Community-Owned Land Trusts Catch Hospitals’ Eye

Build Healthy Places
Crosswalk Magazine
Published in
9 min readDec 8, 2021

The dual benefits of community ownership mean better health for residents and patients.

Maggie Walker Community Land trust home in Richmond, Va. photo/ Bon Secours

As an undocumented immigrant growing up on Chicago’s West Side, Jeisson Apolo and his mother were at the mercy of their landlord. “He saw the fear in our eyes and took advantage of it,” Jeisson said. “He raised the rent every month.”

Jeisson, 28, promised himself he’d never live like that again. After graduating from Cornell with a degree in architecture and another in urban planning, he wanted to sink some roots and buy a home. But in Richmond, Va., where he’d moved after college, prices were already beyond reach.

“Even though I did everything to escape poverty I didn’t do it fast enough,” he said of the ever-rising housing prices in the city.

Photo/ Jeisson Apolo at home in Richmmond.

On a lark, his real estate agent discovered the Maggie Walker Community Land Trust. Homes purchased from a land trust come with lower price tags because the land is owned by the Trust while the buyer purchases the building. In this case, roughly 50 percent lower. For Jeisson, that meant he could afford a two-bedroom home in the Randolph area, a historically Black middle-class neighborhood close to downtown. He also agrees to a cap on profits should he choose to sell, which helps keep the home affordable in perpetuity.

“It’s wild how much they helped me to get to the point where I finally had a key in my hand,” he said, including subsidizing the down payment and closing costs and helping secure a property tax freeze. “I’m deeply grateful.” Jeisson has been a homeowner for three years, and sits on the CLT’s board as a resident voice.

The benefits of homeownership go beyond wealth-building. Being both a homeowner and a board member creates a renewed sense of agency and belonging.

The benefits of homeownership go beyond wealth-building. Being both a homeowner and a board member gives Jeisson a renewed sense of agency and belonging, he said. He enjoys seeing others’ dreams come to life as they become homeowners too, and he finds it gratifying to work on large cultural issues, like the systemic barriers to homeownership for African Americans and others. He’s also meeting his neighbors and hosting get-togethers for owners.

Jeisson Apolo outside his Maggie Walker Community Land Trust home in Richmond, Virg. Photo/ Apolo

He’s even planted three redbud saplings in front of his home, which he now gets to watch grow. “I didn’t think those scrawny trees would impact me this much. It’s great to know I’m making a literal impact on my neighborhood by providing shade for people.”

The future impact doesn’t escape him. “Every single day I’m living in something that is an actual asset to me, that I can pass down to my kids,” he said.

“Every single day I’m living in something that is an actual asset to me, that I can pass down to my kids,”

That kind of social connection and sense of a future — which trickles down to better health and well-being — is one reason, and perhaps the reason, why health systems like Richmond’s Bon Secours are investing in community-owned and managed land trusts.

“That direct sense of personal and collective agency means less stress and more hope,” said Dr. Geoff Gusoff, a research fellow and family physician at UCLA studying community’s impact on health, with well-documented long-term positive impacts on health.

The benefits of land trusts for health systems

Bon Secours was the first investor in the Maggie Walker Community Land Trust in 2016, and has stayed with them ever since. Addressing the social determinants of health that keep their patients healthy meant making sure their homes and neighborhoods were safe and affordable. Becky Clay Christensen, executive director of community health for Bon Secours, said that meant not inadvertently contributing to rising home costs in neighborhoods with every subsequent home rehab and sale they did, as had happened in some of their initial housing projects. That’s not the case with land trusts, she added, which keep homes affordable for the long run by design.

Addressing the social determinants of health that keep Bon Secours’ patients healthy meant making sure their homes and neighborhoods were safe and affordable.

Another benefit for hospitals is that the land trust handles all the transactions and management, a burden the health system didn’t want to undertake, said Clay Christensen. “There was no reason for us to build competency as home builders. We’re in the health business, and we are fortunate to work in a community with several nonprofit developers who deliver quality housing, ” she said.

Bon Secours’ initial $250,000 investment in the land trust was used to spur others to invest, Clay Christensen said. It worked. To date, other donors have committed more than $5 million to the projects, in part because of the reputation and heft of a large institution like Bon Secours throwing in their hat. The land trust had constructed 50 owner-occupied homes as of January 2021, with plans for 50 more in the next two years.

In addition to the Land Trust investment, Bon Secours has contributed $660,000 in grant funds as gap financing for more than 46 homes (not all in the land trust). Its parent health system has created a $250,000 PRI loan fund that has been used in 10 homes, recycling approximately $100,000 per home each time.

Gaining the trust of the community

Because in any land trust purchase, the land beneath the home remains in the hands of the land trust and not the homeowner, many people in lower-income brackets — and African Americans in particular — remain suspicious. For African Americans, the prospect of not owning the land harkens back to the era of contract for deeds, “a predatory agreement that combined all the responsibilities of homeownership with all the disadvantages of renting — while offering the benefits of neither,” as Ta-Nehisi Coates wrote in the Atlantic.

“Distrust is prevalent in African American communities,” said Clay Christensen. “Government has taken houses away from people. That’s real. That happened. So now when others talk about a land trust — having the land belong to someone else — that rightly raises suspicions and doubts.” She added that land trusts present an opportunity to change the narrative to one of wealth building and preserving land ownership opportunities for those previously shut out of traditional financing.

The first land trust helped rural Black farmers secure their land in the face of predatory lending.

Yet land trusts themselves have their roots in the Civil Rights movement, which can be a helpful reminder, said Gusoff. The first land trust helped rural Black farmers secure their land in 1969 in the face of predatory lending. Today, there are approximately 225 community land trusts in the U.S.

Earning trust, regardless of one’s background, is neither quick nor easy, said Clay Christensen. You earn it the hard way, by doing what you say you’ll do and by engaging authentically with community residents with openness and transparency, she said.

“It’s a slower process,” she said of engaging with the community in an authentic way, but worth it. “Finding ways to listen to people you serve is critical and it’s never done, never complete.”

You earn trust the hard way, by doing what you say you’ll do and by engaging authentically with community residents with openness and transparency.

In Columbus, Ohio, Nationwide Children’s Hospital knows how long it can take to build authentic relationships with community members. For more than a decade, Nationwide has used a collaborative model to fuel its Healthy Neighborhoods / Healthy Families initiative, and especially its core housing improvement and construction program, Healthy Homes.

Though not in a land trust arrangement, since 2008 the initiative has built or rehabbed 450 homes, along with numerous neighborhood beautification efforts, wellness programs, work-readiness programs, and more — all through community partnerships.

Homeowners in Columbus, Ohio, as part of the Healthy Neighborhoods/Healthy Families initiative at Nationwide Children’s Hospital. Photo/ Community Development for All People

Key to its success is the strong neighborhood connection they have forged via Community Development for All People, a local nonprofit organization headed by Rev. John Edgar. His organization works as the liaison between community members and the hospital, shuttling information between the two and making sure the lines of communication are kept open.

Listening to the community, he said, is not a one-off deal, and there is no “representative voice” for a group.

“It’s absurd to believe that one person will speak for every Black person in the community or every woman or every transgender person,” Edgar said. “There’s no way that one voice can ever authentically represent a collective of people. So we are never trying to pretend that we know what the community wants, as if that’s a single, monolithic thing.”

“There’s no way that one voice can ever authentically represent a collective of people. So we are never trying to pretend that we know what the community wants, as if that’s a single, monolithic thing.”

It’s important, he said, to just keep listening, and to keep building relationships of trust on both sides — and not in six months, but over years sometimes.

“What we think we do well is listen to lots of voices and dreams and aspirations and then attempt to distill and offer it as the mosaic.”

Edgar also meets weekly with Dr. Kelly Kelleher at Nationwide Children’s Hospital to “talk and dream about where we are and where we want to go next,” he said. Hospital leadership sits on the nonprofit’s housing board, and vice versa, so the work becomes organic to each organization’s mission.

Edgar said it is through these ongoing involvements that shared core values will emerge, and that is where the magic happens. In the hospital’s case, their core values were addressing social determinants of health, and that fits with the neighborhood’s core values of creating more opportunities for their families. And it fits Rev. Edgar’s faith-based mission to“build the front porch of the Kingdom of God,” or the notion that “we can do things right now that get us closer to what it looks like to live in harmony.”

Getting creative in Boise

Across the country in Boise, Idaho, Saint Alphonsus Regional Medical Center is also investing in community-owned land trusts as housing needs skyrocket. Boise has seen double-digit home price increases for the past several years, with median home values topping $550,000 seemingly overnight and rents on the rise as vacancy rates plummet.

Lack of affordable housing is the number one issue in Saint Alphonsus’ health needs assessment and other surveys, said Rebecca Lemmons, regional director of the Community Health and Well-Being division at the health system.

“We can’t be the only investor in these things. You need a lot of folks at the table to make it work.”

Like Bon Secours in Richmond, Saint Alphonsus was the first investor in the LEAP Housing Land Trust, which broke ground on the first of 14 homes in 2020 in the Caritas Commons development. And like Bon Secours, Saint Alphonsus’ $240,000 commitment for six initial sites would jumpstart others, culminating with the Blue Cross Foundation, for a total of $2.1 million, according to LEAP’s website.

That leverage remains important to seeing projects through to the end. “We can’t be the only investor in these things,” said Lemmons. “You need a lot of folks at the table to make it work.”

Saint Alphonsus was drawn to the community land trust for several reasons, first and foremost the connection of housing to health, but also because the trust is working with a local builder, indieDwell, to convert shipping containers into four-bedroom, single-family homes that can be built on smaller parcels as a way to both lower costs and create eco-friendly residences.

Photo/ indieDwell. Architectural rendering of a Caritas Commons home by indiDwell for the LEAP Housing Trust.

The 14 homes in the first development will sell for about $212,000 to households earning 80 percent of area median income or less. All will be laid out in such a way as to foster a sense of community and social connection, said Lemmons.

That social cohesion, said Dr. Gusoff, the UCLA fellow, will likely have a spillover effect on health. Working with other people on shared goals has positive effects, he said, from greater longevity in older people to fewer stress-related conditions stemming from financial hardship.

An affordable future

Both Bon Secours and Saint Alphonsus are excited about prospects for land trusts in making more homes more affordable for more people in their cities. Both agree that the investments spark others to invest, leveraging the initial money into much, much more.

For Jeisson Apolo, homeownership has meant many things, from the freedom to paint a room whatever color he wants to the ability to build equity. He knows he’s lucky that the land trust has supported him, he said, because coming from a poor family, “we don’t know how anything like that works.” The ins and outs of homeownership, he said, are “a giant invisibility for people like us.”

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