1. Personal Safety, Insurance and Liability

2. This module covers: Assessor safety Occupant protection
Health advice vs. healthy homes advice
Liability principles
Instructor – we’re going to take a quick break from going through the evaluation process steps and turn to a different subject. We will cover four topics in this module:
Your safety during home assessments
Occupant safety and protection during assessments
A reminder about the difference between health advice and healthy homes advice
Information about liability that you should be aware of
NOTE: there are a few things we’ll touch upon during this module that we haven’t talked about yet – such as the written report that you’ll provide to the resident after doing an assessment. We’ll discuss those things in greater detail in other modules.

3. Assessor Safety Can you add to this list?
Personal protective equipment to consider:
Tyvek Coveralls
Respirator
Booties
Gloves
Safety Glasses
Hard Hat
Can you add to this list?
Instructor – this is a set of personal protective equipment you should consider using when you do an assessment. But two questions:
What would you add to the list?
Are there times when you would use some of the equipment but not others? Why
Note- this discussion is about professionals who go into people’s homes. Occupation-related personal protective equipment (PPE) is covered by OSHA with specific regulations regarding medical monitoring and guidance on worker protection. 3

4. Fine particles You can breath it in. You can’t see it. 2.4 microns
If a particle is less than 10 microns:
If a particle is smaller than 20 microns:
Most common airborne particle size is:
Most harmful particle size is less than:
You can breath it in.
You can’t see it.
2.4 microns
1 micron
NOT SURE WE NEED THIS
Instructor – keep these details about fine particles in mind. The bottom line is that fine particles can impact the health of your lungs – and those that are most damaging and most common are ones you won’t be able to see.
© 2012 SKC Inc.
Image courtesy of US EPA.

5. NIOSH approved N-95 Respirator mask
Respirator Masks
NIOSH approved N-95 Respirator mask
Minimum protection for dust, mold or smoke particles
No protection from carbon monoxide or other toxic gases.
Instructor – dust, mold or smoke particles MAY bother you, although they don’t affect everyone the same way. If you find that they do affect you, note that a NIOSH approved N-95 mask is at least minimum protection for dust, mold and smoke particles, but that it does not provide protection from any toxic gas.
Note- this discussion is about professionals who go into people’s homes. Occupation-related personal protective equipment (PPE) is covered by OSHA with specific regulations regarding medical monitoring and guidance on worker protection.

6. N-95 Respirator
Minimum protection if high concentrations of unknown particles are observed
Dust, mold, and smoke are made up of particles. First line of defense for protection is a NIOSH approved N-95 rated respirator.
Particle respirators do not provide any protection from carbon monoxide or other toxic gases!
Respirators are only a part of personal protective equipment (PPE).
Note- this discussion is about professionals who go into people’s homes. Occupation-related personal protective equipment (PPE) is covered by OSHA with specific regulations regarding medical monitoring and guidance on worker protection.

7. Wear Respirators properly
Top strap goes high on the back of the head. Bottom strap around back of neck.
Using two hands, mold the nose piece to the shape of your nose. Pinching with one hand usually will not work well enough to make a good seal.
Positive pressure fit check. Cover the respirator with both hands and exhale. If air leaks around nose, adjust nose piece. If air leaks around edge, adjust straps by pulling back along head.
Negative pressure fit check. Cover the respirator with both hands and inhale sharply. If necessary, adjust fit as described above.
Photos courtesy of Curtis Reddington, © 2012.

8. All Masks are Not the Same
Instructor – there’s no substitution that you can do for an N-95 respirator mask. Dust masks and surgical masks will not work. Dust masks don’t provide the necessary minimum level of protection because they lack sufficient particle capture efficiency. They also don’t fit tightly enough. Surgical masks are designed to prevent the spread of particles from the wearer, not to protect the wearer from particles in the air.
Note- this discussion is about professionals who go into people’s homes. Occupation-related personal protective equipment (PPE) is covered by OSHA with specific regulations regarding medical monitoring and guidance on worker protection.

9. Assessor Hazards & Precautions
Be aware of
Significant structural defects and physical hazards
Improperly stored and uncharacterized chemicals and pesticides
Visible and significant biological Contamination
Fire and improperly stored combustible materials
Can you ask for a hazard to be removed?
Instructor – beyond dust, mold and smoke, you should be aware of other hazards that can affect YOU. These include problems with the structure of the house, chemicals and pesticides, biological contamination such as a cockroach infestation, and risk of fire or explosion.
What hazards in these categories have you ever encountered? Have you ever asked for a hazard to be removed? What was it? What was the resident’s reaction? 9

10. OCCUPANT PROTECTION

11. What Information is Confidential?
Be aware of what information is “sensitive” to a resident.
Public agency staff must be aware of federal and state laws related to personal information
Instructor – protecting the occupant starts with understanding that certain information you may collect should be kept confidential. Sensitive information is information shared with you by a person or family because of your professional relationship and their trust that you will not divulge this information. This information should, of course, be kept confidential.
What kinds of data should be kept confidential?
Federal and state law defines what personal information is considered “private” and should be kept as confidential. This is often based on your agency type, job function, and what purpose sharing information would serve. Each law defines this in its own terms. It may a “personal identifier,” “personal health information” or “protected health information.”
Often, public agencies go above and beyond the law and develop their own privacy policies for confidential information. This may be to reduce negative publicity and/or liability.
CONFIDENTIAL

12. Sharing Client Information
Understanding the Health Information Portability & Accountability Act, 1996 (HIPAA)
Most, but not all, government agencies are HIPAA covered entities.
Clients should sign a HIPAA Permission form.
Is your organization a HIPAA-covered entity and do you use contractors/sub-grantees?
If yes and yes, then you should require a written HIPAA agreement with them. If you don’t, the contractor/sub-grantee can share any information you provide and YOU are liable.
Do not publish health and/or personal data on-line.

13. Sharing Client Information
Likely Sensitive
Usually Not Sensitive
Use of addictive products
Illegal conduct
Mental health
Personal hygiene
Medication
Health conditions
Symptoms
Citizenship
Occupation
Birth date/age
Race/ethnicity
Gender
Organizational affiliation
Home address
Instructor – here is a listing of sensitive information that you should keep confidential and information that is usually not sensitive.

14. Child Protective Services
What if you see:
Young children home alone?
Active physical abuse, or evidence of abuse?
Drug activity?
Adults have to leave, You can stay my teenagers are here.
Instructor -In your occupation, you are not a mandated reporter regarding child abuse or neglect. A “mandated reporter” – usually defined under state law – is a person that is in contact with children as part of their normal job duties. Mandated reporters are required to report suspected child mistreatment immediately when they have “reasonable” cause to believe that a child is being abused or neglected.
But, anyone can report suspected child abuse or neglect. Reporting abuse or neglect can protect a child and get help for a family, it may even save a child's life. In some states, any person who suspects child abuse or neglect is required to report. To see how your State addresses this issue, read the Information Gateway publication, Mandatory Reporters of Child Abuse and Neglect. Note that there is training available on how to recognize physical abuse of another person (child, partner or elder). As an example, here is a resource on recognizing child abuse:

15. Discretionary Reporting
To whom do you report?
What do you report?
When?
Instructor - Some information is discretionary or not required to be reported by law. As part of the home assessment you will provide a written report on all of your findings to the occupant of the home so that they can make decisions about improving the conditions. Most importantly, the occupant needs to know if there are immediate hazards that should be corrected as soon as possible.
If the occupant is a tenant, reporting to the property owner can be a little tricky. This is where you must make professional decisions about what to report. Potential consequences could include violating the tenant’s trust, threatening your ability to get back in the house to finish an assessment or intervention, and in a worst-case scenario – lead to an eviction.
If the issue is a safety issue – and only the landlord can fix the problem – you must report it.

16. report to property owner AND tenant
No Smoke Alarms
House does not have any smoke alarms.
Pest Problem
There is an infestation of some type of pest.
No Window Guards
No window guards in high rise building.
Serious Structural Defects
Deteriorated Paint
Water Temp Too High
Property has structural defects that may cause an injury.
Peeling or deteriorated paint in homes older than 1978.
Hot water temperature is above 120 degrees F.
Immediate Threat
Sewage
Instructor - if there are immediate hazards or potential code violations, both the tenant and the property owner need to know. Also, there may be some conditions that only the owner can fix. Tenants don’t always have the financial resources, or the ability under the lease to perform painting or other interventions.
Investigate state and local laws, and be aware of internal policy as well. If there is not an internal policy, encourage your administrators to develop one. There is information that does not need to be reported to the owner. For example, maybe the occupant’s personal habits or hygiene is contributing to unhealthy conditions. Or, they are overcrowding electrical outlets. This information may be SENSITIVE, thus a good rule is to keep if confidential.
Sampling Results
There is sewage intrusion in or very near.
If taken, provide results of lead and radon measurements.
Any other immediate threat to health or life.

17. Health Advice vs Healthy Homes Advice

18. Remember this Slide? You’re STILL not a real doctor . . . . .
Instructor – Remember that you should not provide health advice to the individual or family with whom you’re working -- rather that you talk about the impact on health from a hazard.
You’re STILL not a real doctor

19. What you Can and Cannot Say
Do not say: “Do [this intervention] and your child’s [illness] will improve.” Do say: “I recommend [this intervention]. There is evidence, according to [source] that there is an association between [this intervention] and reduced symptoms.”
Instructor – remember that during the assessment, you should be taking the opportunity to educate the client about the hazards you identified and the association between those hazards and health impacts. Keep in mind though, that you should not make recommendations claiming “if you do this you will get better or your child’s asthma will improve.” You can say “I recommend this because the published evidence has shown an association between [this intervention] and reduced symptoms.” You can also recommend an environmental change without connecting it specifically to a specific health benefit but indicate that this intervention, combined with several other (multi-faceted) interventions have been shown to improve health.

20. Liability Principles

21. What is Your Liability? During the assessment When you draft a report
What are you responsible for?
When you draft a report
What if you leave something out?
If you share information
With another organization
With a landlord
With a former spouse
General liability insurance
professional errors and omissions insurance.
Instructor – during a typical home assessment, you are responsible for looking for and identifying evidence of health and safety hazards. You have a limited responsibility during that time, but it’s important to be thorough, systematic, and objective using some kind of method to document any issues and concerned observed.
When you draft a report – you want to make sure that you include all the information we discussed in putting together a report. Keep in mind that there is a risk in a report of an error of interpretation or leaving something out entirely. This is a liability risk so it is important to indicate that the assessment and the report are limited in their scope. This also provides emphasis on the need to establish a scope of work for the assessment and to consider having a scope of work form or consent form that the occupant signs.
Remember that it’s always important to maintain privacy with someone else’s information. Always seek permission from the occupant (your client) before you share any of the results of your assessment. If possible, have your client share the information rather than going through you. If you are asked to share, once again, use a form, either a scope of work form or consent form that the occupant signs giving you this permission. Even better to have them indicate who you are allowed to share information with, if necessary.
Umbrella policy 21

22. Liability “They can’t sue me, I don’t inspect for these issues!
Auditors / Home Performance
Low / minimum
vs.
IAQ / Asbestos / Mold / Hazardous conditions
High / litigation industry
How about some speaker notes here?!
“They can’t sue me, I don’t inspect for these issues!

23. Hazardous Operating Procedure
If I or my employees suspects hazardous conditions, we will:
Consult the client
Provide X, Y & Z documents
Have it tested by or sent to X lab
Seek and or provide ongoing training
Speaker notes needed!!!

24. Sample Consent Form – First page
Instructor – you may want to consider providing a consent form to residents with whom you’re working. The first page of this sample consent form from Children’s Mercy Hospital includes the following sections:
A description of the assessment activities.
Information about the disclosure of data.
Information about fees and expenses.

25. Sample Consent Form – Second page
Instructor – The second page of this sample consent form includes the following sections:
A description of what will be in the final written report provided to the resident.
The limitations of the assessment (e.g. only readily accessible parts of the house were assessed)
A “hold harmless” release clause.
Authorization to provide copies of the report to certain parties.
Signature of the authorizing individual.

26. “Rules of Thumb” Legal issues and liability Follow laws
Exercise caution when making recommendations for home treatments
Recommend professionals when needed
Use applicable standards when available
Instructor – here are some “rules of thumb” regarding legal issues and liability.
Follow all laws
Exercise caution when making recommendations for home treatments; never “wing it”
Recommend professionals when needed
Use applicable standards when available
Here is an extremely important note: There is a limited amount of research and data for many of the exposure sources seen in residential homes. In some cases, we still do not clearly understand the relationship between exposure and disease, allergic reaction or other etiology or the treatment that addresses the problem.

27. Liability Exposures Multiple sources and types of exposures
Healthy Homes Practitioners
Multiple sources and types of exposures
Limited research and data
Lack of clear standards and guidelines
Testing methods and controls
Instructor - expanding the scope of your work to perform healthy homes assessments and interventions may expose you to new risks. You may consider updating your job description, and carrying your own insurance if you do not already have it through your agency or organization.
Healthy housing practitioners may be responsible for assessing and treating various residential environmental health and safety hazards. These include lead-based paint hazards, mold, mildew, pests, vermin, pesticides, radon and physical injury sources.
Again, except for lead and radon, we have few nationally recognized standards or guidelines for achieving safe or acceptable levels of remediation for a number of environmental health and some safety exposures.
A lack of standards and accepted guidelines means that there is often no clear legal standard of reasonable care owed to residents and others who might be exposed to the hazards.
Efforts are underway to develop effective testing methods and remediation controls. However, these methods and strategies are still being evaluated to determine how effective they are in eliminating or temporarily controlling the hazards. So practitioners will have to carefully select their approaches to testing and remediating.