Addressing Energy Usage and Home Health Conditions ACI Home Performance Conference 2010 Jackie Berger April 22, 2010

Session Outline Evaluation Overview Process Research Program Costs and Measures On-site Interviews Client Pre/Post Survey Pre/Post Client Assessment Summary and Recommendations 2

EVALUATION OVERVIEW 3

Evaluation Goals Documentation Impact measurement Recommendations for statewide implementation 4

Process Evaluation Research Administrative interviews –Ohio Office of Community Services –Cleveland Housing Network, Breathing Association –Partner agencies Document review Baseline client interviews Post treatment client interviews On-site client interviews 5

Outcome Evaluation Research Pre/Post Weatherization Assessment Pre/Post Health Assessment Pre/Post Client Assessment 6

PROCESS RESEARCH 7

Logic Model 8 AssumptionsActivitiesImmediate Outcomes Intermediate Outcomes Program Impacts Unhealthy homes can aggravate existing medical conditions. Conduct pre- screening to select vulnerable households for assessment. Clients with potential for health improvements are identified. Energy use declines. Clients change behavior to reduce energy usage and improve health of their homes. Indoor air quality is improved. Clients receive additional social services through referrals. Clients are able to better afford their energy bills. Clients’ health improves. Clients need more energy programs due to the use of breathing assistance machines. Wx decisions can be better prioritized if health impacts are factored in. Jointly conduct wx & healthy homes assessment. Wx & healthy homes services are identified. Relatively small health-related investments can yield large improvements in health. Jointly deliver wx & healthy homes services. Clients receive services that improve energy efficiency and health. Clients do not know how to reduce energy usage and create healthy homes. Involve and educate the household as a partner. Clients take actions to reduce energy usage and improve heath. Households will be more invested if they are involved in the process. Additional services are available for eligible clients. Make referrals for services. Clients receive additional social services.

Partnerships Health agencies – state, county, city College of nursing Diabetes association OH State University, Environmental Health OH Agency on Aging OH Environmental Protection Environmental Education Rebuilding Together Central OH SERVPRO (fire and water damage cleanup) City of Columbus, Department of Development, Emergency Repair Program 9

Implementation Challenges Model was designed to be sustainable after conclusion of REACH. Concept was modest funding that could continue, using a portion of LIHEAP funds. Focus –Reprioritization of wx measures. –Funding of key measures to affect health and safety. 10

Implementation Challenges Original budget –$500 for home health and energy audits –$1,000 for additional health-related measures –500 homes served HHS approved re-budget –$3,000 average cost –250 homes served Total of 180 homes served in program 11

Implementation Challenges Joint service delivery –Not intended to be delivered after WAP was completed. –Requirement for pre-interview helped to reinforce this. –Each home approached differently. 12

Health Issues Moisture Mold Roof leaks Plumbing leaks Pests 13

Services Needed Plumbing repairs Repairs to gutters and downspouts Central air conditioning repaired or replaced Environmental and mold cleaning Minor roof repairs Ventilation Dehumidifiers Extermination Ramps 14

PROGRAM COSTS AND MEASURES 15

Program Costs 16 All REACH Jobs (n=180) Mean Percentile 25 th 50 th 75 th Labor Costs$2,695$1,485$2,198$3,253 Material Costs$1,516$826$1,263$2,021 Total REACH Cost$2,629$1,444$2,579$3,547 Total Job Cost$4,933$2,942$4,404$6,233

Air Sealing Measures 17 Air Sealing Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Caulking & weather-stripping 13979%3%93%6%8796%5261% Blower door guided air sealing 14180%1%92%7%8897%5362% Non blower door guided air sealing 16895%1%93%7%8897%8094% Duct sealing & repair 11063%2%90%9%4044%7082% Other air sealing work 3419%3%88%15%89%2631%

Insulation Measures 18 Insulation Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Attic15186%1%93%7%7886%7386% Wall13074%0%94%7%8391%4755% Floor2011%5%80%15%78%1315% Duct106%0%90%0%44%67% Other159%0%100%0%44%1113%

Space Heating Measures 19 Space Heating Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Replace5632%4%64%32%3134%2529% Repair4123%5%78%12%89%3339% Tuned up7945%3%89%9%5560%2428%

AC Measures 20 Air Conditioning Measures All Jobs CHN Jobs BA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Window AC32%0% 67%33%00% Central AC148%86%7% 44%1012% Repair42%50% 0%0 45% Tuned up85%75%13%0%22%67% Ceiling Fan116%0%18%82%1112%00%

Ventilation Measures 21 Ventilation Measures All Jobs CHN Jobs BA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Bath9956%73%16%11%8796%1214% Kitchen3419%76%6%18%3235%224% House21%0%50% 11%1 Other2715%19%63%11%89%1922%

HVAC Accessories 22 HVAC Accessories All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Program Thermostat3218%16%75%9%2831%45% Standard Thermostat8649%5%63%31%5560%3136% Standard Air Filter6235%2%66%31%1011%5261% HEPA Air Filter9152%92%6%2%8897%34% Other Accessories3118%26%45%26%55%2631%

Water Heater Measures 23 Water Heater Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Replace2816%7%54%39%89%2024% Repair4727%2%87%9%2325%2428% Wrap4224%0%90%7%2022%2226% Pipe Insul8548%1%89%7%4044%4553% Temp ↓5129%0%92%8%4448%78% Other95%0%67%22%00%911%

Other Baseload Measures 24 Other Baseload Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Indoor Lights3620%0%6%94%2123%1518% Outdoor Lights3118%0%10%90%1820%1315% Refrigerator2414%0%4%96%1618%89% Other106%0% 100%22%89%

Attic/Roof and Repairs 25 Attic and Roof All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Attic Vent9856%0%84%14%7684%2226% Roof Repair2615%23%27%50%2527%11% Chimney Liner2514%16%64%16%1719%89% Repairs All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed Repairs#%REACHWAPOth#%#% Plumbing5632%55%5%41%3741%1922% Sewer2414%29%17%54%2123%34% Electrical148%36%50%36%78%7

Health and Safety Measures 26 Health and Safety Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Smoke Alarm8850%2%14%86%8290%67% CO Monitor9655%7%85%7%8998%78% Gutter/ Downspout 9655%89%7%4%8189%1518% Grading Lot6738%82%7%10%6066%78% Stair Repair127%75%8%37%55%78% Bath Bar53%60%0%20%11%45% No Skid Bath21%0%100%0%22%00%

Health and Safety Measures 27 Health and Safety Measures All JobsCHN JobsBA Jobs Measure Installed Funding Measure Installed #%REACHWAPOth#%#% Lead00% 0 0 Asbestos32%0%33%0%33%00% Poisons32%33%67%0%22%11% Pests74%100%0% 11%67% Environ Cleaning 12470%99%0%1%8796%3744%

Measure Summary Funds leveraged. REACH funding of important health and safety measures. WAP funding of typical weatherization measures. 28

ON SITE INTERVIEWS 29

Interviews 30 Number of On-Site Interviews Interview Dates Cleveland16May Columbus17June Total33

Measure Satisfaction 31 Satisfaction With Recalled Measures Mean Percent of Measures With Each Rating Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied Don’t Know Cleveland65%12%10%11%3% Columbus74%13%7%2%3% All Interviews70%12%8%7%3%

Changed Way they Use Home 32 Change in the Way the Home is Used Number Who Reported at Least One Change Mean Number of Changes Reported Mean Number of Effective Changes Reported Cleveland Columbus All Clients

Reported Changes 33 Changes in the Way the Home is Used Number of Clients Who Reported the Change (Unprompted) ClevelandColumbusTotal Use exhaust fans that were provided 314 Check and adjust for humidity level 314 Keep home cleaner314 No longer allow smoking in the home 112 Change furnace filter101

Changed the Way They Use Energy 34 Change in the Way Energy is Used Number Who Reported at Least One Change Mean Number of Changes Reported Mean Number of Effective Changes Reported Cleveland Columbus All Clients

Reported Changes 35 Changes in the Way Energy is Used Number of Clients Who Reported the Change (Unprompted) ClevelandColumbusTotal Lowered winter temperature5510 Turn lights off718 Increased the summer temperature 123 Installed CFLs303 Shorter showers101 Use timers for television101 Line dry clothes101 Discard freezer101

REACH Health Impacts 36 Health Impacts of the Program Number Who Reported Positive Impact Number Who Reported Negative Impact Cleveland81 Columbus70 All Clients151

REACH Health Impacts 37 Health Impacts of the Program Number of Clients Who Reported the Health Impact (Unprompted) ClevelandColumbusTotal Breathe Better167 Reduced Hospital Visits224 Fewer Asthma Attacks404 Able to Reduce Medication 123 Fewer Sinus Issues202 Able to Work More101 Reduced Doctor Visits101

Program Satisfaction 38 Overall Program Satisfaction Number of Clients With Each Satisfaction Level ClevelandColumbusTotal Very Satisfied Somewhat Satisfied235 Somewhat Dissatisfied112 Very Dissatisfied101 Don’t Know112 Total161733

On-Site Interview Summary Program Understanding: Many understood measures and why they were installed. Behavioral Changes: Many reported important changes in the way that they use their home and energy. Health Impact: Many perceived that the program had positive impacts on the health. Satisfaction: High levels of satisfaction. 39

CLIENT PRE/POST SURVEY 40

Survey Design Purpose – assess impact of the program on client health, safety, and comfort. Pre survey – conducted prior to any service delivery. Post survey – conducted one year later. 41

Home Conditions 42 Client Pre/Post Survey – Home Conditions Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Unsafe or unhealthy condition 85%38%47**80%59%21**26** Unsafe condition (unprompted) -mold 55%16%39**49%20%29**10 Unsafe condition (unprompted) -drafty 18%6%12**15% 012**

Client Behavior 43 Client Pre/Post Survey – Client Behavior Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Smoke in home27%26%122%27%-56** Do not use exhaust fan when showering 58%34%24**73%75%-226** Do not use exhaust fan when cooking 57%46%11*59%54%56 Warm up car in garage 4%5%10%2%2

Mold 44 Client Pre/Post Survey – Mold Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Any mold69%27%42**63%39%24**18* Mold in kitchen5%3%210%7%3 Mold in bathroom42%13%29**37%20%17**12 # Mold in basement51%15%36**47%29%18**18*

Pests 45 Client Pre/Post Survey – Pests Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Pests69%51%18**71%54%17**1 Used baits or poison53%33%20**53%36%17**3 Poison still in home20%15%525%12%13**-8**

Humidity 46 Client Pre/Post Survey – Humidity Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Summer home humidity – just right 22%53%31**27%46%19**12 Winter home humidity – just right 22%44%22**25%34%913 #

Asthma 47 Client Pre/Post Survey – Asthma Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Has asthma56%53%358%53%5-2 Asthma – visited doctor 49%45%453%47%6-2 Asthma – visited emergency room 22%20%225%24%11

Allergies 48 Client Pre/Post Survey – Allergies Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Allergies70%66%473%63%10-6 Allergies – medicine52%49%361%47%14*-11* Allergies - symptoms76%59%17**81%58%23**-6

Allergies and Bronchitis 49 Client Pre/Post Survey – Allergies and Bronchitis Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Allergies70%66%473%63%10-6 Allergies – medicine52%49%361%47%14*-11* Allergies - symptoms76%59%17**81%58%23**-6 Bronchitis or lung disease 43%41%247%42%5-3 Bronchitis – visited emergency room 18%16%224%14%10*-8*

Home Health and Comfort 50 Client Pre/Post Survey – Home Health and Comfort Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Household health – somewhat or very healthy 48%64%16**44%56%12 # 4 Home comfort – somewhat or very comfortable 69%87%18**72%80%810 #

Winter Comfort 51 Client Pre/Post Survey – Winter Comfort Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Drafty in winter83%52%31**76%66%1021** Cannot heat home to comfortable temperature 27%18%9*22%15%72 Home was uncomfortably cold 41%35%642%32%10 # -4

Summer Comfort 52 Client Pre/Post Survey – Summer Comfort Treated Clients (N=93) Untreated Clients (N=59) Net Change PrePostChangePrePostChange Have air conditioner85%84%185%78%-78#8# Cannot cool home to comfortable temperature 29%14%15**19%12%7#7# 8 Home was uncomfortably warm 52%38%14**46%47%15**

Client Pre/Post Survey Summary Significant improvements in safety, healthy behaviors, mold, pests, humidity, health, comfort, and winter and summer temperatures. Net changes were statistically significant with respect to unsafe home conditions, healthy behaviors, mold, humidity, comfort, winter drafts, and summer home temperature. Non-treated had better outcomes with respect to reduced pest poisons in the home, need to use medication for allergies, and need to visit the emergency room for bronchitis. 53

PRE/POST CLIENT ASSESSMENT 54

Pre/Post Assessment Overview Providers to collect information about participant behaviors, home condition, and health at intake and one year later. Not collected for all clients. Post data only collected for minority. 55

Dwelling Condition 56 Dwelling Condition Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses Excellent2%1% 5%3% Good29%24%27%33%48% Average42%52%46%44%41% Below Average21%9%15%16%6% Poor6%14%10%3%2%

Furnace Filter Changes 57 Furnace Filter Changes Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses Every 3 Months54%70%61%60%80% Every 6 Months21%14%18%15%9% Once per Year12%7%10%12%5% < Once per Year2%1% 0% Never11%8%9%12%6%

Mold 58 Mold Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses None28%0%16%24%74% Minor28%49%38%33%18% Significant28%33%30%29%5% Severe15%18%16%14%3%

Pests 59 Pests Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses None51%42%47%51%68% Minor35%34% 32%25% Significant11%16%13%14%5% Severe4%8%5%3%2%

Winter Comfort 60 Winter Comfort Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses Excellent1%2% 0%25% Good12%21%16%17%38% Satisfactory41%53%46%42%28% Unsatisfactory46%23%36%42%8%

Summer Comfort 61 Summer Comfort Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses Excellent1%7%4%0%25% Good18%16%17%21%33% Satisfactory45%47%46%49%25% Unsatisfactory36%30%33%30%16%

Air Quality 62 Air Quality Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses Excellent0%1% 0%2% Good20% 23%54% Satisfactory44%43% 46%32% Unsatisfactory36% 32%12%

Household Member Health 63 Household Member Health Pre Assessment Results Post Assessment Results BACHNAll BA with Post Results Services Received Responses Excellent1%3%2% 5% Good20%12%16%21%22% Satisfactory45%30%38%48% Unsatisfactory34%55%44%30%25%

Pre/Post Client Assessment Summary Much of the pre and post assessment data were missing. Results from the pre and post assessment analysis were consistent with the results of the pre and post client survey. Positive impacts on home comfort and safety. No impact on client health. 64

SUMMARY AND RECOMMENDATIONS 65

Accomplishments 180 clients received services. Allowed agencies to serve underserved households. Program coordination and leveraged funds. New partnerships. Capacity building. 66

Findings REACH funded health and safety measures and WAP funded weatherization measures. Positive impacts on unsafe home conditions, healthy behaviors, mold, humidity, comfort, winter drafts, and summer home temperature. No impact on specific health conditions. 67

Summary WAP can leverage additional funds to provide beneficial health, safety, and comfort impacts for program participants. Providers integrated additional health and safety measures into their established WAP procedures. Additional measures had a beneficial impact for the clients. 68

Recommendations Use LIHEAP funding to provide ancillary services to WAP participants. Find the most efficient ways to integrate measures with current practices. Different models may work better with different agencies’ current procedures. New health and safety measures should be implemented in a flexible way, to take advantage of agency partnerships and to create the greatest benefit. 69

Contact Jackie Berger APPRISE 32 Nassau Street, Suite 200 Princeton, NJ