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Bring Back Housecalls . . . And Fix the House

In his October 14, 2015 opinion in the NY Times, cardiologist Sandeep Jauhar lists two major reasons why the revival of doctor housecalls makes sense: better patient outcomes and savings to the health care system, primarily due to reductions in re-hospitalizations and better care coordination. He recounts a stirring anecdote about his visit to a patient’s home, where his observations of the patient’s living conditions gave the doctor new insights about why this patient had been hospitalized four times in six months.

The link between the home and a person’s health, and the need for clinicians to ask about patients’ home conditions, is something that we here at NCHH have focused on for years. People spend 90% of their time in their homes, and vulnerable populations such as young children and the elderly, spend even more. But clinicians tend to focus on the patients’ medical treatment, without realizing that conditions in their patients’ home can thwart these medical efforts and land patients right back in the hospital. Hazards at home can also cause such a great decline in health and function that the patient faces the trauma of moving away from his/her lifelong home and into a care facility.

While Dr. Jauhar notes the insight the home visit gave him, he doesn’t recount the steps he then took to alleviate the adverse conditions he observed. He did not discuss the housing structure itself, which can play an enormous part in the health of residents. For example, deferred home maintenance, a common problem for elderly homeowners, can lead to escalating health and safety hazards in the home, including faulty electrical wiring posing burn and fire hazards, torn and uneven flooring and shaky or missing stair railings leading to fall hazards, and faulty ventilation systems exacerbating respiratory ailments or posing asphyxiation hazards.

We at NCHH support home visits by clinicians, be they doctors, nurses, or occupational therapists. If they can’t go to homes, clinicians need to take the time during office visits to ask patients about home conditions. Clinicians should have a ready list to refer patients to organizations that can help fix home-related issues, e.g., Meals on Wheels, free prescription mail delivery services, local housing agencies for minor home repairs, and other community organizations that can arrange transportation for homebound residents. Improvement in resident health on a national scale is possible, but only if we take steps to both medically treat people and intervene in their homes.

Remembering Congressman Stokes

Rep. Louis Stokes (D-OH) passed away Tuesday after a battle with cancer at age 90. More than anyone, he was responsible for launching the nation's healthy homes effort at HUD more than a decade ago and was a tireless supporter of our nation's lead poisoning prevention program. Terry Allan (now commissioner at the Cuyahoga County Health Department) and Dr. Dorr Dearborn (now professor  emeritus at Case Western) brought to his attention the importance of addressing housing-related health hazards and he took action. I had the distinct honor of working with him while I was at HUD and he led the HUD appropriations subcommittee in the House; I knew him as a truly visionary leader, one of those rare individuals who really did achieve an ability to reach across the aisle and insist our country do the right thing and get things done. Just a few years ago, he was honored in Cleveland for his healthy homes work and other achievements and I remember him saying something like, "I don't really know what all this fuss is about, I'm just a kid who grew up in public housing who wanted to do the right thing for our children." He was an inspiration to us all. See this link for more details.  

Green Renovation and Senior Living – Three Years of Healthier, Happier Residents

Three recent articles illustrate how innovative green building practices and amenities help ensure that low-income seniors feel healthier and stay mobile, active, social, and most of all, independent. “Self-Reported Health Outcomes Associated with Green-Renovated Public Housing among Primarily Elderly Residents,” a study completed by the National Center for Healthy Housing (NCHH) in 2013 and published in January 2015 by the Journal of Public Health Management and Practice, found that residents have improved mental and general physical health one year after a green renovation, including fewer falls and less exposure to tobacco smoke. “Orness Orness Plaza Atrium, pre-renovation. Photos courtesy of Blumentals/Architecture.Renovation Makes Residents Happier” (Mankato Free Press, July 11) indicates that these health improvements are continuing today as residents utilize the innovative designs developers incorporated in their building to increase walking, exercise, and social engagement. “Renovating Senior Complexes to Be Green, Healthy, and Connected,” (Shelterforce, posted May 25) discusses these and other innovative design practices developers and architects are using to promote health and wellness in affordable senior complexes.

Orness Plaza in Mankato, MN, is a low-income apartment building with 101 independent living units housing primarily elderly residents. Between 2010 and 2012, the building underwent a green renovation, complete with improved ventilation, moisture and mold reduction, and various safety measures. Renovations were funded by the American Recovery and Reinvestment Act through a U.S. Department of Housing and Urban Development (HUD) Competitive Capital grant, the Minnesota Department of Employment and Economic Development, as well as the Mankato Economic Development Authority, Southwest Minnesota Housing Partnership, and the Greater Minnesota Housing Fund.

NCHH’s HUD-funded “Green Rehabilitation of Elder Apartment Treatments” ("GREAT") study was one of the nation’s first examinations of the health outcomes among older Americans following green renovation. While healthy housing has traditionally focused on childhood diseases and injuries associated with housing quality, the GREAT study asked whether improvements might also occur in the at-risk and growing population of low-income elders. The GREAT study concluded that, one year after the green renovation, residents’ mental and general physical health improved, falls were less frequent, and exposure to tobacco smoke was reduced. The Mankato Free Press article describes how, three years after the renovation was completed, residents continue to benefit both mentally and physically, walking along the indoor paths bordered by gardens and pools and participating in fitness programs in an exercise room that was part of the renovation design.

In tOrness Plaza Atrium, post-renovation. Photos courtesy of Blumentals/Architecture.he Shelterforce article, NCHH summarizes interviews with architects and developers who work in senior housing construction and renovation. Recognizing that no amount of grab bars and handrails can minimize risk factors caused by lack of exercise and physical activity, developers are beginning to use innovative design practices that help to improve seniors’ lives and health, including building fitness facilities and exercise programs like those mentioned in the Mankato Free Press article, incorporating wayfinding measures (design elements that help residents recognize where they are) into their building plans, and creating spaces that encourage resident social engagement. The majority of developers interviewed indicated only negligible differences between development costs for family housing and senior housing; however, some indicated a potential of 2% to 10% higher costs (numerous developers disputed others’ claims of costs above 3%) for senior housing due to additional safety features. On the other hand, costs related to operations and maintenance tend to be lower in senior housing because seniors generally cause less wear and tear on building structures and have lower utility usage.

Cost savings from lower operations, maintenance, and energy costs help balance slightly increased costs of developing housing for low-income elderly residents. Affordable senior housing could help reduce the rising costs of healthcare and help seniors maintain their independence longer.

Photos of the Orness Plaza atrium pre-renotation (upper picture) and post-renovation (lower picture) courtesy of Blumentals/Architecture, Inc.

Appropriations Update and Take Action: Funding for Healthy Housing and Lead Poisoning Prevention

It has been a busy few weeks on the appropriations front for healthy housing.

The good news is that the Senate appropriations committee voted on June 25 for level funding for HUD and CDC healthy homes, lead poisoning prevention, and lead hazard control programs! THANK YOU to all of you for your sign-ons and phone calls to make this happen! This is all the more remarkable given the very severe budget caps!

Unfortunately, both Housing and Urban Development (HUD) and Health and Human Services (HHS) suffered billions of dollars in funding cuts overall. The cuts harmed several critical environmental health and housing programs that impact healthy housing, including the National Housing Trust Fund, HOME, and CDBG. We will continue advocacy to lift the onerous budget caps and increase HUD and CDC funding levels.

Please Take Action Today:

Call Senator Susan Collins (R-ME) and Senator Jack Reed (D-RI), the top Republican and Democrat on the Senate HUD appropriations subcommittee:

  1. Call Senator Collins at 202.224.2523 and say: "I'm calling to thank Senator Collins for maintaining level funding for HUD's Office of Healthy Homes and Lead Hazard Control. I greatly appreciate her standing up again for the health and well-being of America's children and communities."
  2. Call Senator Jack Reed at 202.224.4642 and say: "I'm calling to thank Senator Reed for maintaining level funding for HUD's Office of Healthy Homes and Lead Hazard Control and for offering an amendment to increase that funding. I greatly appreciate him standing up again for the health and well-being of America's children and communities."

Also, please forward this email to any friends and colleagues in Maine and Rhode Island, and ask them to make the phone call too!

Join the National Safe and Healthy Housing Coalition.


  1. HUD Office of Lead Hazard Control and Healthy Homes (OLHCHH):
    • On June 9, the House of Representatives passed its HUD appropriations bill cutting HUD’s OLHCHH funding by $35 million to $75 million in 2016.
    • On June 25, the Senate appropriations committee voted in a bipartisan effort to maintain level funding for HUD's OLHCHH at $110 million in 2016.
  2. CDC Healthy Homes and Lead Poisoning Prevention Program:
    • On June 24, the House Appropriations Committee voted to cut this program by $1/2 million to $15 million in 2016.
    • On June 25, the Senate Appropriations Committee voted to maintain level funding for CDC's Healthy Homes and Lead Poisoning Prevention program at $15.5 million in 2016.
Several representatives and senators spoke out and offered amendments in favor of the HUD Office of Healthy Homes and Lead Poisoning Prevention programs, and Representative David Price (D-NC) mentioned the Partnership Effort for the Advancement of Children's Health (PEACH) of Durham, North Carolina, by name. Go PEACH!

Next Steps:

The National Center for Healthy Housing and the National Safe and Healthy Housing Coalition will work to increase the overall budget caps to allow for funding increases to HUD and CDC, and continue to advocate for level or increased funding to healthy homes programs. The House and Senate will continue to deliberate and negotiate final appropriations levels throughout the summer and fall, but the bills passed this week will provide a likely baseline.

Join the National Safe and Healthy Housing Coalition.

Quotes from Capitol Hill:

From the June 25, 2015, Senate Appropriations Committee hearing:

"[This amendment] provides additional resources to protect Americans and ensure their safety. For example, it would add 10 million dollars to lead hazard reduction. This has been a curse, particularly in low-income, older neighborhoods, and we have them all across the county. And once a child is infected by lead, that child's cognitive ability, that child's ability to succeed in school and to contribute to this community, is devastated. And it’s completely avoidable. You simply have to get the lead out."

‎        –Senator Jack Reed (D-RI), Ranking Member, HUD appropriations subcommittee

"I do want to address just one point, specific point that the senator made, and that has to do with lead hazards, which we have worked on for years. For 18 years we've worked on this, we've had hearings in our home states, and I would say that, first of all, the House bill slashed this program to only 75 million. We have funded it at 110 million dollars, which is the same level as last year. So I don't want anyone to leave this room under this mistaken impression that we had slashed the program for lead hazard removal out of old housing stock, because that just would be inaccurate. "

‎       –Senator Susan Collins (R-ME), Chair, HUD appropriations subcommittee

"This bill would be better if we had a bipartisan agreement to lift the onerous sequester funding levels and with the resources in the amendment Ranking Member Reed will offer. His amendment would allow us to meet more of our country's infrastructure and community needs by providing $3.9 billion for aviation and rail safety, housing, lead paint abatement, and transportation infrastructure."

‎      –Senator Barbara Mikulski (D-MD), Vice-Chair, HUD appropriations committee

Tell Congress: No More Cuts to Lead Poisoning Prevention!

“When my son was poisoned by lead, I had to act. But how?”

This was the question posed by Thomas Beller, a New Orleans resident and father whose story of lead poisoning was published yesterday in a New York Times op-ed. Despite Beller’s efforts to avoid his child’s exposure to lead, his son was poisoned by remodeling on his neighbor’s home. Through rapid intervention – received only because his son had routine blood lead screening at age one – his son has since reduced his blood lead levels. Yet like millions of other parents of lead-poisoned children, Thomas is left with the difficult question: What is my next step?

Millions of children living in urban areas of the United States are at a disproportionally higher risk of being lead poisoned. An article in The Washington Post last week identifies lead poisoning as one of the most ignored factors affecting the educational outcomes of poor children.

With blood lead levels playing such a major role in the development and well-being of children, the job of addressing this issue must not be left only to those who are affected by it. Yet Congress has failed to prioritize this issue: Just last week, the House of Representatives cut the HUD’s Office of Lead Hazard Control and Healthy Homes’ funding by 31%.

The Center for Disease Control’s (CDC’s) Healthy Homes and Lead Poisoning Prevention could potentially face similar cuts; the House will release its proposed CDC funding levels tomorrow.

Let’s hope the House is not as short-sighted in its CDC funding as it was with its HUD funding and restores funding for the Healthy Homes and Lead Poisoning Prevention Program to $29 million – or, at a bare minimum, retains the current $15 million funding level. This program provides surveillance for lead-poisoned kids and education to families so that perhaps other parents like Beller can help their kids in time, and so that communities can find the homes making children sick and repair them to be lead-safe.  

Tell your members of Congress that funding levels for these programs cannot be cut further. We must end the scourge of lead poisoning once and for all – and help those kids who have already been poisoned. If you haven’t yet, sign the letter to Congress demanding full funding – and email it to five of your colleagues today!

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