MMHA 6200 Week 11 Community Benefit Proposal Paper Example

Community Benefit Proposal: Home Remediation for Children With Asthma in Port Harmon's East-Side Corridor

Student Name

Walden University

MMHA 6200: Creating Healthy Communities

Instructor Name

Month Day, Year

Community Benefit Proposal: Home Remediation for Children With Asthma in Port Harmon's East-Side Corridor

The Request

Lakeshore Community Hospital's board committee on community benefit, at this composite nonprofit hospital, is asked to approve three things by its next quarterly meeting. First, $699,000 in first-year operating funds, with a 15% contingency on repairs, for a home remediation program serving children with asthma in the east side's rental corridor. Second, three anchor commitments: hiring the program's community health workers from the corridor, contracting repairs locally and moving $1.5 million of invested reserves into low-interest repair lending for small landlords. Third, an evaluation, with a comparison area and a definition of failure set in advance, that could show the program not working. All local figures in this proposal are illustrative.

Why the East Side

Kindig and Stoddart define population health to include not only a group's average outcomes but how those outcomes are distributed within it (Kindig & Stoddart, 2003). By that definition, the county's unremarkable averages hide a large gap. The east side carries much higher premature death, child poverty and renting than the county as a whole, and the gap is concentrated in a corridor of old rental housing along the former streetcar line. There, children's asthma emergency visits run at 30.0 per 1,000 a year, nearly four times the county remainder's 8.0: a ratio of 3.75 and roughly 136 extra visits a year among the corridor's 6,200 children. Following guidance on measuring disparities, both measures are reported, and the target is set on the difference, because it describes the burden the program can reduce (Keppel et al., 2005).

Why These Children

Three populations were considered: children with asthma in the corridor, older adults near the closed supermarket and working adults without cars. The children were chosen because their burden is severe, their gap from the county is large, the hospital can reach them through its emergency department and clinic, effective interventions exist and change can be measured within two years. The other two populations matter, and the hospital will continue to connect them to existing services, but the hospital's reach over food retail and transit is limited, and their outcomes would be harder to measure in the same period.

What the Needs Assessment Found

A needs assessment working outward from the child found a chain. Corridor children have high asthma emergency visit rates and high chronic school absence. Their homes generate a disproportionate share of the city's moisture, mold and pest code citations, though code enforcement waits for complaints and so undercounts the problem. Most corridor buildings predate 1950 and are rented, and elevated childhood lead levels mark the same aging housing. The rules sustain the problem: inspections only on complaint, tenants afraid to complain and a city repair grant that excludes most corridor landlords. Krieger and Higgins describe housing as a modifiable contributor to asthma that public health can act on (Krieger & Higgins, 2002), and the chain points to the home as the place to act.

National Alignment and the Gap It Lacks

The program aligns with Healthy People 2030 objectives on reducing asthma emergency visits and housing cost burden (Office of Disease Prevention and Health Promotion, 2020). It also addresses a local problem no national objective covers: rental code enforcement that waits for tenant complaints. That rule, more than any single defect, explains why triggers persist.

The Coalition

Seven partners make the program possible: a tenants' association, a community development corporation that repairs homes, a legal aid tenant clinic, the county's healthy homes inspectors, the school district's family resource centers, a small-landlord association and the hospital. Each has a stake: the tenants' association gains repairs and a voice, legal aid gains cases that protect tenants, the development corporation gains contracts and the landlords gain repairs paid partly by others. The landlord association could sink the effort, because its members control access to most corridor homes and risk citations if defects are found. The coalition's repair-first agreement, under which defects found through the program are repaired before enforcement is considered, is the condition of its participation. Partnerships that give members clear roles and benefits are more likely to change community conditions (Roussos & Fawcett, 2000).

The Program

Three designs were compared: a clinic resource desk, universal screening and referral, and home-based remediation. Only remediation reaches the home, and it has the most direct evidence. Crocker and colleagues' Community Guide review credits programs that address several home triggers together with fewer symptom days, absences and acute visits among children (Crocker et al., 2011), and in the Seattle trial, families receiving the fuller version of the worker visits used urgent care for asthma less than those receiving the lighter version (Krieger et al., 2005). The program sends a community health worker to each referred home within two weeks for assessment, education and supplies; arranges repairs through the development corporation; refers families facing retaliation to legal aid; and returns at 90 days to confirm triggers are gone. Referrals come from the pediatric emergency department and the school family resource centers.

The Budget and Anchor Commitments

The first-year operating budget is $699,000, of which $360,000 is the program's share of repairs, the largest and least certain line. The anchor commitments are counted separately: three jobs for corridor residents, local contracting for about $360,000 in repairs and a $1.5 million repair loan fund at 2% for small landlords, at a forgone return of about $45,000 a year. Anchor institution strategies of this kind use a hospital's roles as employer, buyer and investor to improve the conditions behind health (Koh et al., 2020). Nonprofit hospitals must assess community needs and adopt strategies to address them (26 U.S.C. § 501(r)); this proposal is such a strategy, more concentrated and more measurable than most.

How the Committee Will Know

The program's objectives run in four tiers: 300 homes assessed and 80% of needed repairs completed within 45 days in year one; triggers confirmed absent in 70% of homes at 90 days; corridor asthma emergency visits falling from 30.0 to 24.0 per 1,000 and chronic absence from 24% to 20% within two years; and the corridor's rate difference from the county narrowing from 22.0 to 17.0 per 1,000. Untreated blocks to the west, with similar housing, serve as a comparison area. Should the comparison blocks improve as much as the corridor over two years, the program's effect will be unproven, and the committee should decide whether to redesign or end it.

What the Hospital Owes the Corridor

What does a nonprofit hospital owe the neighborhood outside its doors? Charity care alone has been a weak answer: a national cost report analysis found nonprofit hospitals spending less of every $100 on it than government or for-profit hospitals (Bai et al., 2021). This proposal offers a different kind of answer: a concentrated effort on one measurable problem, in one place, with partners who live and work there, the hospital's own resources as employer, buyer and investor and an evaluation honest enough to show if it fails. If it succeeds, the comparison area is the next corridor. If it does not, the hospital will have learned why, in public, from the people it set out to serve.

References

Additional requirements for certain hospitals, 26 U.S.C. § 501(r) (2023).

Bai, G., Zare, H., Eisenberg, M. D., Polsky, D., & Anderson, G. F. (2021). Analysis suggests government and nonprofit hospitals' charity care is not aligned with their favorable tax treatment. Health Affairs, 40(4), 629-636. https://doi.org/10.1377/hlthaff.2020.01627

Crocker, D. D., Kinyota, S., Dumitru, G. G., Ligon, C. B., Herman, E. J., Ferdinands, J. M., Hopkins, D. P., Lawrence, B. M., & Sipe, T. A. (2011). Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: A Community Guide systematic review. American Journal of Preventive Medicine, 41(2 Suppl. 1), S5-S32. https://doi.org/10.1016/j.amepre.2011.05.012

Keppel, K., Pamuk, E., Lynch, J., Carter-Pokras, O., Kim, I., Mays, V., Pearcy, J., Schoenbach, V., & Weissman, J. S. (2005). Methodological issues in measuring health disparities (Vital and Health Statistics, Series 2, No. 141). National Center for Health Statistics.

Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383. https://doi.org/10.2105/AJPH.93.3.380

Koh, H. K., Bantham, A., Geller, A. C., Rukavina, M. A., Emmons, K. M., Yatsko, P., & Restuccia, R. (2020). Anchor institutions: Best practices to address social needs and social determinants of health. American Journal of Public Health, 110(3), 309-316. https://doi.org/10.2105/AJPH.2019.305472

Krieger, J., & Higgins, D. L. (2002). Housing and health: Time again for public health action. American Journal of Public Health, 92(5), 758-768. https://doi.org/10.2105/AJPH.92.5.758

Krieger, J. W., Takaro, T. K., Song, L., & Weaver, M. (2005). The Seattle-King County Healthy Homes Project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4), 652-659. https://doi.org/10.2105/AJPH.2004.042994

Office of Disease Prevention and Health Promotion. (2020). Healthy People 2030 framework. U.S. Department of Health and Human Services.

Roussos, S. T., & Fawcett, S. B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health, 21, 369-402. https://doi.org/10.1146/annurev.publhealth.21.1.369