Housing rehabilitation loan and grant programs provide funding to repair, improve, or modernize dwellings, and remove health or safety hazards from those dwellings. Programs primarily serve families with low and median incomes, and may prioritize services for households with vulnerable members such as young children and elderly adults. These programs can adopt a comprehensive housing improvement strategy or focus on individual housing components such as heating and insulation, plumbing, structural concerns, lead, asbestos, or mold. Programs can be focused at local, state, and federal levels (CDC-Home improvement).
Expected Beneficial Outcomes (Rated)
Improved housing conditions
Improved health outcomes
Improved mental health
Other Potential Beneficial Outcomes
Increased energy efficiency
Reduced hospital utilization
Improved neighborhood quality
Increased neighborhood stability
Evidence of Effectiveness
There is strong evidence that housing rehabilitation loan and grant programs enable housing improvements that result in health benefits, especially when improvements focus on increasing warmth through insulation and energy efficiency measures (Thomson 2015, Gibson 2011, Howden-Chapman 2007, NICE-Taske 2005). Housing improvements that increase warmth have shown consistently positive effects on respiratory outcomes, overall physical and mental health, and measures of well-being such as self-rated general health (Thomson 2015, Howden-Chapman 2007).
Housing improvements have also been shown to reduce children’s absences from school, adult absences from work, doctor’s visits, and hospitalizations (Thomson 2015, Howden-Chapman 2007). Low income housing rehabilitation projects that comply with green standards can also improve health outcomes such as asthma, sinusitis, and chronic bronchitis symptoms. Green standards require use of sustainable building products and design elements that reduce moisture, mold, pests, and radon, and improve air quality (Jacobs 2014, Breysse 2011). Building deficits such as inadequate heating and ventilation, lead paint, pest infestation, and safety hazards are associated with negative health outcomes such as serious injuries, chronic respiratory illnesses, and poor mental health, and the spread of infectious diseases (Saegert 2003, Krieger 2002a).
Programs that designate funds for low income families and individuals can decrease disparities in access to quality housing and housing-related health outcomes (Jacobs 2014). Housing rehabilitation efforts in low income and declining neighborhoods may also have positive effects on neighborhood quality and stability (Smith 2011a*, Helms 2012*). A Milwaukee-based study suggests that housing rehabilitation can lead to appreciation for the renovated house as well as neighborhood effects, increasing nearby property values and neighborhood stabilization. Although appreciation is more likely to occur in areas with higher poverty rates, it does not appear to be associated with displacement (Wilson 2017a*).
Partnerships between non-profit organizations and government agencies that coordinate housing rehabilitation, weatherization, and energy conservation programs may avoid redundancies in procedure and streamline application, funding, and inspection processes (Rohe 2010*). Pooling resources can also support a coordinated approach to addressing safety, health, and energy inefficiencies (US HUD-Advancing healthy housing). However, careful coordination is needed to prevent conflicts in funding timelines and renovation schedule requirements among programs (Rohe 2010*).
Housing rehabilitation grants are especially beneficial for individuals whose credit scores do not qualify them for loans, and for older adults with lower incomes who are hesitant to take on debt to improve the quality of their housing and accept loans that their children may have to repay (Rohe 2010*). An evaluation of a Boston-based program which provides grants and zero-interest, deferred loans (i.e., due when the house is sold following a move or death) to qualifying older adults found that funds were used for critical repairs such as heating systems, improving housing conditions, and offering elderly homeowners the opportunity to age in place (Begley 2015*).
Impact on Disparities
The Section 203(k) program is a housing rehabilitation loan and grant program, run by the US Department of Housing and Urban Development (US HUD), that supports rehabilitation of single family homes. This federal program can be combined with Community Development Block Grants (CDBGs), HOME Investment Partnership funds, and other programs (US HUD-203k). The US Department of Agriculture (USDA) Rural Development program’s Section 504 Home Repair program, known as the Single Family Housing Repair Loans & Grants program, offers loans to very low income homeowners and grants to very low income elderly individuals to improve housing quality and remove safety and health hazards (USDA-Section 504 HRP).
The USDA’s Rural Development program also offers Housing Preservation Grants (HPGs) to state and local governments, nonprofit organizations, or federally recognized tribes to repair or rehabilitate low and very low income housing in rural areas; individual homeowners are not eligible (USDA-HPG). In 2016, HPGs were awarded for 107 projects in 48 states, the Commonwealth of Puerto Rico, and the Virgin Islands (USDA-Fletcher 2016).
Partnership programs that focus on housing rehabilitation and energy efficiency improvements exist nationwide. The Green and Healthy Homes Initiative, Local Initiatives Support Corporation, and Build Healthy Places Network are three organizations that create and coordinate partnerships among stakeholders at the state, county, and city level to promote health through safe housing and community development initiatives (GHHI, LISC, BHPN). The Boston Home Center’s Senior Home Repair Program is an example of a local program for elderly homeowners which coordinates repair funding through neighborhood specific agencies (Boston-SHRP).
EmPOWER Maryland Low Income Energy Efficiency Program is an example of a state-sponsored effort to assist low income families with energy conservation, air quality, and warmth improvements (MD DHCD-EmPOWER). MaineHousing’s Home Accessibility and Repair Program offers qualifying low income homeowners grants for housing repairs, including heating and electrical system repairs, energy efficiency improvements, and structural repairs (MaineHousing-Repairs).
CDC-Home improvement - Centers for Disease Control and Prevention (CDC), Office of the Associate Director for Policy and Strategy. Home improvement loans and grants.
GHHI-8 elements - Green & Healthy Homes Initiative (GHHI). The 8 elements of a green & healthy home.
BHPN-Resources - Build Healthy Places Network (BHPN). Network resource library: Access to research, best practices and models demonstrating what works, highlighting the health-related value and impact of community development work.
ACEEE-SmarterHouse - American Council for an Energy-Efficient Economy (ACEEE). SmarterHouse: an up-to-date guide on energy savings in the home.
SWD-Housing resources - SocialWorkDegree.net (SWD). Fair housing & social work: Online resources.
LHS - Local Housing Solutions (LHS). To enhance local affordability and foster inclusive communities. New York University, Furman Center and Abt Associates, Inc.
LHS-COVID-19 response - Local Housing Solutions (LHS), NYU Furman Center, Abt Associates. COVID-19 Housing response plans.
Citations - Evidence
* Journal subscription may be required for access.
Thomson 2015 - Thomson H, Thomas S. Developing empirically supported theories of change for housing investment and health. Social Science & Medicine. 2015;124:205-214.
Gibson 2011 - Gibson M, Petticrew M, Bambra C, et al. Housing and health inequalities: A synthesis of systematic reviews of interventions aimed at different pathways linking housing and health. Health & Place. 2011;17(1):175–84.
Howden-Chapman 2007 - Howden-Chapman P, Matheson A, Crane J, et al. Effect of insulating existing houses on health inequality: Cluster randomized study in the community. BMJ. 2007;334(7591):460.
NICE-Taske 2005 - Taske N, Taylor L, Mulvihill C, et al. Housing and public health: A review of reviews of interventions for improving health - Evidence briefing. London, UK: National Institute for Health and Clinical Excellence (NICE); 2005.
Jacobs 2014 - Jacobs DE, Breysse J, Dixon SL, et al. Health and housing outcomes from green renovation of low-income housing in Washington, DC. Journal of Environmental Health. 2014;76(7):8-16.
Breysse 2011 - Breysse J, Jacobs DE, Weber W, et al. Health outcomes and green renovation of affordable housing. Public Health Reports. 2011;126(Suppl 1):64–75.
Saegert 2003 - Saegert SC, Klitzman S, Freudenberg N, et al. Healthy housing: A structured review of published evaluations of US interventions to improve health by modifying housing in the United States, 1990-2001. American Journal of Public Health. 2003;93(9):1471-1477.
Krieger 2002a - Krieger J, Higgins DL. Housing and health: Time again for public health action. American Journal of Public Health. 2002;92(5):758-768.
Smith 2011a* - Smith MM, Hevener CC. The impact of housing rehabilitation on local neighborhoods: The case of small community development organizations. American Journal of Economics and Sociology. 2011;70(1):50–85.
Helms 2012* - Helms AC. Keeping up with the Joneses: Neighborhood effects in housing renovation. Regional Science and Urban Economics. 2012;42(1-2):303–13.
Wilson 2017a* - Wilson B, Kashem SB. Spatially concentrated renovation activity and housing appreciation in the city of Milwaukee, Wisconsin. Journal of Urban Affairs. 2017;39(8):1085-1102.
Rohe 2010* - Rohe WM, Cowan SM, Quercia R. Supporting low-income homeowners: Lessons from a program to coordinate weatherization and rehabilitation services. Housing Policy Debate. 2010;20(3):523-546.
US HUD-Advancing healthy housing - Advancing healthy housing: a strategy for action. A report from the Federal Healthy Homes Work Group, US Department of Housing and Urban Development (US HUD), 2013.
Begley 2015* - Begley J, Lambie-Hanson L. The home maintenance and improvement behaviors of older adults in Boston. Housing Policy Debate. 2015;25(4):754-781.
Citations - Implementation Examples
* Journal subscription may be required for access.
US HUD-203k - US Department of Housing and Urban Development (US HUD). 203(k) rehabilitation mortgage insurance.
USDA-Section 504 HRP - US Department of Agriculture (USDA) Rural Development Programs & Services. Section 504 Home repair program (HRP): Single family housing repair loans & grants, program 101.
USDA-HPG - US Department of Agriculture (USDA), Rural Development Programs & Services. Housing preservation grants (HPG): Program 101.
USDA-Fletcher 2016 - Fletcher J. USDA awards grants to preserve affordable rural housing. US Department of Agriculture (USDA) News Release No. 0188.16; 2016.
GHHI - Green & Healthy Homes Initiative (GHHI). Learn about home health hazards: Learn the warning signs of home health hazards and how to create a healthy, safe, energy efficient and sustainable home.
LISC - Local Initiatives Support Corporation (LISC). Helping neighbors build communities: LISC equips struggling communities with the capital, strategy and know-how to become places where people can thrive.
BHPN - Build Healthy Places Network (BHPN). Working at the intersection of community development and health.
Boston-SHRP - City of Boston, MA. How to apply for senior home repair: Senior Home Repair Program (SHRP).
MD DHCD-EmPOWER - Maryland Department of Housing and Community Development (MD DHCD). EmPOWER Maryland Low Income Energy Efficiency Program (LIEEP).
MaineHousing-Repairs - MaineHousing: Maine State Housing Authority. Home Accessibility and Repair Program
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