1. 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

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

3. 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.

4. 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

5. 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.

6. Resources

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. City-Wide Intervention; 11-Partners

14. 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

15. 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.

16. Questions?

17. 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

18. 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

19. 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

20. 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)

21. 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?

22. 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

23. 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)

24. 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
x229
Inspection Services 24 Hour Hotline