the low income home energy assistance program (liheap ... · • resorting to unsafe methods to...
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The Low Income Home Energy Assistance Program
(LIHEAP)
Health and Safety August 16, 2016
Leon Litow, Division of Energy Assistance, OCS Administration for Children and Families, HHS
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1995 Chicago Heat Wave- 739 heat-related deaths over 5 days
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Staying Healthy and Safe at Home
• Affordable home energy burden
• Energy to cool or heat one’s home; electricity to operate home energy equipment
• Maintenance, repair, replacement of home energy equipment
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Unaffordable Home Energy
• Raising or lowering indoor temperatures to unsafe levels or cutting back on food, medication, etc.
• Resorting to unsafe methods to keep homes warm or cool
• Utility shutoffs and/or dry fuel tanks; electricity not available to operate home energy equipment
• Home energy equipment failure or damage from natural disasters
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• Block grant flexibility for LIHEAP grantees to design programs to meet home energy needs
• LIHEAP grantees-50 states and District of Columbia, Indian tribes or tribal organizations, and U.S. Territories
• Not entitlement program – $3.4 billion funding for Federal Fiscal Year 2016
• Priority for vulnerable households at risk for hypothermia (too cold) or hyperthermia (too hot) -Elderly, persons w/disabilities, & young children
• Priority for high energy burden households – cutting back on basic necessities
LIHEAP Basics
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Low Income • Household income adjusted by household size -
percent of poverty level – no lower than 110% poverty; no higher than 150% poverty or 60% state median income (can be expressed as % of poverty)
• Households in which at least 1 person is receiving TANF, SSI, SNAP, and certain Veteran benefits
• Grantee’s can use additional program criteria such as receipt of a utility disconnect notice or meeting a resource or asset test
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Home
• Single/duplex dwelling, mobile home, multi-unit building, etc.
• Owners
• Renters
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Energy to heat or cool home– regulated and unregulated fuels
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Assistance
• Assistance with payment of part of home heating / cooling costs – usually paid directly to energy suppliers
• Energy crisis assistance – funds or in-kind assistance for weather-related, supply shortage emergencies and other household energy-related emergencies -- – Reasonable amount of crisis funds reserved until March 15th
– After applying for energy crisis benefits implementation of
48/18 hour rule if a household is eligible for such benefits
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Assistance
• Weatherization and energy-related home repairs (install or repair window and door screens)
• Installing or repairing home energy equipment
• Home energy education
• Budget counseling – payment plans
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Lessening the Risk of Heat Waves
• Establish cooling centers and coordinate with community emergency response teams
• Loaning or giving air conditioner units
• Provide higher crisis benefits for electric bills to help offset higher demand for air conditioning
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Lessening the Risk of Heat Waves
• Provide targeted outreach to identify households at greatest risk to heat
• Provide client education about how to keep their homes cool during extreme heat wave
• Provide PSAs on critical information about emergency resources, how to recognize signs of heat-related illness, and steps to stay cool
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Where to Apply • Local energy assistance office--Community Action
Agencies, AAAs, Department of Social/Human Services, Health Department
• The National Energy Assistance Referral (NEAR), a free service providing information on where to apply for LIHEAP. 1-866-674-6327or [email protected]
• OCS’ LIHEAP Grantee Directory at OCS website -www.acf.hhs.gov/ocs/programs/liheap
• Health officials, Red Cross, Salvation Army, Consumer Protection, local government – Utility Fuel Funds
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Some Resources
• National Center for Benefits Access, March 2016, LIHEAP 101
• LIHEAP Clearinghouse, March 2014,LIHEAP 101 What You Need to Know
• U.S. Office of Community Services, LIHEAP Brochure (in English and Spanish)
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Public Health Implications of LIHEAP for Older Adults
CDR Jonathan White Administration for Children and Families
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Key Topics
• Describe home energy security in the context of social determinants of health.
• Identify key mechanisms for indoor temperature and air quality related to affordable heating and air conditioning to affect human health.
• Discuss energy assistance as a public health intervention in the context of risks faced by older adults and multigenerational households led by older adults
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Social Determinants of Health
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Human Services & the Social Determinants of Health
Factors Impacting Population Health
PhysicalEnvironment (10%)Health Care (20%)
Health Behaviors(30%)Social & EconomicDeterminants (40%)
University of Wisconsin Population Health Institute (2010)
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Socioeconomic Determinants of Health
• Socioeconomic determinants of health are the foundation of population health.
• Interventions in the social and economic conditions that affect health have the largest population-level impacts.
Centers for Disease Control & Prevention (2015)
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Energy Assistance Programs
One of the Best-Kept Secrets in Public Health
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How Can Extreme Temperatures Affect Human Health? • Heat injury (heat cramps, heat exhaustion, and heat stroke) • Cold injury (hypothermia and frostbite) • Ischemic heart disease • Cardiovascular disease • Stroke • Asthma • Allergies • Chronic obstructive pulmonary disease (COPD) • Respiratory disease • Mosquito-borne illness • Environmental pollutant exposures • Accidents and burns • Dehydration • Food-borne illness • Behavioral health/stress
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Who is at heightened risk? • Children (0-5) • People with certain
chronic health conditions
• Individuals experiencing homelessness
• Low-income individuals and families
• Older adults
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Heat Injury Risk
• Outdoor Temperature Risk
• Indoor Temperature Risk
• Economic vulnerability raises both types of risk
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Cold Injury Risk • Outdoor Temperature
Risk • Indoor Temperature
Risk • Economic vulnerability
raises both types of risk • Older adults have
slightly higher outdoor temperature risk and much higher indoor temperature risk
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Cold-Related Injuries • Older adults are at higher
risk than of indoor cold injury
• Most indoor hypothermia deaths in the United States occur in older adults living alone
Heat-Related Injuries • Older adults are at higher
risk of indoor and outdoor heat injuries
• Heat waves cause more deaths in a typical year than any other natural disaster—and 80% of deaths and hospitalizations are people over 60
Older Adults at Risk
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Mechanics of Temperature Risk
Temperature Health Risk
Outdoor Temperature
Built/Natural Environment
Pre-Existing Health Risks
Age-Related Risk
Home Energy
Insecurity
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Air Conditioning and Health
• The largest study yet attempted in the U.S. which looked at California from 1999 to 2005… “…observed a significantly increased risk of hospitalization for multiple diseases, including cardiovascular disease, ischemic heart disease, ischemic stroke, respiratory disease, pneumonia, dehydration, heat stroke, diabetes, and acute renal failure, with a 10º [Fahrenheit] increase in same-day apparent temperature. They also found that ownership and usage of ACs significantly reduced the effects of temperature on these health outcomes, after controlling for potential confounding by family income and other socioeconomic factors.”
-- Ostro, Green, Malig, & Rasu 2010, Am J Epidemiology 172(9)
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Indoor Air Quality
• Economic disadvantage and IAQ risk • Energy security, extreme heat/cold, and IAQ • Key factor in respiratory disease burden for
older adults and multigenerational households with older adults – Asthma (in children and adults) – Allergies (in children and adults) – COPD (in older adults)
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Weatherization & Indoor Air Quality • The Environmental Protection Agency (EPA) has determined
that weatherization improvements to a home, if they are not accompanied by steps to protect Indoor Air Quality (IAQ) may lead to increased health risks for people in the home.
• Weatherization “tightens” the home, decreasing airflow in and out of the house. This increases the daily exposure of residents to indoor air pollutants, unless mitigated.
• EPA has established recommendations on public health mitigation steps to keep weatherization safe and healthy. These are worth reviewing or sharing as part of LIHEAP Weatherization Programs.
Environmental Protection Agency: http://www.epa.gov/indoor-air-quality-iaq/protocols-home-energy-upgrades
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Climate Change Health Risks “The populations most vulnerable—children, elderly people, those living in poverty, people living in certain geographic areas and people with underlying health conditions—are at even greater health risk from climate change.”
-- Luber, Knowlton, & Beard (2014),
CDC Public Health Grand Rounds
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• “High-Risk” Clients and Eligibility Determinations – “High-Risk” populations for
purposes of LIHEAP by statute • Includes older adults
– “High-Risk” populations for adverse indoor temperature health outcomes based on available scientific evidence
– Implications of science for eligibility prioritizations—options for state program policies
High Risk Clients & Energy Assistance
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• Access to home energy can significantly reduce ER visits
• ER admissions represent one of the highest-cost health care services and are a focus of cost reduction efforts by HHS
• A critical area for emerging and future investigation: are there net public savings (in Medicaid and Medicare costs) created by investments in energy assistance?
Public Investment and Health Care Cost Savings
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Partnerships and Paths Ahead • To address heating/cooling-
related risks to older adult clients, improved outcomes are likely with strong partnership between aging services agencies and… – Energy assistance programs – Community Action Agencies – Public health authorities – Clinical health care systems – Bridge organizations – Environmental health &
justice groups
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Questions?
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CDR Jonathan White, Ph.D., LCSW-C, CPH Senior Adviser for Strategic Initiatives
Immediate Office of the Assistant Secretary Administration for Children and Families