Category Archives: Housing
A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.
Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).
Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.
Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.
The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.
The goals of the guidelines for the respite care centers are to:
- Align with other health industry standards related to patient care
- Represent the needs of the patients being served in the medical respite centers.
- Promote quality care and improved health
- Create standards for a range of respite center types with varying degrees of resources
NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.
There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.
“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.
Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.
EBOLA Update: RWJF Gives $1M to the CDC Foundation’s Global Disaster Response Fund
(NewPublicHealth is monitoring the public health crisis in West Africa.)
In order to assist the U.S. Centers for Disease Control and Prevention’s (CDC) ongoing efforts to combat the Ebola outbreak in West Africa, the Robert Wood Johnson Foundation (RWJF) has given a $1 million grant to the CDC Foundation’s Global Disaster Response Fund. The CDC has activated its Emergency Operations Center and deployed more than 70 public health experts in response to the outbreak, which so far has killed more than 1,400 people. “The spread of the Ebola virus in West Africa represents a global public health crisis,” said Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, in a release. “We are privileged to assist CDC in its heroic efforts to contain this outbreak, and we are confident of their ability to control this scourge—provided they have the support required to do the job. Additional resources are urgently needed, and we encourage other funders to respond as well.” Read more on Ebola.
CDC: More than a Quarter-Million Youth Who Never Smoked Used E-Cigarettes in 2013
More than a quarter-million middle school and high school students who had never smoked regular cigarettes used electronic cigarettes—or e-cigarettes—in 2013, according to a new U.S. Centers for Disease Control and Prevention (CDC) study appearing in the journal Nicotine and Tobacco Research. The study found that youth who had never smoked traditional cigarettes, but had tried e-cigarettes, were twice as likely to intend to smoke traditional cigarettes than were youth who had never used e-cigarettes. “We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development.” said Tim McAfee, MD, MPH, Director of CDC’s Office on Smoking and Health, in a release. Read more on tobacco.
U.S. Veteran Homelessness Down 33 Percent Since 2010
There has been a 33 percent decline in U.S. veteran homelessness and a 40 percent decline in the number of veterans who sleep on the street since 2010, according to new national estimates from the U.S. Department of Housing and Urban Development (HUD); the U.S. Department of Veterans Affairs (VA); and the U.S. Interagency Council on Homelessness (USICH). The agencies credited evidenced-based practices such as Housing First and other federal programs for the declines. There were an estimated 49,933 homeless veterans in American in January 2014. “We have an obligation to ensure that every veteran has a place to call home,” said HUD Secretary Julián Castro, in a release. “In just a few years, we have made incredible progress reducing homelessness among veterans, but we have more work to do. HUD will continue collaborating with our federal and local partners to ensure that all of the men and women who have served our country have a stable home and an opportunity to succeed.” Read more on the military.
Helping the Homeless Quit Smoking: Q&A with Michael Businelle and Darla Kendzor, The University of Texas School of Public Health
Not surprisingly, a recent study in the American Journal of Public Health found that homeless smokers struggle with quitting more than economically disadvantaged smokers who have their own housing. The study compared homeless smokers receiving treatment at a shelter-based smoking cessation clinic to people enrolled in a smoking cessation program at a Dallas, Texas, safety-net hospital.
“On average, homeless people reported that they found themselves around about 40 smokers every day, while the group getting cessation care at the hospital reported that they were more likely to be around three to four smokers every day,” said Michael S. Businelle, PhD, assistant professor of health promotion and behavioral sciences at The University of Texas School of Public Health Dallas Regional Campus, and the lead author of the study. “Imagine if you had an alcohol problem and were trying to quit drinking—it would be almost impossible to quit if you were surrounded by 40 people drinking every day. That is the situation homeless folks have to overcome when they try to quit smoking.”
Businelle said research shows that about 75 percent of homeless people smoke and that smoking is a leading cause of death in this population. And although homeless smokers are just as likely to try to quit smoking as are other smokers, they are far less successful at quitting, according to Businelle’s work. He said tailored smoking cessation programs are needed for homeless people, including smoke-free zones in shelters.
NewPublicHealth recently spoke with Businelle and his wife, Darla Kendzor, PhD, who is a co-author of the recent study on smoking and the homeless, as well as an assistant professor at The University of Texas.
NPH: Why did you embark on the study?
Michael Businelle: The smoking prevalence in this population is so high and homeless people are not enrolled in clinical trials so we don’t know what will work best for them. We’ve developed, over the last 50 years, really good treatments for the general population of smokers, but there are very few treatments that have been tested in homeless populations.
Darla Kendzor: And cancer and cardiovascular disease, which are in large part due to tobacco smoking, are the leading causes of death among homeless adults. So quitting smoking would make a big difference for them.
Earlier this year, when a federal task force convened to look at how to help Detroit pull out of bankruptcy and regain resident and business confidence, one of the first recommendations was to assess the many blighted areas of the city—typically created when residents leave an area in droves, or when a business moves out of a building and isn’t replaced by another—and begin restoring them for residential, business or green space use.
Blight matters. Beyond making a city ugly, abandoned areas become a haven for trash, toxic elements, drug sales and prostitution. In Dorchester, outside Boston, a space sold by the city for a parking lot was left vacant for years and became a trash dump with mounds of cigarettes, and cars and tires—all leaching toxins.
A growing number of communities are starting to clean up those lots. In Baltimore, flight from the city has left close to a million homes and apartment buildings vacant over the last few decades, leaving in their place empty, dirty spaces that invite crime and trash. Bon Secours Community Works—the foundation of the Bon Secours Health System with hospitals in Baltimore and other cities—supports initiatives aimed at creating stable housing, including a program called Clean and Green, which is a part of Bon Secours' Housing and Neighborhood Revitalization Department.
Clean and Green is a landscaping training program that has transformed more than 85 vacant lots into green spaces, and has also begun to initiate community arts projects such as large public murals and community gardens. The program is designed to teach green job development skills, as well as provide free cleanup and beautification services to Baltimore neighborhoods.
Each program team is hired for six months of on-the-job training in green landscaping, during which they learn how to use landscaping and gardening tools and then go out into the field to clean lots, plant trees, pick up trash and do weeding. As part of their training, each individual gives at least three presentations about some aspect of green landscaping that they’ve learned, further preparing them for job interviews and jobs in the field. Each summer, youth employees also join the Clean and Green team for six weeks, working alongside the adults to learn about green landscaping and giving back to a community.
Planners, public health experts, community development leaders, architects and many others have come together over the past decade to focus on housing as a framework for a healthy life. A report released earlier this year by the Robert Wood Johnson Foundation’s (RWJF) Commission to Build a Healthier America made the link between health and housing clear:
“Living in unhealthy homes and communities can severely limit choices and resources. Healthy environments—including safe, well-kept housing and neighborhoods with sidewalks, playgrounds and full-service supermarkets—encourage healthy behaviors and make it easier to adopt and maintain them.”
Housing also impacts health when people spend so much on their rent or mortgage that they don’t have enough left over to pay for critical expenses such as food and medicine. According to the MacArthur Foundation—which released its second annual “Housing Matters” survey last month—during the past three years more than half of all U.S. adults have had to make at least one sacrifice in order to cover their rent or mortgage, including:
- Getting an additional job
- Deferring saving for retirement
- Cutting back on health care and healthy foods
- Running up credit card debt
- Moving to a less-safe neighborhood or one with worse schools
Ianna Kachoris, a MacArthur Foundation program officer who oversees its How Housing Matters to Families and Communities research initiative, said that the quality and safety of a home make a significant impact on a person’s overall quality of life. Among the housing specifics that can impact health are lead or mold; the need to move frequently; having to live with many other people to make housing affordable; and concern over being able to afford the rent, the mortgage or needed housing repairs. The survey also found that accessing affordable quality housing in their communities is difficult for many people, including families with average income, young people just getting started in the labor force and families who want to live in quality school districts.
Report: Food Sodium Levels at Many Top Chains Continue to Be Unhealthily High
From 2009 to 2013, the nation’s top restaurant chains reduced the sodium in their foods by an average of only 1.5 percent annually, according to a new report from the nonprofit Center for Science in the Public Interest (CSPI). In a review of 136 meals from 17 chains, researchers determined that approximately 79 percent of the 81 adult meals contained more than 1,500 milligrams (mg) of sodium—or one mg more than the U.S. Centers for Disease Control and Prevention recommends as a full day’s limit. The study also found efforts to reduce sodium to be inconsistent, with some chains actually increasing the amounts over the studied time period. CSPI Executive Director Michael F. Jacobson said the findings indicate that the U.S. Food and Drug Administration’s “wait-and-see” approach to sodium in packaged and restaurant food doesn’t work and that a new approach is needed. Read more on nutrition.
CDC: Antibiotic-resistant Foodborne Germs Remain a Serious Public Health Issue
New data from the U.S. Centers for Disease Control and Prevention (CDC) indicates both positive and negative trends in the ongoing public health fight against antibiotic-resistant foodborne germs, which contribute to an estimated 430,000 U.S. illnesses every year. According to the data, multi-drug resistant Salmonella—which causes approximately 100,000 U.S. illnesses annually—decreased over the past decade, but Salmonella typhi resistance to certain drugs increased by 68 percent in 2012, meaning one of the common treatments for typhoid fever may not be effective. “Our latest data show some progress in reducing resistance among some germs that make people sick but unfortunately we’re also seeing greater resistance in some pathogens, like certain types of Salmonella,” said Robert Tauxe, MD, MPH, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases. “Infections with antibiotic-resistant germs are often more severe. These data will help doctors prescribe treatments that work and to help CDC and our public health partners identify and stop outbreaks caused by resistant germs faster and protect people’s health.” Read more on food safety.
Four Communities to Share $120M in HUD Grants for Community Revitalization
Four U.S. communities will split nearly $120 million in U.S. Department of Housing and Urban Development (HUD) grants earmarked for the redevelopment of severely distressed public or HUD-assisted housing and their surrounding neighborhoods. "HUD's Choice Neighborhoods Initiative supports local visions for how to transform high-poverty, distressed communities into neighborhoods of opportunity," said HUD Secretary Shaun Donovan. "By working together, with local and state partners we will show why neighborhoods should always be defined by their potential—not their problems. Together, we will work to ensure that no child's future is determined by their zip code and expand opportunity for all."
The four communities are:
- Columbus (Ohio) Metropolitan Housing Authority — Columbus, Ohio
- Housing Authority of the City of Norwalk/Norwalk (Conn.) Redevelopment Agency
- City of Philadelphia, Office of Housing & Community Development/Philadelphia Housing Authority
- Housing Authority of the City of Pittsburgh/City of Pittsburgh
Read more on housing.
Depression Linked to Higher Heart Disease Death Risk in Younger Women
Women age 55 and younger are twice as likely to suffer a heart attack, die or require artery-opening procedures if they’re moderately or severely depressed, according to new research in the Journal of the American Heart Association. Investigators assessed depression symptoms in 3,237 women with known or suspected heart disease who were scheduled for coronary angiography, an X-ray that diagnoses disease in the arteries that supply blood to the heart. After nearly three years of follow-up, researchers found:
- In women 55 and younger, after adjusting for other heart disease risk factors, each 1-point increase in symptoms of depression was associated with a 7 percent increase in the presence of heart disease.
- In men and older women, symptoms of depression didn’t predict the presence of heart disease.
- Women 55 and younger were 2.17 times as likely to suffer a heart attack, die of heart disease or require an artery-opening procedure during the follow-up period if they had moderate or severe depression.
- Women 55 and younger were 2.45 times as likely to die from any cause during the follow-up period if they had moderate or severe depression.
Read more on heart health.
HUD Provides Additional Funds for Hundreds of U.S. Programs for the Homeless
The U.S. Department of Housing and Urban Development has announced a second round of grants totaling $140 million to nearly 900 local homeless assistance programs for both permanent and transitional housing programs. The grants will fund programs including 436 new local projects aimed at providing permanent supportive housing for people experiencing chronic homelessness. Read more on housing.
NIH Launches Public Website on 3D Printing
The National Institutes of Health (NIH) has launched the NIH 3D Print Exchange, a public website that lets users share, download and edit 3D print files related to health and science. Among other uses, the files can be used to print custom laboratory equipment, as well as models of bacteria and human anatomy. NIH uses 3D printing—or the creation of a physical object from a digital model—to study viruses; repair and enhance lab apparatus; and help plan medical procedures. The 3D Print Exchange also includes video tutorials; a discussion forum; and tools that convert scientific and clinical data into ready-to-print 3D files. Read more on research.
Evidence-based practices and model homelessness reduction programs that have been effective in other cities are the key tools behind a new initiative, the Mayors Challenge to End Veteran Homelessness, launched earlier this month by the U.S. Department of Housing and Urban Development (HUD) and the U.S. Department of Veterans Affairs (VA).
The goal of the Mayors Challenge is to end veteran homelessness by the end of 2015.Close to 60,000 veterans are homeless on any given night. Housing experts say the model practices and speed of their deployment can also serve as examples to greatly reduce homelessness in the general population—which can be as high as 3.5 million in any given year, according to HUD surveys.
Ending veteran homelessness has received increased attention in recent years. According to Eric Grumdahl, policy director of the U.S. Interagency Council on Homelessness, there has already been a 24 percent reduction in veteran homelessness in the last three years that is directly tied to evidenced-based practices, including:
- Housing First, a concept that eliminates prerequisites such as sobriety and minimum income before a veteran can be given housing.
- Permanent supportive housing, which adds mental health services.
- Rapid re-housing aimed at people who are homeless from time-to-time rather than chronically homeless.
San Diego and Phoenix were both recently cited by both HUD and the VA for effectively ending chronic homelessness among veterans.
In Phoenix, where one in five homeless adults was a veteran—about twice the national average—the city leveraged partnerships and local, state and federal funding to find housing solutions for veterans. Partnerships included state and federal government; the business and faith community; and non-profit groups. The city’s mayor, Greg Stanton, credits “a united front” and Housing First’s work to speed up placing veterans in safe housing.
Older Hispanics Taking their Medicines Because of Medicare Prescription Drug Plans
Hispanics have reduced the gap with whites in taking prescribed heart medicines since the 2006 launch of Medicare’s prescription drug benefit—Medicare Part D. The findings were reported in a study presented at the American Heart Association’s Quality of Care and Outcomes Research 2014 Scientific Sessions earlier this month. Researchers reviewed prescription drug data from Medicare’s national Medical Expenditure Panel Survey for white, African-American and Hispanic Medicare seniors for the years 2007-10. After Part D, adherence rates increased among all racial groups, with the highest increase in whites and Hispanics, but increased only slightly among African-Americans.
- Hispanics’ total group adherence rate improved about 60 percent.
- Whites’ adherence rate improved 47 percent.
- African-Americans’ adherence rate improved about 9 percent.
Read more on heart health.
USDA Announces Grants to Help Repair Houses in Rural Areas
The U.S. Department of Agriculture (USDA) has announced it is seeking applications for grants of about $4 million to preserve and repair housing for very-low- and low-income families living in rural areas. The funds are being made available by the USDA Rural Development's Housing Preservation Grant program. Eligible applicants include town or county governments; public agencies; federally recognized Indian Tribes; and non-profit and faith-based organizations. Applications are due July 28. Examples of previous grants include a 2012 award to Habitat for Humanity Lake County (Calif.), which received a $55,000 Housing Preservation Grant to help 12 low-income homeowners repair their homes. One person helped was a Vietnam veteran who used a wheelchair and could not leave his home without assistance. Habitat for Humanity widened his doorway and installed a wheelchair lift. Read more on housing.
Many U.S. Cancer Survivors Face Serious Financial Burdens
Many U.S. cancer survivors face significant economic burdens due to growing medical costs, missed work and reduced productivity, according to a study by the U.S. Centers for Disease Control and Prevention (CDC). “Cancer survivors face physical, emotional, psychosocial, employment and financial challenges as a result of their cancer diagnosis and treatment,” said Donatus U. Ekwueme, PhD, a senior health economist at CDC’s Division of Cancer Prevention and Control. The number of cancer survivors is expected to increase by more than 30 percent in the next decade—to 18 million Americans. Researchers analyzed data from the Agency for Healthcare Research and Quality’s 2008-2011 Medical Expenditure Panel Survey to estimate annual medical costs and productivity losses among cancer survivors aged 18 years and older, and among persons without a cancer diagnosis. Among those employed, more than 42 percent had to make changes to their work hours and duties. The report also found that about 10 percent of survivors aged 65 years and younger were uninsured and likely to have a larger financial burden compared to survivors with some source of payment for medical services. Read more on cancer.
HUD Awards $40 Million in Housing Counseling Grants
The U.S. Department of Housing and Urban Development (HUD) has awarded more than $40 million in grants to hundreds of national, regional and local organizations to help families and individuals with their housing needs and to prevent future foreclosures.
“HUD-approved counseling agencies use this funding to support a wide range of services from assisting lower income persons to locate an affordable apartment to helping first-time homebuyers avoid unsustainable mortgages,” said Secretary of Housing Shaun Donovan.
More than $38 million will directly support the housing counseling services provided by 29 national and regional organizations, seven multi-state organizations, 22 state housing finance agencies and 232 local housing counseling agencies. In addition, HUD is awarding $2 million to three national organizations to train housing counselors with the instruction and certification necessary to effectively assist families with their housing needs.
In 2012, HUD released two reports on the impact of HUD-approved housing counseling for families who purchase their first homes and those struggling to prevent foreclosure. In both studies, HUD found housing counseling significantly improved the likelihood homeowners remained in their homes.
Read more on housing
Chest Pain Incidence Drops for Whites, But not for Blacks
The percentage of people reporting angina (chest pain) dropped in the last two decades among Americans 65 and older and white people 40 and older — but not among black Americans, according to a study in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.
Angina is chest pain or discomfort that occurs when the heart isn’t getting enough oxygen-rich blood.
Researchers analyzed national health survey data starting in 1988 to find how many patients reported that a health care professional had told them they have the condition and how many people report angina symptoms.
- The rates for whites 40 and older reporting a history of angina dropped by about one-third, from the 2001-04 survey to the 2009-12 survey.
- The rates for whites 40 and older reporting angina symptoms declined by half from the 1988-94 survey to 2009-12 survey.
- For blacks, the rates were essentially unchanged.
- The rates for American women 65 and older reporting a history of angina dropped nearly in half from the 2001-04 survey to the 2009-12 survey.
- The rates for women 65 and older reporting angina symptoms declined by almost 60 percent from the 1988-94 survey to 2009-12 survey; the rates for men in this age group declined by more than 40 percent during this same time period
Read more on heart health
United States, Canada and Mexico Set Guidelines to Strengthen Information Sharing in Health Emergencies
The United States, Canada and Mexico have adopted a set of principles and guidelines on how the three countries’ governments will share advance public information and communications during health emergencies impacting the countries.
The Declaration of Intent calls on the three countries to:
- Share public communications plans, statements and other communications products related to health emergencies with each other prior to their public release;
- Apprise other appropriate authorities, depending on the type of health emergency, within their respective governments when the declaration is invoked;
- Conduct an annual short communications exercise to improve joint coordination; and
- Hold recurrent meetings to review and propose amendments to the Declaration of Intent.
Read more on preparedness