Collaboration In Health/Wellness: Doorway to an Accessible, Safe and Healthy Home

This Coalition Keeps People Healthy in Ways Its Partners Couldn’t Achieve Alone

By Joseph Bednar

If there’s anyone who understands the impact of asthma in Greater Springfield, it’s Sarita Hudson.

Specifically, as director of programs and development for the Public Health Institute of Western Massachusetts and manager of the Pioneer Valley Asthma Coalition, she understands the connections between one’s physical environment and health — and the factors that have consistently placed Springfield high on lists of riskiest places to live with asthma. But even the Asthma Coalition has its limits.

“We had been doing asthma interventions, working with community health workers, working with clients, doing education, helping them identify triggers,” she said. “But it’s not enough if we can’t actually fix anything in the home.”

Meanwhile, as vice president of Public Health for Baystate Health, Frank Robinson understands the many ways the system’s community health programs and providers promote preventive health and wellness.

Still, “Baystate would never be going out and creating healthy homes by doing environmental changes and mitigations,” he explained. “That is not the work of the healthcare system. To be aligned with someone who does that work and gets the health implications and health impacts is perfect, though — it makes a perfect marriage.”

That organization would be Revitalize Community Development Corp. (CDC), which does have a long history of making critical repairs, modifications, and rehabilitation on the homes of low-income families with children, military veterans, the elderly, and people with disabilities.

We had been doing asthma interventions, working with community health workers, working with clients, doing education, helping them identify triggers. But it’s not enough if we can’t actually fix anything in the home.”

When these three organizations started talking — about asthma and other issues — they were intrigued by what they might accomplish by working together, said Revitalize CDC President and CEO Colleen Loveless.

“We’d been doing some of this work — mold remediation, pest control — but hadn’t formalized the process in collaboration with insurance companies and the healthcare system,” she said.

Now, thanks to a collaboration called Doorway to an Accessible, Safe and Healthy Home (DASHH), these three organizations are not only identifying families in need of intervention for environmental health issues, and not just educating them on lifestyle changes, but actually making the necessary physical changes to their homes.

“We started talking, and we applied for a technical-assistance grant from the Green & Healthy Homes Initiative in Baltimore. They’ve been doing this work for decades,” Loveless explained. “We were one of five sites awarded that technical-assistance grant.”

Baystate followed with a capacity-building grant, other state grants followed, and DASHH was in business. Since its beginning in 2015, the program has served 130 households with asthma remediation and education, as well as 101 households for age-in-place modifications. Last year, it launched a COVID-19 response project (more on that later), impacting more than 1,550 households and approximately 6,881 individuals.

“It’s a business model that shows that, by intervening and creating healthy homes through environmental remediation, removing asthma triggers, and improving the physical environment, we could reduce asthma incidence in high-risk populations,” Robinson said.

Families referred by Baystate for environmental interventions receive three to five visits to conduct testing, at the start and end of the process, and provide education on how to keep the home clean and safe. If needed, Revitalize CDC brings in services ranging from air-duct cleaning to mold remediation; from pest control to floor covering and replacement, and also provides air purifiers, HEPA vacuums, and cleaning supplies.

“The goal is to keep people from having to access primary care or the emergency room, and not miss school or work,” Loveless said. “Asthma has such a ripple effect.”

Better Together

The initial goal of DASHH was to help older people by improving their housing conditions related to asthma and falls, most notably by providing home assessments and home repairs to help them stay healthy and age in place. Breaking down this enterprise that has earned the title of Healthcare Hero for 2021 in the Collaboration category, the individual honorees are:

• Revitalize CDC; which performs assessments and interventions for adults and children with asthma and COPD and makes safety modifications and aging-in-place improvements so seniors may safely remain in their home;

• The Public Health Institute of Western Massachusetts, which provides support on asthma issues; measurement evaluation; support and coordination for referrals, education, and outreach; coordination and support for asthma home-visiting services; and technical assistance and support, as well as providing materials and services in Spanish;

• Baystate Health and the BeHealthy Partnership (a MassHealth accountable-care partnership plan option made up of the Baystate Health Care Alliance and Health New England), which provide referrals to DASHH through five health centers: Baystate General Pediatrics at High Street, Brightwood Health Center, Caring Health Center, High Street Health Center Adult Medicine, and Mason Square Neighborhood Health Center; and

• The Green & Healthy Homes Initiative, a national network that provides technical assistance on planning, database services, and access to best-practice strategies. The organization worked with the other partners on feasibility studies to come up with ways to fund interventions in the home and determine how those efforts might impact healthcare costs and decrease healthcare utilizations regionally.

After its initial success with Baystate, Revitalize CDC expanded its service area in 2019 to begin collaborating with Holyoke Medical Center and its team of community health workers and navigators. To boost such efforts, the city of Holyoke recently awarded Revitalize CDC’s Healthy Homes Program $100,000 from American Rescue Plan Act funds.

DASHH serves low-income families in Hampden County, which ranks last among the Commonwealth’s 14 counties for health outcomes and health factors for racial/ethnic groups. Springfield had been the asthma capital of the U.S., according to the Asthma and Allergy Foundation, until 2019, and now ranks 12th — still not the most desirable ranking, but an improvement, to be sure.

“You talk to the families, and you see that this is the kind of impact that changes their health,” Hudson said of DASHH’s efforts. “It means they can breathe easier and get the supplies they need.”

For instance, in some cases, “the ventilation ducts have never been cleaned, and every time the heat comes on, they have an asthma attack. Now they’re clean, and it doesn’t happen,” she went on. “Some of these are small, simple repairs.”

This issue has been important to Hudson for a long time, through the Pioneer Valley Asthma Coalition, which was formed 15 years ago to address childhood asthma by improving medical and self-management of the condition, as well as by reducing environmental triggers.

The coalition focuses on outdoor air pollution and indoor air quality and has successfully advocated for new policies, including statewide regulations to prohibit tobacco sales to those under 21; green cleaning policies and procedures adopted by Holyoke Public Schools; an ordinance against burning construction and demolition debris; and asthma protocols and an idle-free vehicle policy adopted by Springfield Public Schools, among many other successes.

It’s work — not just the physical interventions, but education of homeowners, landlords, and primary-care physicians — that should be happening on a wider scale, Hudson said, not just in homes, but in schools and other older buildings where people gather.

“We really see a lot of our housing stock as old, with deferred maintenance, including so much of our rental housing. That’s why we are pleased to see more funding around whole-house renovations.”

Quick Pivot

Last year, the DASHH coalition began supporting patients at risk of contracting COVID-19 by providing them with essential supplies and access to nutritious food at home. It made contactless deliveries that also included COVID-prevention supplies, including disinfectants, microfiber cleaning cloths, cleaning gloves, dish detergent, food-storage containers, hand soap, disinfectant wipes, paper towels, and food from local pantries.

“These are people who were quarantining, and we were providing them with cleaning supplies, hand sanitizer, and facemasks — and we found many were food-insecure, so they were provided food from local food pantries,” Loveless said. “The whole DASHH program just expanded from asthma to COVID, and we’re still seeing it now.”

Meanwhile, she’s excited about seeing the coalition continue its broader work — and those regional asthma statistics improve further.

“It’s been a really, really great partnership. It’s a win-win situation — the healthcare system saves money, we’re serving more low-income families in need, and patients are healthier. So it’s really a win-win-win.”

Robinson agrees. “I think the role of Revitalize and other housing providers that understand these issues have made a difference — and make healthcare providers’ jobs much easier,” he said. “They have been instrumental partners in creating safe and healthy houses for older adults as well as creating healthy homes for folks with respiratory diseases, asthma in particular.”

The work is both deeply collaborative and, dare we say, heroic.

“I’m so appreciative,” Loveless said. “Together, we’re able to serve more people in need.”