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Ensuring an Asthma-Safe Home: The Role of Tenants and Landlords


Creating a safe and healthy home for someone with asthma is challenging. The home can play host to many serious asthma triggers, including pests like cockroaches and dust mites, dampness, and ventilation problems that allow accumulation of particulate matter and other types of air pollution. People spend a significant portion of their time inside their home, and about 20% to 30% of asthma cases are linked to home environmental conditions.

While there are certainly steps that individual households can take to reduce these triggers in their home, renters often face unique barriers.

For example, while a household can take steps to remediate a pest problem in their apartment, the infestation may be present in the entire building. Mold and fungi due to leaks or dampness may be caused by structural problems outside of the renter’s control. Tenants may also be restricted in the changes they can make to their unit, like removing carpeting.

Given that over a third of U.S. households rent and one in four live in multiunit buildings, challenges like these warrant particular attention. Moreover, communities of color are both disproportionately burdened by asthma and more likely to live in rental housing.

Preventing and resolving housing issues is most successful when landlord and tenant work together. Multnomah County, Oregon’s Public Health Department, created a resource that highlights these opportunities: What Makes a Healthy Home: A Guide for Landlords and Tenants. The toolkit outlines the seven principles* of a healthy home (dry, clean, safe, ventilated, pest-free, maintained, and contaminant-free), and outlines how both tenants and landlords can play a role in maintaining the healthy status of a unit.

Regarding moisture, for example, the guide explains how landlords are responsible for ensuring all fans are in proper working order and are ventilated outside of the property, regularly inspecting the gutters and making sure all windows are well sealed. Tenants, on the other hand, are in charge of using the fans when showering or cooking, communicating water leaks to landlord immediately, and keeping their unit temperature around 68 degrees to both prevent mold and keep it well ventilated.

While in many case tenants and landlords can work together to solve these problems proactively, if a problem does arise that the landlord is not addressing, tenants have rights. When considering issues of tenants rights, it would be wise to seek legal assistance, especially before taking any action regarding the lease or payment. The U.S. Department of Housing and Urban Development (HUD) allows tenants to search for legal aid by state.

Most states have an implied warranty of habitability, which means that landlords must keep their properties “habitable” even if the upkeep isn’t specifically stipulated in the lease. Every state except Arkansas requires rental housing be kept in “livable condition,” which means that it must have safe electrical, plumbing, heating, and ventilation systems, as well as clean and safe hallways and stairs. These requirements also require garbage removal and vermin extermination. Beyond these baseline standards, the definition of “habitable” varies under state and local law. Households living in Section 8 or other federally-sponsored housing are covered under more strict federal standards.

If an issue goes unaddressed, tenants can contact the building manager with a written request about the situation. It is important to document the problem in detail including photos, a description of the issue, and the date and time of the issue. If the building manager is not responsive, however, tenants can request a city or county inspection for violations. Each state has slightly different processes for such complaints, but a call to the local health department is often a good place to start.

Finally, the U.S. Fair Housing Act (FHA) and the Americans with Disabilities Act (ADA) provide additional protections for individuals with disabilities who live in subsidized rental housing. Asthma is specifically classified as a disability under FHA and ADA. Tenants with asthma have “a legal right for reasonable accommodations to rules, policies, practices or services. They also are entitled to structural changes by the reasonable modification provision when a particular asthma trigger in the housing environment impacts their disability.” FHA and state fair housing laws provide similar protections for market-rate housing.

The process of submitting a formal complaint or request for accommodations can be challenging and new for tenants. Many tenants often don’t feel comfortable making complaints about their housing quality due to uncertainty as to how their landlord will respond or fear of retaliation. This is especially true for tenants living in high-demand rental markets where eviction rates are high. Many tenants also face other barriers to submitting complaints, including language access and work schedules. Local asthma coalitions, tenants rights organizations, and  local public health departments can provide support to tenants through this process. While there is no comprehensive list of asthma coalitions, you can usually find resources by searching “asthma coalition city, state” or “public health department city, state.” Some of these groups even coordinate environmental assessments using the EPA environmental assessment checklist and are able to triage violations directly.

For households living in rental housing, the challenges to creating a healthy home environment can be significant. Ideally, tenants and landlords can work together to prevent asthma triggers and remediate any issues. However, while protections and processes are in place to support this collaboration, in practice resolving these problems can be time-consuming and discouraging for tenants. Understanding their rights as tenants and enlisting the support of local organizations can be critical to a tenant’s success.


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*Note: At the time that What Makes a Healthy Home: A Guide for Landlords and Tenants was published, there were seven accepted principles of healthy housing. An eighth, "thermally-controlled," has since been adopted by the healthy homes community.

A version of this article was published in July 2013 as "How to Create an Asthma Safe Home Part II: Solutions for Tenants and Landlords" on the Propeller Health site. The author has modified portions of the article for publication here.




Justine Marcus is currently pursuing a dual degree, Masters in City Planning and Masters in Public Health, at the University of California Berkeley. Through her graduate studies, Justine is exploring how community infrastructure‎ – from housing, to water, to governance ‎– can be used to address health disparities and build community power. She is currently a graduate student researcher for the UC Berkeley Center for Community Innovation, where she is examining the health and material impacts of evictions on households. Justine is a proud Wisconsinite and lifelong public school alumna.  

Reasonable Accommodations and Housing Code Compliance

Ideally, a landlord who gets a complaint from a tenant about cockroaches, mice, water damage, or mold in a building will promptly assess the complaint and, if it is confirmed, fix the problem and eliminate its cause. If the landlord is slow to act, the tenant may complain to the local housing code official, who, if the problem is confirmed, would order the necessary corrections. If the landlord still does not act, the code official may take the case to court. In some communities, the tenant could go to a special housing court to demand fixes.

Unfortunately, life is not always ideal. Code violations linger as the enforcement process drags out. Tenants become frustrated as they frequently feel forgotten or even blamed for the dangerous conditions that make their own homes a real threat to their health, safety, and welfare.
 
For tenants with asthma, the threats are not only real but significant. The presence of pests or dampness can worsen their asthma and increase their risk of an asthma attack that can diminish their health, disrupt their success at school or work, and even endanger their lives. Nine people die of asthma every day in the U.S., and, though the underlying causes are myriad and complex, asthma triggers such as cockroaches, mice, water damage, and mold may be contributing factors and are usually preventable.
  
Some tenants with asthma – and their landlords – may not understand their rights and responsibilities under the American with Disabilities Act (ADA) and the Fair Housing Act (FHA). Because asthma is a disability under the ADA and FHA if it substantially limits a major life activity, the tenant experiencing those effects is entitled to reasonable accommodations. When the definition of a disability under the ADA was expanded in 2008, asthma was specifically identified as an example because it physically impairs the respiratory system. Though more may well be required, complying with the housing code is certainly a reasonable accommodation to help prevent unnecessary exposure to asthma triggers like pests, mold, and dampness.

The ADA and FHA apply to housing that is subsidized by the federal, state, or local government. In private housing, such as market-rate rentals, the FHA and state fair housing laws require reasonable accommodations for disabilities like asthma and, unlike most housing codes, protect the tenant from retaliation by the landlord for making a complaint.

Unlike many housing codes, the FHA protects tenants from retaliation by their landlords for seeking a reasonable accommodations or filing complaints. Everything hinges on a tenant making a request for accommodation. This means the tenant must inform his/her landlord that someone in the unit (an adult whose name appears on the lease or one of his/her dependents) has asthma and requests a reasonable accommodation. While it’s acceptable under the law to verbally communicate the request to the landlord, it will help a tenant’s case to put the request in writing and provide a doctor’s letter. It is advisable to have a doctor document the diagnosis of asthma and, based on a photo or their understanding of the apartment conditions, affirm that the presence of pests, dampness, or mold can worsen asthma.

If the landlord does not respond quickly enough, or the tenant is not satisfied with the accommodation provided, he or she can file a “Section 504 complaint.” While there may be a local option, the person may file the complaint directly with HUD, and the agency will route it to the proper authority. HUD’s website has options for filing in seven languages, including Spanish, Arabic, and Chinese. No lawyers need to be involved, although they are not prohibited from participating in the process. Importantly, the FHA requires any person providing housing to accommodate disabilities, even if the landlord is a private party without any federal funding.

HUD has 10 days to acknowledge receipt. Within 20 days of acknowledging receipt, HUD must accept, reject, or refer the complaint. Referral may be to another agency. If HUD accepted the complaint, the landlord has 30 days to respond. HUD will strive for a voluntary resolution but is responsible for ensuring that the landlord follows the law.

If the housing problems are pervasive and persistent within a building or development, tenants can go to court to enforce the law. For example, in December 2013, the New York City Housing Authority’s (NYCHA) tenants and two community advocacy organizations, Manhattan Together and South Bronx Churches, represented by the Natural Resources Defense Council (NRDC) and the National Center for Law and Economic Justice (NCLEJ), filed a class action lawsuit against the housing authority. Click here for a sample request for accommodation from a tenant to NYCHA. Click here for a NYCHA-specific checklist (delveloped by NRDC and NCLEJ) to help make a request for accommodation. Note that other housing authorities may have different requirements.

NYCHA and the plaintiffs negotiated a court order designed to address water and dampness problems in a systematic manner that protected all residents. NYCHA has to:
  • Revise its policies, practices, and procedures.
  • Provide plaintiffs with detailed quarterly and annual progress reports.
  • Conduct random audits of its work orders to ensure that 95% of problems were resolved in a timely manner.
  • Abate flooding in 24 hours, with wet material dried in 48 hours.
  • Complete repairs that could be fixed in a single visit within seven days and complete complex repairs within 15 days, on average.
This type of large-scale litigation is a last resort when tenants do not get a satisfactory resolution through their requests for accommodation or appeals to code officials or the housing court. A wise landlord recognizes that complying with his/her obligations to accommodate tenants with asthma prevents major maintenance problems later on and results in healthier and happier tenants as well as lower maintenance costs. Landlords should understand that their responsibilities to address resident complaints in a timely manner and prioritize pest and dampness problems posing a threat to residents with asthma

Fund Healthy Housing NOW!

ACT NOW to ensure continued funding for HUD’s Office of Lead Hazard Control and Healthy Homes and CDC’s Healthy Homes and Lead Poisoning Prevention Program!

The home is the most dangerous place for U.S. families. Nearly six million families live in housing rivaling that of developing countries, with broken heating and plumbing, holes in walls and windows, roach and rodent infestation, falling plaster, crumbling foundations, and leaking roofs. Millions more in all 50 states live in housing with serious health and safety hazards including mold, exposed wiring, radon, unvented heaters, toxic chemicals, broken stairs, missing smoke detectors, and other hazards. Home-based interventions to address health hazards improve health and have a large return on investment: Each dollar invested in lead paint hazard control results in a return of $17 to $221, and each dollar invested in asthma home-based interventions that include education and remediation results in a return of $5.30 to $14.00.

That's why it makes both great common sense and great fiscal sense to direct more funding to the critical government programs that invest money in America's future by making homes safer and healthier. Unfortunately, these programs are always in serious danger of debilitating budget cutting.

Please take these simple steps now to ensure healthy homes and lead hazard control and lead /poisoning prevention programs continue!


STEP 1: SIGN your organization on to the attached letter to Congress for HUD and CDC funding.

Click here to sign on to the attached letter. And forward these links to your networks!


STEP 2: CALL your representative in the U.S. House!

1. Call the U.S. Capitol switchboard at 202.224.3121 and ask to be connected to your representative. (If you don't know who your representative is, the switchboard can tell you based on your address.)

2. Ask to speak with the staff person who handles the health or housing issues for the office.

3. When you reach or leave a message for the staffer (or speak to the receptionist if the staffer is not available), tell him or her:

  • "I'm calling to urge Representative [representative's last name] to sign on to the Congresswoman Slaughter sign-on letter in support of healthy homes and lead poisoning prevention funding for HUD and CDC. The sign-on letter deadline is March 19.
  • "I also urge the representative to submit a request to the health appropriations subcommittee to fund CDC’s Healthy Homes and Lead Poisoning Prevention Program at $29 million.
  • "These funds will ensure the protection of over 500,000 lead-poisoned children who need CDC-funded services.
  • "Thank you!"

STEP 3: Call your senators! (Coming soon!)

Only you can help us win this budget battle.

ERMI Data Used as a Predictor of Asthma

Many private firms recommend collecting mold samples to determine whether a home has a mold problem. Yet, federal and state agencies, and many non-governmental organizations (including NCHH) don’t think it is necessary. Instead, we support visual assessment over mold sampling when identifying a mold problem and choosing the appropriate remediation. In two recent articles, investigators used the Environmental Relative Moldiness Index (ERMI) to analyze settled dust samples and found a link between mold and asthma development by age 7. Investigators also conducted visual assessments in the study homes but did not find an association between visible mold and asthma. Do these studies mean that visual assessments are not useful for determining whether a mold problem exists?  Do they indicate that complex sampling and analysis methods are required to identify home mold issues?

I would argue that ERMI is not ready for prime-time as a home assessment tool. In 2009, the Federal Register stated that, while ERMI is a “prototype research tool,” it has not been validated for wider use in identifying mold-contaminated environments. A 2012 industrial hygiene conference presenter noted that ERMI did not pass an internal 2009 EPA peer review. Indeed, the methods used to develop ERMI have not been subjected to external peer review. The DNA-based lab method on which ERMI (called MSQPCR) is based has not been subjected to internal and external laboratory tests needed to verify its precision and accuracy.

Reducing home moisture problems to minimize exposure to mold and other moisture-related toxins is a vital goal. Although the recent asthma study did not find an association between mold found through visual inspection and asthma development, a large body of literature suggests that water damage identified by home inspection is associated with increased asthma and respiratory disease risk. For example, the two articles referenced above indicate ERMI may have potential as a research tool, but trained eyes (and noses)  are a more accessible and practical approach to identifying mold problems in homes. 

Looking for an Apartment ? - Part I

Let’s face it, we don’t always remember to watch for healthy home indicators (or lack thereof) when searching for an apartment. Looking for the “right” apartment can be a very stressful, time-consuming, and a daunting task - especially if you are without the services of a realtor. Stress and all, it helps to be mindful of a few things while in search of an apartment.

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