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Bring Back Housecalls . . . and Fix the House

In his October 14, 2015, opinion in The New York 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.

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-renovation (upper picture) and post-renovation (lower picture) courtesy of Blumentals/Architecture, Inc.

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