Visiting overcrowded, damp and cold houses to follow up children with health problems is the daily reality for Kidz First public health nurses.
The Counties Manukau District Health Board nurses refer eligible families to the healthy housing schemes AWHI and Warm Homes Counties Manukau (see below) and work collaboratively with other agencies to try and make a difference.
Lemau Tesese recently followed up a 6-year-old girl with bronchiectasis to find her living in a damp, mouldy, uncarpeted, meagrely furnished, three-bedroom home with six siblings and a single mum with many social issues. She advocated for the mum, got the school involved and collaborative inter-agency work saw the family able to move into a well-insulated, carpeted, five-bedroom Housing New Zealand home.
“It is a new beginning for them and they are much happier and we’ve seen a huge improvement in the child’s health, as well as the mum.”
A child with numerous positive strep throat swabs drew Liz Tiamulu to a family of three children where the mum herself had had rheumatic fever. A pattern emerged that when the boy was living with parents he had numerous throat infections but when he went to stay with his grandfather he did not. A visit to the family home found that it was cold, windows closed and the parents smoking inside so Tiamulu gave them some health education about ventilation, smoking outside and encouraged them to quit. A recommendation to AWHI saw the family put on the waiting list and in 18 months they were moved to a warmer home and the boy hadn’t come back positive since.
Dolly Chetty tells of an 11-year-old intermediate school pupil with frequent bleeding noses, hay fever and repeated positive strep throat infections whose single mum had taken him to the GP but failed to get a resolution. Chetty referred the family back to the GP, leading to an ENT referral and surgery in Starship. She also referred the family, which had three children, to AWHI and the family were rehoused and overall are much healthier and happier.
Health promotion about how families can help make their houses warmer and drier is also stressed by Pam Williams who visited a family on a beautiful warm spring day during the recent school holidays to find the three children playing inside the cold house with all the windows closed. “And the mum wearing a puffer jacket as it was actually warmer outside than it was inside the home.” She shared some of the Key tips for a warmer, drier home (see tips on p.6) from the recently released Living Well toolkit, including getting the kids outside, opening windows and wiping down the mould in the hallway. Williams sees sharing such knowledge as having always been a huge part of the public health nurse role.
Joanne Rosier agrees and shares a story about arranging a visit to a home where a family had multiple strep throats to see whether there was anything they could do about improving the housing situation. She found mouldy carpet in the bathroom that had resulted from the kids flooding the bath. “And although the mum knew it didn’t smell nice she had no idea about the health effects that mould could have on her children.” So Rosier has been working with the mum and Housing New Zealand to get the carpet replaced. She said the mum’s lack of knowledge about the health consequences of mould was not uncommon.
Housing situations in Auckland are also hindered by high prices with families forced to pay up to $500 plus a week. Samantha Anderson says this is hard on client families who are often “part of the working poor” but do the best they can with what they’ve got. The low incomes prompt overcrowding as families take in other relatives to try and spread the cost.
Pele Latu backs this saying the average weekly rent for a three-bedroom house is $450–$480 a week and this can lead to three families sharing a three bedroom house so they can share the rent. “I’ve got a family at my school with a child who was diagnosed with rheumatic fever.” When their housing was assessed they found the landlord had thrown up light partitions in a cold, damp basement so it could be rented as a “three-bedroom” dwelling.
Migrant families trying to gain New Zealand residency can face even more difficulties with Lemau Tesese reporting she found a mum, dad and seven children living in one bedroom at a boarding house after one of the children was admitted to Kidz First with respiratory problems several times. But because they aren’t residents they aren’t eligible for AWHI or Warm Up so finding help for them is especially challenging.
Finding suitable warm, dry and affordable housing in Auckland for all families in need is far from easy and families can sit on waiting lists for a very long time. Kidz First public health nurse clinical nurse manager Lizzie Farrell says a strength of public health nursing is that they can develop relationships with families and support them until rehousing does happen. “And we can make it happen sometimes.” Particularly if health and social agencies pull together and collaborate. But it is a “miracle” if rehoused children can keep attending the same school.
Farrell also manages the Warm Up Counties Manukau scheme which, unlike most schemes around the country, includes a health assessment by a community nurse after the insulation is installed – bringing some Auckland houses’ temperatures up from just nine degrees to something more healthy and liveable.
Farrell thinks a major issue that does need addressing is improving the standard of private rental housing and she for one would love to see some form of rental warrant of fitness.
Healthy housing schemes
Healthy Home/Well Home initiatives
Funding targeting rheumatic fever was announced in the 2013 budget initially for the Healthy Home initiative in Auckland. Budget 2014 saw further funding spread to the Well Home initiative in the Wellington region, as well as initiatives in Northland, Waikato, Lakes, Bay of Plenty, Tairawhiti, and Hawke’s Bay. Referrals can be made by sore-throat clinics, hospitals and bicillin injection services, and criteria include the number of positive strep throat swabs or reason for hospitalisation and the age and number of children in the household.
AWHI (the Auckland-wide Healthy Homes Initiative) is the coordinator for nine providers offering Healthy Home services in Auckland. Chae Simpson, the AWHI manager, says in the 12 months to June 2015 it received about 1,160 eligible referrals, of which 950 came from Counties Manukau DHB. Community health workers are sent out to visit eligible families to carry out a standardised assessment and develop an action plan to resolve issues that can include applying to Housing New Zealand for a new or larger home if overcrowding is established. Simpson says the situation is challenging as Auckland is in the midst of a housing crisis but AWHI providers had been able to successfully rehouse or house close to 65 AWHI families in social housing in Auckland.
Warm Up New Zealand
The Warm Up New Zealand scheme provides free ceiling and underfloor insulation for low-income households occupied by people with health needs related to cold, damp housing. Homeowners or tenants may be eligible if they have a Community Services Card and the house is occupied by someone under 17 years or over 65 years.
Warm Up Counties Manukau
Warm Up Counties Manukau also provides free home insulation for eligible families but accesses additional funding to offer a comprehensive health and social assessment by registered nurses of Warm Up families, after the insulation is installed, to ensure they are accessing appropriate health and social services.
Wellington’s Regional Public Healthy Housing Assessment and Advice Service
This is a nurse-led service offering free home visits and housing, health and social needs assessments to low-income families identified as having a housing-related health condition in households outside the rheumatic fever, age and condition-limited Well Homes/Healthy Homes services.
The service is funded by the Service Integration and Development Unit (SIDU), which was formed from a merger of the Planning and Funding teams in the Wairarapa, Hutt Valley and Capital and Coast DHBs.
Compulsory insulation and ‘WOF’ for housing
Healthy housing advocates would like to see some form of warrant of fitness (WOF) introduced to ensure minimum health and safety standards for New Zealand’s rental housing.
The government is yet to be convinced but this winter announced it has reformed the Residential Tenancies Act so that from July next year all social housing must have retrofitted ceiling and underfloor insulation and from 2019 all other rental housing will require insulation. Smoke alarms will also be required in all tenanted properties from July 2016.
Housing Minister Nick Smith said at the time the changes would make houses warmer, drier and safer and were a more pragmatic and efficient way of improving housing standards than a housing warrant of fitness. “Such a scheme [WOF] would cost $100 million a year and $225 per house for inspections alone, and these costs would be passed on to tenants in rent.”
In June the Health Research Council awarded a $5 million Health Research Council grant to the University of Otago’s He Kainga Oranga/housing and health research team to further its ongoing research, including trialling a rental warrant of fitness prescribing minimum standards for existing properties. Lead researcher Professor Philippa Howden-Chapman said rental housing was on average of lower quality than social housing or owner-occupier housing and just under half of children in households below the poverty line lived in private rental dwellings.
The study aims to establish the effect of implementing a rental WOF on tenant health, particularly children’s health, and to determine the effect of a rental WOF on housing supply and affordability. (Earlier research by the team on the health impacts of insulation prompted the government’s Warm Up New Zealand scheme that lead to retrofitting insulation in state housing stock and subsidising or funding nearly 280,000 more homes being insulated.)
An initial draft rental WOF – developed by the He Kainga Oranga team with the New Zealand Green Building Council and in collaboration with ACC and five of the country’s largest local bodies – has been pretested and is being refined.
This WOF has 31 health and safety criteria including: ceiling and underfloor insulation; no cracks or holes in roof or cladding; opening bedroom and living area windows (with latch); curtains in the lounge and bedrooms; fixed, effective and safe heating in the living areas; an operational toilet; and a functional bath or shower.