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Generational Housing Instability: A Hidden Healthcare Crisis We Can No Longer Ignore

“If a child grows up without stable housing, they’re not just inheriting a zip code they’re inheriting risk.”

In healthcare, we talk about chronic conditions, adverse childhood experiences (ACEs), and the social determinants of health (SDOH) as if they’re isolated levers to be pulled. But what if one of the most potent and preventable predictors of lifelong health outcomes is where you sleep at night?

At Upside, we specialize in housing for health. And one of the most urgent, under-discussed challenges we’re tackling with our health plan partners is generational housing instability: the deeply entrenched cycle of families moving from crisis to crisis, often for decades, without ever finding a place to land let alone thrive.

This isn’t just a housing issue. It’s a longitudinal health emergency. And the data backs it up.

What Is Generational Housing Instability?

Generational housing instability refers to unstable housing conditions, evictions, overcrowding, frequent moves, homelessness passed down across two or more generations. It’s poverty’s footprint on the American home.

This cycle is shaped by forces far beyond the control of any one individual:

• Low and volatile incomes
• Discrimination in housing and credit markets
• Underfunded safety nets
• Eviction histories that never fade
• Inadequate affordable housing supply

In fact, households living below the federal poverty line move nearly twice as often as their non-poor counterparts. And each move compounds stress, disconnection, and instability especially for children.

How Housing Instability Shapes a Lifetime

The research is clear: unstable housing in childhood leaves an indelible mark on mind, body, and opportunity.

Mental & Emotional Health

• Children in unstable housing are twice as likely to experience anxiety and depression.
• Chronic housing instability triggers toxic stress, impairing brain development and emotional regulation.
• Those who experience housing instability as children face elevated rates of depression and PTSD in adulthood.

Academic Disruption

• Children who move frequently score lower on standardized tests and have 50% higher dropout rates.
• One study found that students experiencing homelessness are twice as likely to repeat a grade and face a higher risk of learning disabilities.
• Frequent school changes disrupt relationships, erode confidence, and delay cognitive development.

Physical Health

• Infants born into homelessness are at elevated risk for respiratory illness and low birth weight.
• Exposure to mold, pests, and lead in substandard housing raises rates of asthma and other chronic conditions.
• Overcrowding increases infectious disease transmission and makes treatment adherence harder.

And the impacts don’t end in childhood. Adults who experienced housing instability as children are:

• More likely to develop chronic illnesses like diabetes and hypertension
• Less likely to complete higher education
• More likely to experience mental illness, job instability, and housing insecurity themselves

This is what we mean by a generational crisis. It’s not a one-time hardship. It’s a compounding health liability.

It’s Bigger Than the Rent

At Upside, we work with health plans to address housing as a systemic health driver, not just a member issue. That’s why we study the ecosystem not just symptoms, but structural causes:

Level	Driver
Individual/Household	Income volatility, eviction records, single-parent household dynamics, chronic health conditions
Housing Unit	Unsafe housing, disrepair, landlord conflict
Neighborhood	Crime, gentrification, vacancy, displacement
Metro Area	Affordable housing shortages, exclusionary zoning
Systems-Level	Underfunded vouchers, foster care exits, reentry after incarceration
Generational	Cycles of poverty and intergenerational trauma

This web of disadvantage requires intervention on multiple fronts, especially for vulnerable Medicaid and Medicare populations.

What Breaks the Cycle?

We know what doesn’t work: waiting until a member ends up in the ER. Or providing fragmented support after a crisis hits.

We also know what does work. The evidence is mounting:

Rental Assistance

Housing subsidies significantly reduce homelessness and improve health outcomes, yet only a fraction of eligible families receive them due to underfunding.

Supportive Housing

When housing is paired with services like behavioral healthcare, job training, and case management, it leads to:

• Fewer emergency room visits
• Improved treatment adherence
• Higher housing retention rates

Two-Generation Programs

Supporting both parents and children through early childhood education, parental job supports, and stable housing interrupts the intergenerational transmission of poverty.

Housing First Models

Immediate access to permanent housing without preconditions leads to better long-term outcomes than requiring treatment or job readiness first. It works especially for those with complex needs.

Housing as Preventive Care

Medicare and Medicaid leaders are starting to embrace housing as healthcare. And rightfully so:

• Medicare Advantage plans are increasingly implementing utilization-based housing support programs strategically designed to serve their most at-risk, high-cost members with services like rent assistance, housing navigation and utility support.
• Medicaid waivers in several states now fund housing stabilization services, eviction prevention, and one-time transition costs for high-risk members.

These aren’t just social programs. They’re cost containment strategies.

At Upside, we help health plans turn housing into a high-impact intervention. We integrate:

• Proactive member identification
• Tailored housing solutions
• Local partnerships and rapid response teams
• Outcomes measurement tied to health plan KPIs

This is about value-based care done right, where stable housing becomes the foundation for every other health intervention to succeed.

Why This Matters for Health Plans

Here’s what our payer partners care about and what Upside delivers:

Goal	How Housing Helps
Lower Medical Costs	Prevents avoidable ER visits and readmissions
Improve Retention	Keeps vulnerable members stably housed and engaged
Boost Star Ratings	Addresses key SDOH metrics, improving satisfaction
Win State RFPs	Differentiates your bid with real-world impact solutions

Housing instability is costly, avoidable, and addressable. And the ROI—financial, social, and moral is undeniable.

Collaboration or Consequence

If we fail to act, the cycle continues.

• More children trapped in housing insecurity
• More emergency care driven by preventable conditions
• More taxpayer dollars spent on downstream interventions that never address root causes

But if we act strategically, urgently, and collaboratively we can shift this dynamic.

Upside is here to help health plans become part of the solution.

We bring:

• Deep expertise in housing strategy
• Proven results across diverse populations
• Scalable, localized housing programs
• A human-first approach grounded in dignity and outcomes

Because when housing is stable, health improves. When families stay rooted, kids thrive. And when healthcare systems take housing seriously, everybody wins.