Keith Hambly, left, CEO of Fred Victor Housing, and Dr. Andrew Boozary, executive director, social medicine for the University Health Network, outside a new supportive housing development, on Oct 1, 2024.Fred Lum/The Globe and Mail
Dr. Kevin Smith is not a developer.
As the CEO of the University Health Network, he’s in the business of imaging, clinical care, health care human resources, emergency medicine and the thousand other tasks that make a sprawling teaching hospital system get from one day to the next.
But, as it turns out, the health care veteran has lately found himself dabbling in the housing game, which comes as both a surprise as well as an entirely rational response to the layered crises of homelessness, addiction and housing affordability.
In the past year, UHN – which encompasses seven hospital sites, 44,000 employees and eight million square feet of space – has found itself anchoring two novel housing initiatives: one, a rapidly constructed transitional housing project on Dunn Avenue in Toronto’s Parkdale neighbourhood for 51 frequent ER users; and the other, a complicated joint venture with the City of Toronto and two developers – a 50-50 partnership between Kilmer and Tricon – to create 100 affordable rental apartments for UHN employees, as well as a 25,000 sq.-ft clinical space for UHN, on the former bus station site on Bay Street near Dundas Avenue. (The two-phase, all-rental project, which also includes a paramedic station, begins construction later this year and will open in fall 2028 and spring 2029.)
UHN is already looking at future housing possibilities for its lands, says Rebecca Repa, the executive vice-president who oversees the real estate portfolio. “We’re taking a really wide view around what’s possible, and then we’re going to look at what’s important to our staff.”
A rendering of a project undertaken in partnership between UHN, the City of Toronto and developers Kilmer and Tricon to create 100 affordable rental apartments for UHN employees, as well as a 25,000 sq.-ft clinical space for UHN, on a former bus station site on Bay Street near Dundas.University Health Network
Dr. Smith acknowledges that the men and women on his board posed tough questions about allocating scarce capital resources to what may seem like a detour away from UHN’s core mandate. “This is a big, thorny problem,” he says. “Is this our area of expertise? We transplant organs, and we do the most advanced cancer care, and we do all this other stuff for really sick people. Is this taking our eye off the ball?”
The answer, he continues, was no. “They quickly saw that for themselves, because those hard headed business people [on the board] also saw that at the root of most of our largest societal challenges lay challenges of income distribution and poverty. When they looked at the challenges Canada is facing, they also came to the conclusion: If not us, who?”
It’s a question coming up in other high-cost cities, including Edmonton, Portland, Ore., and Columbus, Ohio. There, a local land trust and a national children’s hospital banded together last year to build 28 affordable homes. “A number of the faith-based health care systems in the United States, Providence most notably, has also seen housing as part of their mission,” adds Dr. Smith. (Providence, a non-profit, operates 51 hospitals and more than 1,000 clinics across the U.S.)
In Newark, N.J., University Hospital drew on a state mortgage and finance program, plus US$3-million of its own funds, to team up with a local developer to build a 78-unit affordable apartment complex, which includes 16 spaces for unhoused people; it opened last summer.
“The Hospital Partnership Subsidy Program stems from the recognition that access to quality housing is critical to maintaining good health and that hospitals are crucial anchor institutions well-positioned to advance housing in conjunction with health care,” says a University Hospital spokesperson. “Research has highlighted a correlation between homelessness and limited access to health care. The ability to provide housing and health care services in one place can help improve quality of life for community members.”
UHN’s Dunn Avenue project, situated on a former parking lot behind the UHN’s EW Bickle Centre for Complex Continuing Care, came about after a study of individuals making multiple ER visits over the course of a year. The analysis showed there were approximately 300 people, many of them dealing with both addiction and homelessness, who were coming in repeatedly, often just to seek shelter in the waiting room. Fifty-one were eventually given the apartments.
Dunn House, one of several novel housing initiatives undertaken by UHN. The rapidly constructed transitional housing project on Dunn Avenue, in Parkdale, can host 51 frequent emergency room users.University Health Network
In a May, 2024, op-ed in the Canadian Medical Association Journal, Dr. Andrew Boozary, UHN’s executive director of social medicine and population health and a driving force behind the Dunn project, laid out the prevention case for hospital-provided housing for high-frequency ER users – an outlook that has come to be known around UHN as “prescribable housing.” Many acute health issues, he wrote, could be attributed directly to chronic homelessness.
“This is the first time that housing has actually been developed as a prescription,” says Ms. Repa, noting that Fred Victor operates the Dunn Avenue site and provides support services such as nursing and access to addiction treatment. Dr. Smith adds that researchers at Harvard will be evaluating whether the project reduces ER use.
The Dunn venture was financed with donations from the Gattuso family foundation and $14-million that Ottawa kicked from its Rapid Housing Initiative. As with several other transitional housing projects around the city, the building was constructed with prefabricated modular components and was completed quickly.
The coach terminal joint venture, in turn, focuses on a more broad-ranging concern, one that is shared by a growing number of employers in high-cost cities such as Toronto. Even after a small recent dip, real estate prices and rents are stuck at levels that make it extremely difficult for those earning average wages to secure conveniently located housing. A critical segment of this part of the labour force includes essential health sector professions such as nurses, personal support workers, and technicians and trades people.
Following the pandemic exodus, UHN has taken to monitoring its recruitment and two-year retention rates intensively, especially because some of its employees' wages are provincially regulated and were capped by the Ford government, despite cost-of-living hikes.
Mr. Hambly and Dr. Boozary in one of the units at a new supportive housing development.Fred Lum/The Globe and Mail
“Many people pass many hospitals on their way to UHN,” observes Ms. Repa. “They have options, and they make choices.” Her team reckons there are about 7,000 people on UHN’s payroll who qualify for the affordable housing options that the hospital hopes will come with the apartments set aside in the City-Kilmer/Tricon joint venture. (The partnership includes the Hospital Workers Housing Co-operative, WoodGreen, March of Dimes and Wigwamen.)
Andrew Joyner, Tricon’s managing director of multifamily housing, says that after the city issued a call for proposals for the bus station site, Kilmer/Tricon executives reached out to UHN about a partnership. “On the back of COVID,” he says, “there was a need to ensure that key workers in our city want to be downtown, want to live downtown, want to raise their families downtown, and can be close to work where they save lives. It was top of mind for us.”
(Because the project is entirely rental, it’s not exposed to plummeting condo pre-sales. Mr. Joyner notes that various policy tweaks to incentivize rental have helped make the math work, and adds that Kilmer/Tricon will be submitting an application under CMHC’s apartment construction loan program later this spring.)
The B.C. government made a similar move last fall, announcing the development of affordable rental housing for the health care workers who will eventually be employed at the new $2.88-billion Surrey, B.C., hospital and cancer care centre. “This is a site where we’re using publicly owned land, health authority land, to build housing for health-care workers to support in recruitment and retention at the beautiful new Surrey hospital,” B.C. premier David Eby told reporters at the ground-breaking last fall.
For his part, Dr. Smith says the UHN’s twinned forays into housing have garnered attention from hospitals across Canada, including, most recently, Hamilton’s. “We’ve actually had a couple of sessions where a number of interested hospitals and partners and cities have come together to learn about our experience, and just talk about how this is working, and what model we’ve used and how we’ll evaluate it,” he says. “I think there’s a great deal of interest.”
The forces pushing these two sectors together, as Dr. Smith adds, “are not unique.”