Controlling Asthma and the Benefits of Prevention

ANGELICA: [INAUDIBLE].

(SINGING) Clean, clean, clean.

[BABY COUGHS]

(SINGING) Clean a las manos.

REPORTER: Three-year-old Jesus Cresto has been to the emergency room twice in the past 12 months for asthma attacks. His mom, Angelica, says she isn't getting much sleep these days.

ANGELICA: I'll just be checking on him. Is he OK? It is really hard because they change your life. I just want to take care of my kids better.

REPORTER: The Cresto family lives in East Oakland, a predominantly low-income community in Alameda County which has some of the highest rates of asthma in California.

Children with uncontrolled asthma, especially those from low-income families who often have government-funded health care insurance, account for a disproportionate number of costly ER visits and hospital stays. So keeping Jesus loose the more than 1 million other kids with asthma in California healthy is a big priority. And Alameda County has been leading an effort to do just that, focusing on the place where kids spend the most time their home.

On a recent morning, a team of cleaners specializing in asthma trigger remediation arrived at the Cresto home. They cleaned up pest droppings behind the fridge, removed mold spots on a bedroom window, and put a dust mite cover on the mattress.

The cleaning visit was arranged by Sandra Rodriguez, a community outreach worker from the county's Healthy Homes department. She is part of a unique collaboration between housing and public health agencies.

SANDRA RODRIGUEZ: Where does Jesus who spend a lot of the time?

ANGELICA: He usually likes to be on the floor. So how I clean the house, I use Clorox a lot.

SANDRA RODRIGUEZ: OK.

ANGELICA: Because I think I want to keep the floors clean.

SANDRA RODRIGUEZ: Using harsh chemicals like Clorox can really exacerbate a child's asthma. And so we recommend that you try natural products, just soap and water. Soap and water. And one of the additional is baking soda.

ANGELICA: OK.

REPORTER: The program, which began in 2001 and was among the first of its kind in the country, is open to all children in the county who have been diagnosed with asthma. Allergen reducing products like HEPA filter vacuums are offered to families who can't afford them. And the program will even pay for minor home repairs.

BRENDA RUEDA-YAMASHITA: We saw these very high rates in our county. And we didn't want to have residents who were dealing with issues like that.

REPORTER: Brenda Rueda-Yamashita manages the public health department's side of the program, called Asthma Start. She says the upfront costs, which average about $2,500 per family, depending on the needs, are worth spending to prevent the back end costs.

BRENDA RUEDA-YAMASHITA: It's around $23,000 for a child to have an asthma hospitalization, and around $3,500 for an ER visit. So that's the highest impact. Mom losing money, dad losing money because they have to stay home with the child or take the child to the ER and their employer doesn't pay for sick time. There's a cost to cities and/or counties for their fire because fire departments show up to 9-1-1 calls.

REPORTER: The other key priority for the program is educating families about the importance of taking prescribed asthma medications. That's where medical social worker Amy Sholinbeck comes in.

AMY SHOLINBECK: We're going to watch him breathe. Yeah, excellent. Good boy.

REPORTER: On this day, she is back for a second visit with two-year-old Romani Webb and his mom, Artensi. Romani has had several hospital stays for asthma attacks. But after an initial two-hour visit a month ago, the family has been on top of his medications.

AMY SHOLINBECK: So have you noticed that he's been having less symptoms since you've been doing this?

MOTHER: At the nighttime, definitely. He sleeps a lot better too.

AMY SHOLINBECK: Oh, I'm so happy to hear that. It's all about his health.

MOTHER: Yes.

AMY SHOLINBECK: We want to keep you out of the hospital, baby.

Excellent.

Sometimes the family ends up confusing the inhalers, or it wasn't explained to them in enough detail. So we're in a calm environment in their home, and we take a lot of time to make sure they understand what the medications do in the body. And we have special stickers we put on the medicines. And we just make sure they really get it.

HEALTH WORKER: So I just wanted to give you an update on our numbers.

REPORTER: The program has served about 250 families each year. It's been funded through a combination of sources, including grants, taxes, tobacco settlement money, and a local Medicaid managed care program.

A data review by that organization in 2012 found health care costs for pediatric patients ages 0 to 5 were cut in half during the 12 months after they went through the program. Those results and the program's long track record are generating new interest in Alameda County's preventative approach.

LINDA NEUHAUSER: I have studied a lot of programs. But when I got introduced to this program, what I saw was a very seasoned, careful intervention that draws on the best practices that we get from research to date.

REPORTER: UC Berkeley professor Linda Neuhauser is leading an in-depth study of the program. Her research is ongoing, but she believes policymakers around the country should pay attention.

LINDA NEUHAUSER: It's hard to estimate the cost savings. But I think in Alameda County alone, we might be able to save as much as $16 million a year just on hospitalizations of children. This is an amazing saving of health care costs.

REPORTER: Eight-year-old Milan Michael is one of those children who is happy to be out of the hospital. Her mom, Neviette Hagos, says some big changes have happened since the asthma teams visited their home.

MOTHER: Now, she's doing a lot better. She hasn't been to the ER in at least a year. They made a great difference. We were living close to a freeway. And they mentioned to me how that affects asthma. So we moved away from the freeway now. And that also helped.

REPORTER: Hagos is now working for the program and using the training she received to help other families with asthma.

The home-based asthma program recently got a temporary boost in funding from a national nonprofit and the Alameda County Board of Supervisors. That money is being used in part to help an additional 250 families this year.