Dear Friends,
In this edition of From the Front Lines, I share with you my perspective on Boston’s housing crisis. Ensuring stable housing continues to be one of the most challenging crises affecting our patients’ social determinants of health. Housing costs are rising along with utility costs, putting increased burdens on families. Many are forced to choose between paying rent, paying their utility bills, or buying food – a situation no family should have to face. Unfortunately, having to make that choice is more widespread than you might think.
Below, I detail a particularly vexing example at BCP, which also illustrates the systemic and policy challenges we all face in order to provide better and more stable housing to Boston’s families.
False Hope for Finding Suitable Section 8 Housing
One BCP family has five children ages 1- 18, two of whom (ages 11 and 18) have asthma and allergies. They had been living in an over-crowded, mice-infested apartment. Mom was so excited to finally have an opportunity to move out of this awful place and into Section 8 housing. Mom had found what she thought was a great apartment. It looked like it needed some work, but the landlord assured her all the work would be completed by the time they moved in. Mom was hopeful and signed the lease.
Unfortunately, when the family moved, the work had not been done. They had already moved everything out of their old apartment and signed the lease, but they showed up to an apartment that was dirty and not up to Section 8 standards. Even worse, there were mice in the apartment yet again! The landlord again reassured the Mom that they would take care of everything. Days went on, more mice came, and nothing was fixed. Mom could not keep up with the infestation and could not believe she was once again in this situation.
Unsafe Housing Leads to Serious Health Consequences
The 11 year old’s asthma, which had previously been well-controlled, started acting up. She had to go to the nurse almost daily to use her inhaler, causing her to miss class and learning, and she was getting behind in school. The school nurse called Mom several times, worried about her. The housing conditions were making her asthma worse and her preventative asthma medication wasn't working because of the constant exposure to mice droppings. The child missed multiple school days because her asthma was flaring up. She ended up needing to go to the emergency room twice. She followed up with me, her pediatrician, and I did what I could to adjust her medications. Then she got sick [with a viral illness] and that illness, coupled with the exposure she had to the mice droppings in her home, meant she had to return to the emergency room a third time. This time, she ended up in the intensive care unit (ICU). She had become seriously ill.
Meanwhile, her Mom was doing everything she could to get the apartment cleaned and get rid of the mice. She called the City of Boston Inspectional Services, met with the social worker in the hospital, and she asked BCP for support. BCP referred the family to Breathe Easy, a program that partners with the City of Boston to expedite urgent inspections for children with asthma, since the family’s own request had not led to significant changes. Through this program a housing inspector came and found mice feces everywhere. The landlord then sent an exterminator, which was only a temporary fix to the problem, since nothing actually improved. The mice returned.
Frustrated and worried about the negative impact of this environment on her children’s health, Mom asked the landlord to release her from the lease. She knew she had to move somewhere else to protect her children - their home was making them sick. The landlord refused. Mom spoke with her housing worker who said that if the landlord refused to fix the problem and refused to terminate the lease, there was nothing more that could be done.
I thought to myself “NOTHING that can be done? A child is in the ICU because of poor housing conditions and no one feels responsible? No one is taking action? This child’s life is in danger, but no one - not the landlord or the housing worker - is doing what is needed to solve this problem.
As her pediatrician, I knew that if the housing conditions were bad enough to send the child to the ICU once, it could happen again, and I was concerned that something even worse could happen. I got to work: I called Mom's housing worker, BCP's contact with the City's Breathe Easy program, and the Deputy Director at the Office of Housing Stability in Boston. Now that the patient's pediatrician called and told them that this 11 year-old patient's life depended on it, people had to pay attention. This team assured me that they would help Mom get out of her lease and find a new apartment. Around this time, the family’s older daughter had an exacerbation of her asthma and was rushed to the emergency room. Luckily, she did not need to be admitted to the hospital.
Back to the ICU
The 11-year-old daughter eventually went back to school after many missed days. Mom thought she was improving and the school nurse was keeping a close eye on her – but there were still mice. The City was working on getting her out of her current housing situation, but it was not happening quickly enough. She got sick again and went back to the ICU. Once again, her life was in danger due to the conditions she was being forced to live in.
After 4 days in the ICU, she was discharged. But it was not until 4 weeks later that she moved into a new apartment without mice (she has not been back to the emergency room or ICU since). At this point, she was behind academically, which in turn had taken a toll on her mental health. She felt insecure both socially and academically, was having a hard time adjusting, and was feeling depressed. BCP remained by her side and was able to not only help navigate the housing situation, but provide the necessary mental health services with one of BCP’s onsite integrated mental health clinicians.
The High Cost of a Failing System
This family had to endure several emergency department visits, a hospital admission and not one - but two - ICU stays, resulting in not only very expensive healthcare bills, but also (and most importantly) dramatic negative impacts on physical health, school performance, and mental health – all because our current policies protect landlords over children and allow people to live in unsanitary, mice infested “homes.” That is not a suitable home for anyone – and the costs of these poor housing conditions far outstrip the cost of fixing the problem right away.
This situation has impacted all of us at Team BCP, and left us wondering when will our elected leaders make effective policies that protect our children without needing a pediatrician to take matters into her own hands so that children don’t become sick from our very broken system.
Sincerely,
Robyn
Stay tuned for further updates "From the Front Lines" and do not hesitate to send us your questions, thoughts, and feedback. We have been seeing lots of issues with housing among our patients and will be sharing some observations and thoughts on that soon.