Healthy Housing Issues A proactive approach to addressing HOUSING Issues related to HEALTH James A Brooks Healthy Homes program manager City of Worcester Executive Office of Economic Development, Housing Development Megan L DeNubila Prevention specialist/tobacco control coordinator City of Worcester, Division of Public Health Ted Kremer, MD UMass Memorial, Pediatric Pulmonology Landlord summit; October 22, 2016

Benefits to landlords and resources around implementation Smoke-Free Housing Benefits to landlords and resources around implementation

Poor Health Outcomes Secondhand smoke represents a significant trigger and exacerbating agent in children and adults with asthma. Increased protection against secondhand smoke in the home may reduce asthma diagnoses in children1.

Why go smoke-free? In a 2009 survey, 99% of Massachusetts landlords who had a smoke-free rule felt it was a good decision2. 1. Attract more tenants 2. Save money by reducing the need for repairs 3. Eliminate one of the leading cause of residential fire deaths 4. Reduce conflict among tenants 5. Reduce potential legal liability 6. Potentially reduce your insurance premiums

How do I go smoke-free? STEP ONE – Finalize Your No Smoking Lease Addendum. STEP TWO – Decide When to Make the No Smoking Rule Effective. STEP THREE – Notify Tenants and have them Sign the No Smoking Lease Addendum. STEP FOUR – Enforce the No Smoking Rule3.

Resources www.makesmokinghistory.org

References Massachusetts Department of Public Health: Tobacco Cessation and Prevention Program www.makesmokinghistory.org Massachusetts Smoke-Free Housing Project: Massachusetts Department of Public Health Massachusetts Smoke-Free Housing Project and Public Health Advocacy Institute, Inc.

Addressing High Rates of Pediatric Asthma in the City of Worcester How Landlords can help and Resources Available Ted Kremer, MD UMass Memorial, Pediatric Pulmonology

What is Asthma? A condition that: is chronic produces recurring episodes of breathing problems is potentially life-threatening can occur at any age is not contagious cannot be cured, but can be controlled

What are the Symptoms of Asthma? Shortness of breath Wheezing Tightness in the chest Coughing Waking at night with any of the above symptoms* * a key marker of uncontrolled asthma

How Does Asthma that is not Well-Controlled Impact Children Fatigue – child up at night with coughing, wheezing and other symptoms are tired in the morning Absenteeism related to asthma episodes, health care appointments, and hospitalizations Missed class time due to frequent school health office visits

Why Worcester is Addressing Pediatric Asthma Pediatric Asthma Home Visiting Intervention Asthma is prevalent among low income populations living in public and older housing stock, and particularly among Hispanic and Black populations. Rates per 100,000 visits for pediatric asthma-related Emergency Room visits are nearly double in the City of Worcester compared to the state. In 2014; UMass Memorial had 220 pediatric asthma admissions and 978 pediatric ED visits for asthma Poverty – primary and secondary from the literature

City-Wide Intervention; 11-Partners

Pediatric Asthma Home Visits Identify and address home triggers such as mold, pests, rodents; provide supplies and refer to CLA when necessary Specially-trained, culturally-competent CHWs provide basic education to improve medication understanding and adherence

Top Home Triggers Identified Top Three triggers identified in homes: Dust clutter: 25% Strong cleaners: 21% Insects and rodents:11% Top three reasons for referral to Community Legal Aid: Mold Pests Mice Pediatric Asthma Policy Task Force: Addresses environmental issues in schools; Pilot launching at three public schools with rates of asthma and high absenteeism.

Questions?

Worcester Healthy Homes Overview A proactive approach to addressing Health Issues related to Housing A brief overview James A Brooks Healthy Homes program manager City of Worcester Executive Office of Economic Development, Housing Development

Worcester Housing Challenges $500,000,000 of Deferred Maintenance of Residential units* 47% of them built before 1920 45% of population over 65 by 2030 46% of them will have physical limitation *2012 Worcester housing Market study

Pediatric Asthma Rate 11.7% Worcester vs. 10.8% Massachusetts 12 Schools have 25% of kids missing more than 20 days/year due to Asthma

Worcester Housing Challenges Continued Lead Poisoned Children Only 5600 units of the city’s 32,221 units are deleaded 300 Children with elevated blood levels Preventable Injuries 11,469 Emergency Room visits due to home preventable injuries (falls, burns, asthma, etc)

What does it mean to Investors $5,600,000 in water bill costs due to leaky pipes $11,000,000 in wasted electric costs 890 court cases per year due to housing code violations Approximately $37,000,000 in medical costs associated with housing issues Potential Legal fees? Potential Law suits? Potential Lost rent?

What Landlords can do to help Install bath fans that turn on with light or are on a humidistat Install hard flooring rather than carpet Remove gas on gas stove when upgrading heating Ensure handrails, stairs and balusters are in good condition Fix any leaks in unit including roof and plumbing leaks Plug any holes around plumbing or walls that will allow for pest intrusion

City of Worcester Healthy Homes Program Grants and Loans Available Community Development Block Grant ($5000/unit) Owners & Tenants must income qualify HUD Lead & Healthy Homes Grant(90% of deleading cost) Owners & Tenants must Income Qualify Home Modification Loan Program (up to $30,000) For Universal Design improvements (ramps, grab bars, etc) MassHousing Home Improvement Loan Program (up to $50,000)

City of Worcester Healthy Homes Program Contact Information James Brooks Healthy Homes Program Manager Executive Office of Economic Development, Housing Development 455 Main St 4th Floor (City Hall) Worcester, MA 01608 508.799.1400 x229 brooksj@worcesterma.gov Inspection Services 24 Hour Hotline 508-929-1300