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By BETSY TAYLOR

A new program, Healthy Homes Des Moines in Iowa, is trying to keep asthmatic children out of the emergency room and from unexpected visits to the doctor's office by reducing the conditions in the child's home or apartment that can lead to an asthma attack. "Common household substances like dust, mold, chemicals and pests" can trigger an asthma attack, and children whose lungs are still developing are particularly vulnerable, according to the program's educational material.

In the Healthy Homes Des Moines program, qualified households receive no-cost home repairs to reduce asthma triggers, such as dust from old carpeting and mold caused by leaky pipes or roofs. The families also get education on ways to keep asthma under better control.

Mercy Medical Center — Des Moines and its Mercy Children's Hospital and Clinics, and two other Des Moines hospitals — UnityPoint Health Des Moines and Broadlawns Medical Center — collaborate on Healthy Homes Des Moines.

Jolene Vos, Mercy Children's Hospital and Clinics outreach coordinator, is a Child Life specialist working on Healthy Homes Des Moines. She said of the program: "We can treat and treat a patient, but even if they're medically compliant, if we keep returning them to the same home, their asthma symptoms are going to be triggered."

Qualifying families
The participating hospitals analyzed their data on patients ages 2 to 12 with respiratory conditions, including each child's clinic visits, emergency department visits and inpatient stays. Program organizers sent letters about the home remediation program to Des Moines families, who had a child who had four clinic visits or one emergency department admission over a six-month period. They also asked clinicians and school nurses in Des Moines if they treated children whose legal guardians should be referred to the program. In some cases, families with asthmatic children self-referred as word spread about the program, Vos said.

To qualify for the free home repairs, families must have incomes at or below 80 percent of the median income in Polk County, where Des Moines is located. A family of four making less than $60,000 a year would qualify, Vos said. And families who qualify for Medicaid benefits automatically are financially eligible for Healthy Homes Des Moines services.

Sixty families with asthmatic children had been referred to the program through mid-May, with 39 families taking part in the program. Some of those referred don't qualify for reasons like living outside of the city limits of Des Moines, or because their children don't fall within the program's target age group.

Clean and dry
Repairs totaling about $25,000 have been made to four homes, with old carpets ripped out and replaced with wipeable hard surfaces, and leaky bathroom fixtures and roofs replaced, Healthy Homes Des Moines Project Manager Claire Richmond said. Repairs are made to owned homes or to a rental property, with the landlord's permission. Property managers agree to extend leases a year from the date repairs are made and agree not to raise the rent for the family of the asthmatic child for that year, ensuring the family a length of stay in the rental, she explained. Only two families have completed the entire process, which includes a follow up two months after the intervention. However, Richmond said the interventions the program uses are evidence-based and are known to reduce asthma triggers and asthma rates.

When it was unveiled last summer, Healthy Homes Des Moines was known as Healthy Homes East Bank, and it focused on one zip code, 50316, in three East Bank neighborhoods, which are located east of the state Capitol. Data had identified a high concentration of pediatric asthma cases in that zip code. But many suitable candidates resided elsewhere in Des Moines, and so organizers expanded the program to include the entire city in March.

Putting it all together
Healthy Homes Des Moines has an annual operating budget of around $800,000, said Richmond. National funding comes from the BUILD Health Challenge, a coalition of funders that includes the Robert Wood Johnson Foundation, the Kresge Foundation, The Advisory Board Co., the de Beaumont Foundation and the Colorado Health Foundation.

Local matching funds come from the participating Des Moines hospitals, and the Mid-Iowa Health Foundation.

Kiersten Cooley, a family outreach specialist with Visiting Nurse Services of Iowa, calls families to schedule an appointment within two days of receiving a referral to the Healthy Homes Des Moines program. A representative of the Polk County Health Department accompanies her on home visits, where the duo looks for pediatric asthma triggers.

If a member of the household smokes, they encourage the person to enroll in a smoking cessation program; if a residence has cockroaches or vermin — a situation that can exacerbate respiratory problems — they offer to pay for the services of a pest management company.

If the family pet sleeps on the child's bed at night, they might suggest ending that practice, and keeping the pet out of the bedroom altogether — pet dander being an asthma trigger. The program can give families vacuums with filters that remove allergens and dust from upholstery, or steam cleaners that can be used on hard floor surfaces.

Open bidding
County health and housing officials come up with a list of home repairs to reduce asthma triggers and the remediation work is put up for bid. An open house is held at each property where contractors can assess the scope of the work, and bid for the job. (A committee evaluates what to do if estimates for repairs exceed the value of a property.)

After repair work is completed, Cooley conducts a post-intervention asthma control assessment. Families taking part in the program receive an asthma symptom tracking work sheet, where they check off if a child has been wheezing during the day or waking up at night due to asthma. They also record if daily medication was given to control symptoms, and if emergency medication was needed. Two months of a family's responses are used as data to gauge health improvement. The program is too new for any telling results related to these health assessments.

Improving health and homes
Eric Burmeister is executive director of the Polk County Housing Trust Fund, a planning, education and funding organization for affordable housing. He sees much to like about Healthy Homes Des Moines, a program his agency supports. The trust, funded by a variety of community sources, spends about $2 million annually to increase the number of affordable housing units in the county and to preserve existing affordable housing structures. "Many times we would allocate our repair resources based on whoever asked first, or rose to the top of the list," he said. Healthy Homes Des Moines allows for "a really different way to allocate resources."

The project allows for "quality of life improved, along with quality of property," he said.

A school nurse referred the family of 8-year-old Madizyn Bucklin to the Healthy Homes Des Moines program. Madizyn does breathing treatments at home and at school to manage her asthma and uses an inhaler daily.

Healthy Homes Des Moines is paying for carpeting to be removed in the Bucklin home, for new flooring for the basement, for a door to be weatherized and for the installation of a bathroom exhaust fan. Madizyn's dad Byron Bucklin, who also has asthma, said, "At first it seemed too good to be true, but I had no concerns when we sat down and talked to them."

In May, contractors walked through the home to prepare bids on the work. Byron Bucklin said of Healthy Homes Des Moines, "It's a blessing for them to come in and help improve her health, and to fix up the home."