Pediatric Environmental Home Assessment
Background for General Housing Characteristics Section
Type of ownership is not an area of concern. However, it is a crucial factor in determining how to get problems fixed.
Special Note on Rent-to-Own: Many low income residents enter into agreements with the owner to rent the property with a portion of the "rental" payment going to the purchase of the property. These situations are essentially a contract to purchase the home and a rental agreement. The guidance on rental housing below applies but, generally, the resident is more responsible for maintenance and repairs. The arrangement is potentially subject to abuse by the owner/landlord. Advise the resident to get legal assistance.
Owner-Occupied Housing: If the resident owns the home, the resident has control of the property and can make the repairs. Most of the repairs can be made with only a small investment. When repairs are extensive - such as for major moisture or structural damage - the resident may not have the financial ability to make it work. Some key resources that might be available:
Rental Housing: If the resident is a renter, responsibility is split between the owner/landlord and the resident. Generally, the landlord is responsible for structural and major maintenance issues and the resident is responsible for housekeeping. Rent-to-Own situations are especially complicated. There are three steps to determine responsibilities:
Special Federal Regulations: In some cases, Congress has authorized the federal government to establish special rules to protect citizens. These standards benefit residents who rent or who own their home. But .
Shelter: Shelters are complicated. The shelter provides an essential service for the community. But they are often operated on limited funding. It is best to work directly with the non-profit or agency running the shelter to resolve problems.
The age of the home is important to know because it helps housing professionals you work with better understand the potential problems in a home. It is usually the first question they will ask.
It is also a special area of concern since a home built before 1978 may contain lead-based paint. According to the 2005 American Housing Survey, 65.5% of all homes were built before 1980. Deteriorated lead-based paint can poison children. Homes built before 1950 are much more likely to have lead-based paint on the interior and exterior, especially on the windows. After 1950, lead-based paint began to be phased out of interior use. In 1978, Congress banned use of lead-based paint in residences. The table below describes the situation around 2000. If a resident doesn't know the age of the home, presume it was built before 1978. See the lead paint hazards section of indoor pollutants for more information.
Action Steps for "Age of Home": If a nurse is working with a resident of a home built before 1978, the nurse should
Type of structural foundation is not an area of concern. However, it is a crucial factor in determining what problems might be present. It is also a question that housing professionals that you may call on will ask.
Basement: A basement is a helpful asset in a home. According to the 2005 American Housing Survey, 30.9% of all single-family homes have a full or partial basement. However, it can be a problem.
Slab on Grade: A house set on a concrete on the ground is a "slab on grade" home. According to the 2005 American Housing Survey, 21.1% of all single-family homes have a home on a slab. This type of foundation is common where there is a shallow groundwater that makes a basement too difficult to keep dry. A slab avoids many of the problems with basements. However because concrete is porous to water, it can have moisture problems. Also homes on slab often have wall-to-wall carpeting to avoid the cold floor. Wall-to-wall carpeting can result in serious problems with cleaning and moisture that lead to asthma triggers. Also cracks can allow radon and insects to enter the home.
Crawlspace: A crawlspace is the area under a home that you must crawl into to access. According to the 2005 American Housing Survey, 17.5% of all single-family homes have a home on a slab. Some homes are raised above the ground - often to avoid floods - and the crawlspace is the area under the floor. In other situations, the area under the floor is excavated. Crawlspaces share many of the same problems as basements.
Crawlspaces should be sealed and made part of the home because it is too difficult to keep the air in the home isolated from the air in the crawlspace. See Keep It Dry - Slide 25. They do not need to be heated or air-conditioned.
The number of floors lived in is not an area of concern. However, it is a factor in identifying safety hazards. if the home has more than one floor, the stairs may pose a safety hazard and may limit mobility for the disabled. In addition, upstairs windows may pose a falling hazard.
The fuel used to heat the home may present a danger to residents if equipment is damaged. Anything that burns a fuel is going to produce carbon monoxide and nitrogen oxides. Carbon monoxide is an invisible, tasteless, odorless gas that can - and does - kill. The residents fall asleep and die because the carbon monoxide is more easily absorbed by the blood than oxygen. Nitrogen oxides are an irritant to the respiratory system. A smoldering burn or yellow flame produces more carbon monoxide. A hot or blue flame produces nitrogen oxides - but not usually at levels of concern in a home.
Natural Gas/Liquid Propane Gas: Used in furnaces, stoves, water heaters, and space heaters. Devices burning gas should always be vent outside. If there is a gas leak, you will smell it. Producers add a stenching agent that smells like rotteneggs. Call the supplier and fire department immediately if you smell this stenching agent.
Oil: Used in furnaces, water heaters, and space heaters. There is usually a storage tank in the basement. Oil burning equipment must be vent outside
Electric: Electric heat does not produce carbon monoxide or nitrogen oxides in the home.
Wood: Used in furnaces, water heaters, and fireplaces. Wood burning equipment can produce high levels of carbon monoxide. They must be vented outside.
Action Steps for Fuel Used:
If the home is heated by a space heater or an appliance such as the stove or oven, the resident is at serious risk of carbon monoxide poisoning. Counsel the resident to stop using the space heater or appliance until they are sure it is safe. If there are problems with the furnace, they need to get it fixed.
Beyond concerns with the space heater, it is helpful to know whether the home is heated with a radiator or forced hot air system.
Forced Warm Air System: Homes use a forced air system where air in the home is pulled by a fan through ductwork to a furnace. According to the 2005 American Housing Survey, 62.7% of all homes use a forced air furnace. The air is heated by a heat exchanger in a central furnace. The heat exchanger is a metal device that is heated by combustion of oil or gas one side of the metal. The hot metal warms the air passing over it. The warmed air sent by separate ductwork throughout the home. A furnace has a filter to remove dust that can clog the heat exchange or cause respiratory problems for residents. The forced air furnace is often located in the attic in the South and in basements where there is a basement.
Radiators: A radiator uses hot water or oil to heat the home. You typically see them in older homes. The radiators are usually located on the exterior walls of the home. You may also see electric baseboard heaters to supplement the radiators. The oil or water is typically heated in a central heater and distributed by pipes. The major concerns with radiators is localized hot and cold spots. Some radiators are put in boxes with fans to reduce the problem.
In a forced warm air system and on radiators with fans, filters are used to keep the heat exchanger clean. If the heat exchange gets dirty, it will not transfer the heat was effectively. If high enough quality filter is used, the filter can also removed fine dust that can irritate the respiratory system and exacerbate asthma. Filters are rated on a system called MERV - Minimum Efficiency Rating Value. The higher the number, the more effective it is at removing particles. NCHH recommends a MERV 10 or higher. Click here for more information and photos of various filters.
The nurse should counsel family to:
A home should be comfortable. According to the 2005 American Housing Survey, 7.3% of all homes were uncomfortable cold for 24 hours or more the previous winter. Most housing codes set a minimum temperature in a home - usually around 65F. If it cannot maintain this temperature, the ventilation may be poorly designed or maintained. It needs to be repaired.
In high-rises apartments or condominiums, the ventilation may be poorly designed so that some residents are hot. They must open windows. This is a waste of energy and may create unhealthful conditions.
It is helpful to understand how the home is cooled. Air conditioning removes humidity from the air and then cools the air. Window air conditioners can cause water damage in the walls if not properly installed. Central air conditioning can also cause water damage if poorly installed or maintained.
In some cases, especially humid areas, the cool interior may cause water too form in the wall cavities of exterior walls. This moisture can result in mold.
Each bathroom and the stove should have a fan that exhausts outside. The fan removes moisture, smells, and other contaminants. If the bathroom has a shower or bath or the stove/oven is not electric, the fan is essential.
10320 Little Patuxent Parkway,
Suite 500 • Columbia, MD 21044