to housing from the acute healthcare sector. He brought a systems perspective with him. WECHC houses thousands of tenants, 91% of whom come from priority lists, meaning they arrive with complex, high needs. The old way of operating was not going to hold.

His team reoriented their approach to partnerships. Rather than asking what health partners could do for them, they started asking how they could support their partners instead. The shift changed the nature of the relationships. Working closely with the Windsor Police for more intentional collaboration, they have seen a 14% reduction in 911 calls, a 65% reduction in drug-related crime, and a 35% reduction in property damage. Partnering with a nurse police team, they have diverted upwards 500 emergency department visits. One of their high-needs neighbourhoods went from the top source of 911 calls in the city to outside the top 10.

Goyette put it perfectly: hospitals and housing are working with the same clients, just through different lenses.

Deb Galet, President and CEO of Baycrest Hospital and Long Term Care, brought the healthcare perspective to the conversation. Her organization partnered with Toronto Seniors Housing Corporation and several Ontario Health teams to wrap services around tenants in their own buildings. Before jumping in to design, they asked tenants what they wanted. The answer, was one team, walking through the door together.

So that’s what they built. Shared clinic rooms inside buildings, with physicians, nurses, social workers, pharmacists, and rehab professionals operating as a single unit. In buildings with these care teams, emergency department visits and hospitalizations dropped by 15%.  

A Wrong Pocket Problem

The challenge is structural. A tenant is also a patient. They are also, often, someone receiving social services. But the ministry responsible for their housing is not the ministry responsible for their health, and neither is responsible for the gap in between. Funding flows through separate channels, and accountability is tracked separately. The person caught in the middle just has to manage.

The result is that each sector ends up carrying costs that belong, in part, to the others. When community housing cannot support a tenant’s health needs, the healthcare system absorbs the consequences in emergency departments, hospitalizations, and long-term care placements. When the healthcare system discharges a patient without coordinating with their housing provider, the person may return home to a situation that puts them back at risk. That 92-year-old and his 14 stairs is an example of what the current system struggles with.

Doing More with Less

Housing providers are already doing the work. They are tracking outcomes, building partnerships, and bringing services into buildings. But they are doing it under a lot of pressure. The expectations placed on property managers and tenant services staff have grown substantially, without a matching increase in resources or support. More complex needs, but operating under the same budgets.

The evidence that investments payoff is there. The CP@clinic, for example, has already reached about 6,000 individuals across Ontario, delivering a 25% reduction in 911 calls and returning $2 to the emergency healthcare system for every $1 invested. The challenge is that the savings and the investments rarely land in the same budget.

Investing in community housing is investing in the healthcare system. The two are not as separate as our budget lines suggest.

A Permanent Shift in Care

ONPHA’s CEO, Marlene Coffey, opened the conversation with a reflection that makes this moment different from other policy trends she has seen rise and fall over the years. She has watched momentum build around good ideas before, only to stall when political wind shifted.

“It isn’t a passing idea or a policy trend. It’s real, it’s needed, it’s solid. It’s grounded in evidence, in lived experience, and in a shared understanding that neither housing nor healthcare can do this alone.“

Can we build the systems to sustain this? That’s how we can help that 92-year-old, so that when he is discharged, he’ll be coming home to a team that’s already waiting for him at the bottom of those 14 stairs.

Don’t Miss What’s Next

The future of housing and health won’t build itself. Join the practitioners, researchers, and leaders designing it at the 2026 ONPHA Conference happening in Toronto from October 29-31.

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