People with Asthma: Appropriate Rental Housing Accommodations

Transcription

1 OFFICIAL STATEMENT People with Asthma: Appropriate Rental Housing Accommodations OVERVIEW American Lung Associations (ALAs) and other advocates for people with lung diseases such as asthma are in prime positions to assist families in getting solutions for their rental housing conditions that trigger their asthma symptoms or episodes. We realize that many people with chronic diseases, including asthma, have other difficulties such as care of several children, no or limited transportation, low or no health insurance, meager understanding of their disease or effective environmental controls, budgeting difficulties, exhaustion, or low problem solving skills. Many urban residents rent. Although renting makes some housing conditions beyond their immediate control, options are available for all renters, and additional protections exist for those in public or subsidized housing. Through our sound advice and referrals, these families can better partner with housing officials to effectively minimize their housing-related asthma trigger exposures. Key facts for this are: 1. Most states and countries have an implied warranty of habitability as a basic, legal human right. These laws also prohibit landlord retaliation or eviction when a tenant pursues these housing rights. 2. The U.S. Fair Housing Act Amendments (FHAA, 1988) added disability discrimination protections regarding both public and private rental housing units whenever there are four (+) units. People with disabilities have further protections in public housing: Section 504 of the Rehabilitation Act (1973) and Section 2 of the U.S. Americans with Disabilities Act (ADA, 1990) offers 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. 3. People with asthma may have personal triggers in their rental housing environments that have been shown to increase asthma symptoms and/or precipitate asthma exacerbations. Research presented at the American Lung Association-American Thoracic Society San Francisco annual meeting in May 2001 noted the following asthma exposure risks, from an asthma patient skin test study in seven inner cities: Cockroach allergen (especially in the inner city and southern US): 73% Dampness, leaks, mildew: 70% House-dust mites (accumulated in carpeting, floor cracks, etc): 62% Wall to wall carpeting: 55% Rodents: 49% 1

2 Humidifiers: 33% Indoor fungi/molds (Alternaria, Aspergillus, Cladosporium, Penicillium): 31% Proximity to furry pets (cat dander is particularly sticky): 30% Other risk factors to people with lung disease such as asthma can be: Ventilation problems that allow accumulation of ozone, fine particulates, sulfur dioxide, or nitrogen oxides Temperature over 72 degrees that cannot be adjusted Chemical insecticides, herbicides Strong odors from products such as cleaning agents, paints, bonding agents Aerosols, foggers, sprays Indoor/outdoor inhaled allergens (trees, grasses, weeds) Fumes from inadequately or unvented gas, oil, or kerosene stoves; wood burning appliances or fireplaces Second-hand tobacco smoke effects on children under five years of age The National Institutes of Health s National Asthma Education and Prevention Program (NAEPP) Expert Panel Report (EPR) 3 documents that a sound asthma care plan for each individual requires both environmental controls and self-management skills, in addition to adherence to that person s medication plan. DETAILS: 1) IMPLIED WARRANTY OF HABITABILITY IS A BASIC, LEGAL HUMAN RIGHT: States are likely to have this warranty of habitability prescribed by common law or defined in their statutory Codes. The state law specifies the variables it will address. The laws also prohibit landlord retaliation/eviction when a tenant pursues these housing rights; state sanctions may be imposed. In Massachusetts, for example, the housing code appears in the Sanitary Code; it specifies the rental premises must be livable, what maintenance must occur, and what sanitation/removal criteria need to be met. A) If a violation is suspected (eg, excessive dampness, rodent or pest infestation, extreme temperature ranges that cannot be controlled): i) the renter should report the issue to the building manager, with a written request for repairs; if not corrected within ten days, then ii) the renter should request a city or county inspection for violations [each state code will identify whether the building or health department has jurisdiction. If you do not know, call either one and get the exact contact information]. o If violations are found, clean up/resolution must occur within a specified time period o If resolution does not occur on time, fines may apply the person or a legal advocate can request an emergency transfer; attach a copy of the doctor s letter (see description under the FHAA-ADA section below, and see sample letter in Attachments) 2

3 check with the inspector or legal advisor regarding actions that are allowed in your state. These might include the renter withholding rent until the apartment is cleaned up; doing the repairs and deducting costs from the rent; moving out/breaking the lease without penalty; suing to get repair costs reimbursed learn what rights the tenant has: an overview of landlord-tenant laws and some state statutes are available at [California statutes are not included at this time] report a bad landlord; if federally subsidized housing is involved, call U.S. Department of Housing and Urban Development (HUD) toll free at (M-F, 9-5 Eastern time). B) California law and local ordinances: California housing laws are defined in the California government code, section The California Fair Employment and Housing Act (FEHA) is administered by the Fair Employment and Housing Department; it regulates and investigates complaints. Information is readily available at (M-F, 8-5: English and Spanish options available) and In California, complaints relating to habitability of residential rental units are addressed by: o the local Health Department when the unit is a general, full fee rental unit, while o the County Housing Authority covers public housing and subsidized housing units. This includes any rental that receives federal funds, be it state or local housing authorities, or private developers with HUD subsidies who accept Section 8 vouchers (described in more detail below). County Housing Authorities contract with subsidized housing units. The Housing Authority must inspect each Section 8 rental unit before approval, before move in, annually, and if a problem is reported. The Housing Authority staff person will assist and probe inquirers regarding situations that are code violations, for example excess moisture problems from improper plumbing or structural problems, such as a leaking ceiling pest infestation such as cockroaches That Housing Authority office sends a complaint letter concerning the alleged condition to the landlord, giving 10 days to correct most issues. Immediate action is required for serious health or safety issues, such as a leaky toilet or a sewage complaint When the stated time limit has expired, the Housing Authority calls back to verify that the repair is completed If the issue is not resolved, then a Housing Authority person is sent to inspect. A Notice of Violation is issued, with 15 days to fix the condition(s) 3

4 If necessary, the Housing Authority then files the violation with the city attorney for further action. California Housing Authorities rely on uniform housing codes available from HUD (see more detailed description below, in C) at and International Conference of Building Officials, at (Pacific time) and English and Spanish options available. The California Housing Authority and Health Department staff persons assist people with mold problems via basic excess moisture complaints and maintenance requirements. San Francisco adopted an ordinance specific to indoor mold that applies in that County. [See the copy in References; consider promoting a similar decision in your municipality.] Los Angeles and San Diego did likewise. Since passage of the Toxic Mold Protection Act in 2001, the California Housing Code has begun to address mold per se. Written disclosure of a mold condition now is required to potential buyers, tenants, renters, landlords or occupants. [See Chapter 584 (SB 732, 2001) listed in References.] The Housing Authorities work closely with county and state health departments regarding environmental health and sanitary issues under their jurisdiction. They assist in raising awareness about such issues and available resources, including emerging mold concerns. If the concern is not regulated in the housing code, you may want to direct unresolved clean-up requests or civil liability questions to an attorney and to your legislators, so they can sponsor an appropriate bill to bring housing codes in line with current scientific knowledge of health and safety risks. Mold information from reputable sources include: Indoor Air Quality Info Sheet Mold in My Home: What Do I Do? California Department of Health Services, Environmental Health Investigations Branch Revised July Health Effects of Toxin-Producing Indoor Molds in California, California Department of Health Services, Environmental Health Investigations Branch, April U.S. EPA indoor air quality references Mold Remediation, EPA, March 2001 C) Federal public housing assistance: Both state and federal governments fund public housing, which assist very low-income families, the elderly and the disabled find decent, safe, sanitary and affordable apartments. Eligibility is limited to U.S. citizens and those non-citizens who have eligible immigration status. Every state Housing Authority has its own application system: get the access phone numbers for each from HUD Customer Service at (M-F, 8-5:15 Eastern time), and at People will learn from HUD what services are available in their state, how to obtain them, income limits, the rights and 4

5 responsibilities of both the tenant and the landlord, the Housing Authority obligations, and any established local preferences. Such preferences may include i) a homeless person or those in substandard housing ii) a family paying more than 50% of its income on housing or iii) those involuntarily displaced. Basic housing terms and criteria include: Public housing developments are run by a city or county Housing Authority Subsidized housing are privately owned rental-housing units; interested people first apply for a Section 8 subsidy voucher at that city or county Housing Authority. When an applicant s name is reached on the waiting list, the Housing Authority contacts him or her. The prospective renter then visits the management office of privately managed buildings on the local HUD office listing to see approved units and to select suitable housing. The Housing Authority inspects each unit annually to ensure it continues to meet minimum housing standards. See the HUD fact sheet concerning roles of the tenant, landlord, and Housing Authority in References and at Federal Section 8 voucher allows renters to find their own place to rent, with government Housing Authority vouchers to pay all or part of the rent. The renter generally pays 30% of his/her monthly adjusted gross income for rent and utilities Project based Section 8 is used when a sliding scale establishes the rent amount for a tenant General advice for tenants on landlords and the law are available at Cornell Law School rental housing info online for landlords, tenants, real estate investors National Housing Law Project National Housing Institute: affordable housing publications The Urban Institute: economic and social policy research National Low Income Housing Coalition 2.) PEOPLE WITH DISABILITIES ARE PROTECTED FROM DISCRIMINATION IN BOTH PUBLIC AND PRIVATE HOUSING BY THE U.S. FAIR HOUSING ACT AMENDMENTS (FHAA, 1988). FURTHER PROTECTIONS IN PUBLIC HOUSING ARE COVERED BY SECTION 504 OF THE U.S. REHABILITATION ACT (1973) AND SECTION 2 OF THE U.S. AMERICANS WITH DISABILITIES ACT (ADA, 1990). FHAA covers disability protections in all public and private housing markets with four (+) units. A landlord must allow a person with a disability to reasonably modify the premises. The tenant is responsible for the cost; the landlord may require that the tenant restore any interior changes to the original condition only if the modification would interfere with its usability for future tenants (such as lowered counters). If a state disability law predates this 1988 federal law, it may enhance the renter s case. 5

6 Title 2 of ADA and Section 504 exceed the minimum standard for habitability for those with a disability who have public (ie, any federal funding) housing. For example, a person with asthma who can document personal exacerbation can request and require either A) a reasonable accommodation of rules, policies, practices or services where necessary, to allow a person with a disability the opportunity to use and enjoy a dwelling. An example is placement in a unit away from the prevailing breeze that blows pesticide spray or heavy pollen from the neighborhood, or B) a reasonable modification changing the structure at either the landlord s or (with Section 8 vouchers) the Housing Authority s expense. Removal of wall-to-wall carpeting is an asthma-related example (relocation to a comparable unit without carpeting would be a reasonable accommodation, as described in A above). Document the need for rental property accommodation: see the Attached examples: sample advocacy letter which supports the person s right to a particular accommodation, and sample patient s physician verification letter that o documents the nature of the housing problem o describes your state s law/rule/requirement that applies to the patient s health problem [Note: some local jurisdictions may have additional helpful statutes. See the San Francisco County ordinance concerning indoor molds in the References] o applies the housing rule to the patient s condition (that is, spells out the link between the housing exposure and its health consequences for this patient) o notes there is a qualifying disability due to asthma if FHAA or ADA accommodation or modification is involved, and o requests specific action(s) Fair Housing Information Sheet # 2: Structural Modifications in Public and Section 8 Housing, Bazelon Center for Mental Health Law Fair Housing Information Sheet # 4: Using Reasonable Accommodations to Prevent Eviction, Bazelon Center for Mental Health Law When a person appears to qualify yet needs further legal information, refer that individual to U.S. Department of Justice ADA information at or Self help legal resources; one good resource for fact sheets and the analytical structure for any ADA concern is Bazelon Center for Mental Health Law, fax or Disability Rights Education & Defense Fund (DREDF), a nationwide organization at (Pacific time) or the local Bar Association or Legal Aid/pro bono attorneys for low or no cost legal help. Access is easy with Legal Services Corporation (LSC), established by U.S. Congress to provide low income Americans with access to civil legal aid, via approximately 260 local aid programs that serve every county in the nation: simply click on your state at the upper right to find the main office of that legal assistance program; some will refer you to a branch office even 6

7 closer to you for help National Legal Aid & Defender Association State Bar of California Encourage health care providers to apply asthma care advances by reviewing the four components of effective asthma management available in the National Institutes of Health s National Asthma Education and Prevention Program (NAEPP) Expert Panel Report (EPR) 3 (2007 at: spotting the issues regarding housing conditions that impede asthma trigger control, advising the patient-renter to pursue all the clean-ups and FHAA (private housing) or ADA (public) reasonable accommodations and modifications allowed by law, providing the patient with the appropriate letter of medical documentation, placing a note in the patient s chart for follow-up at the next patient visit concerning resolution of the housing clean-up or accommodation, to better control factors contributing to asthma severity for this patient California state disability laws parallel and sometimes exceed federal requirements. People with disabilities who believe they have a public accommodations complaint can get more information about the process, and get the California pre-complaint questionnaire at 3. PEOPLE WITH ASTHMA MAY HAVE PERSONAL TRIGGERS IN THEIR RENTAL HOUSING: A) Asthma triggers and indoor air quality references: American Lung Association (ALA); click on Asthma, top item on the left column listing, for the full list of current asthma items. Spanish items available: click on Espanol in the blue column on the left. Your local ALA staff is easy to reach at LUNG-USA. Clear Your Home of Asthma Triggers, EPA, July All About Asthma interactive education movie with sound. Developed by Rajeev Venkayya, MD, Pulmonary & Critical Care Medicine, University of California San Francisco. Click on either English or Spanish versions B) California asthma data and references: Asthma in California, California Health Investigation Branch. Includes links to the statewide strategy for asthma, mortality and hospitalization statistics California DPHS Indoor Air Quality Program. Mold contamination fact sheets and reliable links. English or Spanish versions available ATTACHMENTS: 1. Landlord-Tenant Law: an Overview, Cornell Law School, September Sample advocacy letters to send the landlord and/or local Housing Authority a. Lawyer s Reasonable Accommodation Disability Letter 7

8 b. Doctor s Verification Of Disability/Reasonable Accommodation Letter Asthma c. Lawyer s Not Vacating Apartment Letter For Temporary Emergency Transfer 3. California Lawyer Referral Services listing, the State Bar of California REFERENCES ~~~~~~~~~~ 1. Housing Choice Voucher Program Fact Sheet, HUD 2. Fair Housing Information Sheet # 2: Structural Modifications in Public and Section 8 Housing, Bazelon Center for Mental Health Law 3. Fair Housing Information Sheet # 4: Using Reasonable Accommodations to Prevent Eviction, Bazelon Center for Mental Health Law 4. California Fair Housing Agencies listing, alphabetical by city, from National Fair Housing Advocate 5. California Housing Complaint Process, Department of Fair Employment and Housing 6. San Francisco County Indoor Mold Ordinance 7. California SB , Chapter 584 Toxic Mold Protection Act of Boston Affordable Health House Design Guidelines, Margaret Reid, Asthma Prevention and Control Program, Boston Public Health Commission DEVELOPED FOR THE CTS CLINICAL PRACTICE (CP) COMMITTEE Prepared for CTS by Colleen H. Richardson, CAE Approved by CTS Executive Committee and CTS 2001, revised 2008 CTS guidelines are developed to enhance a physician s ability to practice evidence-based medicine; these should not be considered a substitute for the experience and judgment of a health care provider. FAX: VOICE: ctsinfo@alac.org WEBSITE: ADDRESS: 202 FASHION LANE SUITE 219 TUSTIN CA CONTACT YOUR AMERICAN LUNG ASSOCIATION: CALL LUNG-USA, or download ALA public and patient items at Visit the ALA of California website for state activities & advocacy issues at We welcome your comments: see CTS contact information above! 9/14/01; v 3/17/08 O:\CTS\AA\CTSword\CTS position papers 08 on\people w Asthma + Hsg Accom.doc 8