LIHEAP Report to Congress on Preventing Loss of Life Due to Extreme Indoor Temperatures FY 2007

Low Income Home Energy Assistance Program
Report to Congress on:

Preventing Loss of Life Due to Extreme Indoor Temperatures

Required by Section 1894 of Title XVIII of the Energy Policy Act of 2005
(Public Law 109-58)

U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Administration for Children and Families
Office of Community Services

U.S. Department of Health and Human Services
Administration for Children and Families
Office of Community Services
370 L’Enfant Promenade, S.W.
Washington, D.C. 20447

Table of Contents

I. Introduction and Background

Purpose of Report
Relevant LIHEAP Statutory Provisions for Prevention of Loss of Life
Background

 II. State Recommendations

Outreach and Education Efforts

Education and Outreach Methods
Education and Outreach Topics

Weatherization and Energy-Related Home Repairs

Home Inspections
Home Repairs and Replacements

Special Assistance for Vulnerable Populations

Program Design

Establish Partnerships

Federal Programs
State and Local Government Agencies
Local Energy Providers and Suppliers
National and Local Non-Profit Organizations

Appendix

A. Examples of Community-Based, Home Energy-Related Health and Safety Programs

I. Introduction and Background

The Low Income Home Energy Assistance Program (LIHEAP) is authorized by Title XXVI of the Omnibus Budget Reconciliation Act of 1981 (OBRA), Public Law 97-35, as amended. The Administration for Children and Families (ACF) within the U.S. Department of Health and. Human Services (HHS) administers LIHEAP at the Federal level.

The purpose of LIHEAP, as stated by Section 2602(a) of the LIHEAP statute, as amended, is: "to assist low income households, particularly those with the lowest income, that pay a high proportion of household income for home energy, primarily in meeting their immediate home energy needs." The LIHEAP statute defines home energy as "a source of heating or cooling in residential dwellings."

Each State operates its own energy assistance program that includes taking applications, establishing eligibility, and providing benefits. Grantees may provide assistance to households for heating, cooling, weatherization, and emergency crises. LIHEAP funds are distributed to LIHEAP grantees by allocation formula procedures.

Purpose of Report

The public health aspects of LIHEAP have been underscored in the Energy Policy Act of 2005 (Public Law 109-58) that President Bush signed on August 8, 2005. Specifically, this Report is submitted in accordance with Section 1804 of Title XVIII of the Energy Policy Act that states:

Not later than 1 year after the enactment of this Act, the Secretary of Health and Human Services shall transmit to Congress a report on how the Low Income Home Energy Assistance Program could be used more effectively to prevent loss of life from extreme temperatures. In preparing such report, the Secretary shall consult with appropriate officials in all 50 States and the District of Columbia.

Due to the LIHEAP statute definition of home energy as "a source of heating or cooling in residential dwellings," this report to Congress focuses on the prevention of loss of life from extreme "indoor" temperatures.

Relevant LIHEAP Statutory Provisions for Prevention of Loss of Life

The following LIHEAP statutory provisions are relevant to the prevention of loss of life due to insufficient home energy:

• LIHEAP assistance is intended primarily to assist low income households "in meeting their immediate home energy needs" (emphasis added) (Section 2602(a)).
• Energy crisis intervention is to be provided not later than 18 hours after a household applies for crisis benefits "if such household is eligible to receive such benefits and is in a life-threatening situation" (emphasis added) (Section 2604(c)(2)).
• LIHEAP outreach activities are to be "designed to assure that eligible households, especially households with elderly individuals or disabled individuals, or both, and households with high home energy burdens, are made aware of the... availability" of LIHEAP assistance (emphasis added) (Section 2605(b)(3)).
• LIHEAP grantees are to "provide, in a timely manner, that the highest level of assistance will be furnished to those households which have the lowest incomes and the highest energy costs or needs in relation to income, taking into account family size..." (emphasis added) (Section 2605(b)(5)).
• One of the purposes of the LIHEAP Residential Energy Assistance Challenge Option (REACH) program1/ is to "minimize health and safety risks that result from high energy burdens on low income Americans" (emphasis added) (Section 2607B(a)(1)

Background

While extreme indoor temperature is not a new problem, attention to it is increasing as home heating and cooling bills rise due to the combination of rising home energy-prices and changes in the weather. Extreme indoor temperature is an energy-related health issue in that such temperatures can lead to cold stress/hypothermia or heat stress/hyperthermia, which can directly or indirectly lead to death. Extreme indoor temperature is a LIHEAP-related issue when low income households cannot afford to heat or cool their homes adequately due to their difficulty in paying for home energy, home energy efficiency improvements, or home energy related repairs.

The LIHEAP statute defines the term "highest home energy needs" as "the home energy requirements of a household determined by taking into account both the energy burden of such household and the unique situation of such household that results from having-members of vulnerable populations, including very young children, individuals with disabilities, and frail older individuals" (emphasis added) (Section 2603(4)).

Although it is unstated in the LIHEAP statute, the implied concern is that such populations are "vulnerable" or at risk of serious health risks if they do not have adequate heating or cooling of their homes. Health risks can include death from hypothermia and increased susceptibility to other health conditions, such as stroke, heart attacks, and lung disease. Persons, can be especially at risk due to age and health factors. Safety risks can be caused by natural disaster, the use of makeshift heating sources and inoperative or faulty heating/cooling equipment that can lead to indoor fires or asphyxiation, etc.

ACF, State LIHEAP agencies, and the National Energy Assistance Directors' Association (NEADA)2/ recognize the importance of extreme temperatures, especially for vulnerable populations. To that end, the following efforts have been conducted to address such health and safety risks:

• A number of States. LIHEAP agencies already make health and safety an element of their LIHEAP outreach activities and overall program design;
• Beginning in Fiscal Year (FY) 2004, ACF implemented a Federal outreach campaign to make elderly households aware of hypothermia and how LIHEAP can assist such households; and
• NEADA has documented a number of health' issues faced by LIHEAP recipient households in NEADA's 2005 National Energy Assistance Survey.3/ NEADA also is involved in developing public health information and outreach programs on home energy-related risks.

In accordance with the mandate in the. Energy Policy Act of 2005, ACF solicited feedback from States on how LIHEAP can effectively prevent loss of life from extreme indoor temperatures.

Based on the input received, this report highlights the strategies States can use within current LIHEAP law to aid in preventing the loss of life through:

1. Education and outreach, especially to vulnerable and at-risk populations;
2. Weatherization and energy-related home repairs, including mitigation of health and . safety risks;
3. Special assistance for vulnerable populations, including modifications of assistance provided, service delivery, benefits, and eligibility;
4. LIHEAP program design, on behalf of vulnerable populations;
5. Partnerships with other social service programs and energy providers; and
6. Program research on the needs of– and best practices for helping – vulnerable households.

Outreach and Education Efforts

Many States highlighted the benefits of establishing a public education and outreach campaign about the health and safety risks associated with extreme temperatures, as well as with heating/cooling appliances and fuels. This includes educating the public on energy conservation and financial matters, such as managing a household budget in order to afford one's energy bills. States also mentioned the importance of specifically targeting campaigns to households with vulnerable populations – elderly or disabled individuals or young children – or those especially at-risk of home energy termination.

Education and Outreach Methods

States recommended numerous public education and outreach campaign activities ranging from distributing print materials to regularly broadcasting public service announcements to holding educational workshops. Other suggested methods included:

 

• Providing health and safety brochures at intake.
• Inserting health and safety brochures into recertification packages.
• Asking energy suppliers to provide health, safety, and LIHEAP information on the bottom of their bills.
• Including health, safety, and LIHEAP information in local publications.
• Conducting energy fairs.

Several. States also named specific ways to identify and target those at-risk individuals, households, and subgroups of the population that are especially vulnerable to health and safety risks associated with extreme temperatures. For example, coordinating with community resource agencies to identify households with vulnerable populations, including very young children, individuals with disabilities, elderly, or those with special medical needs; those who need air-conditioner replacement and home weatherization; and those at-risk of having their energy supply terminated due to payment problems. Additionally, the importance of targeting outreach to persons, specifically at-risk households, for emergency assistance more than once during the year was emphasized; it was noted that it is often too late to reach the intended audiences when health, safety, and LIHEAP assistance information is made available only at the time of an extreme weather threat.

Many States recommended using multiple outlets of communication in order to ensure these critical messages have a wide reach to the general public and especially vulnerable populations.

Education and Outreach Topics

States also provided feedback on what topical content should be included in public education and outreach campaigns, regardless of the dissemination methods utilized. Most States stressed the importance of educating the public about the following themes: health and safety risks associated with extreme temperatures; health and safety risks associated with heating/cooling appliances and different types of fuels; energy conservation; financial literacy matters related to household budgets and payment of energy bills; and availability of LIHEAP and other public assistance.

Specific messages within these broader educational categories included:

Health and Safety Risks Associated with Extreme Temperatures

• Dangers of extreme heat/cold.
• Techniques to handle extreme temperatures when a threat exists, i.e. information on staying cool and hydrated during heat waves.
• Warnings not to wait or avoid use of heating/cooling units out of worry that utility bills will rise.

Health and Safety Risks Associated with Heating/Cooling Appliances and Fuels

• High risk factors associated with using coal, kerosene, propane, wood, and fuel oil as a heating source.
• Risks associated with heating/cooling appliances, including space heaters and using inadequate fans in enclosed rooms.
• Dangers of fire and carbon monoxide poisoning from alternative, risky heating sources.
• Dangers associated with overloading circuitry — especially old or defective wiring — with cooling appliances.
• Encourage the use of smoke/carbon monoxide detectors.
• Techniques to stay warm without resorting to makeshift heating sources.

Energy Conservation

• Techniques to prevent households from running up excessive bills.
• How to conserve energy during periods of extreme indoor/outdoor temperatures.

Financial Literacy

• Explanation of bill, payment options, and importance of paying energy bills on time.
• How to manage money and create a household budget.
• How to seek financial help before termination of energy supply occurs.

Availability of LIHEAP and Other Public Assistance

• "Who, When, Where, and How" about obtaining energy assistance through LIHEAP.
• Other energy assistance and social service agencies that provide assistance in the community.
• Other federal and local public assistance benefits for which individuals might be eligible

Weatherization and Energy-Related Home Repairs

Another important way that States identified to help prevent loss of life due to extreme temperatures is through the provision of weatherization and energy-related home repairs. Health and safety risks can include the absence of heating/cooling units and use of makeshift heating sources, high-risk fuel sources, and problematic heating/cooling equipment that could lead to indoor fires, asphyxiation, or poisoning. Consequentially, health and safety risks could be mitigated through repairs and replacement of inoperative, faulty, or dangerous heating and cooling units. These efforts also will reduce the amount of LIHEAP recipients' energy bills due to inefficient or faulty heating and cooling units.

Home Inspections

Home inspections are recommended to determine the health and safety risks, as well as the weatherization and energy efficiency needs, of the household. States recommend coordinating home inspections with the Weatherization Assistance Program to determine if households' heating/cooling units are in need of replacement.

Home Repairs and Replacements

A number of States report the importance of providing or repairing heating/cooling units that are not functioning or are functioning inadequately with mechanisms that will not compromise the households' safety. Related to this discussion is the provision of weatherization services and energy-efficient means for heating and cooling homes in order to control the cost of energy bills. Specific suggestions from States included:

• Replacing or providing heating/cooling devices (including fans and air-conditioners)
• Providing window AC Units.
• Providing energy-efficient systems as replacements.
• Converting households using deliverable heating fuels — specifically coal, kerosene, liquefied petroleum gas, wood, and. fuel oil — to other fuel sources.
• Purchasing smoke or carbon dioxide detectors for households using high risk fuel sources.
• Upgrading electrical systems that support cooling appliances.
• Distributing weatherization materials that enhance households' energy self-sufficiency.

Special Assistance for Vulnerable Populations

Among the other suggestions States provided were ways to provide special assistance to vulnerable populations or vary program design to accommodate the unique needs of these LIHEAP recipients. State recommendations included the following:

 

• Contacting at-risk and elderly households regarding LIHEAP assistance individually if possible and secondarily by distributing printed materials.
• Providing timely (within 24 hours) follow-up for homebound persons and other households who are unable to maintain adequate home temperatures.
• Establishing higher LIHEAP benefits for elderly and other vulnerable populations.
• Lowering or eliminating co-payments to vulnerable households during the crisis period of the LIHEAP program.
• Sponsoring special service days just for elderly and other vulnerable LIHEAP recipients.
• Creating a crisis program especially for vulnerable populations.

One State operates a "Summer Crisis Program" (SCP), which was created especially for vulnerable populations. This program was established to assist the elderly and individuals who have health risks from a medical condition with energy costs associated with home cooling. To be income-eligible for SCP a household must have a total household income, for the last 12 months or 90 days, equal to or less than 175 percent of the federal poverty guidelines. Any household, which has a member who has a medical-related health risk, must provide a medical statement. Elderly applicants over the age of 60 who are income eligible qualify for summer crisis program services. They receive an energy-star air conditioner and a one-time payment of $200 on their electric bill. Persons with a medical condition are provided an air conditioner. For the 2005 Summer Crisis Program, 14,922 elderly households and 14,627 medical health risk households were served.4/

Program Design

In addition to these specific areas of LIHEAP assistance, States may design their overall LIHEAP program in order to better protect against extreme temperatures and serve vulnerable populations. States have great flexibility regarding their operating procedures, service delivery, eligibility and benefits, and client assistance mechanisms. States offered the following recommendations regarding elements of LIHEAP program design:

• Providing blankets and throws.
• Providing case management services for at-risk households least able to maintain indoor temperatures of 69 degrees when external temperatures are at or below 40 degrees or above 90 degrees.
• Providing a second issuance of regular assistance during the current program year, at least for persons at the lowest end of the income guidelines without additional application, particularly for those with "high energy burdens."
• Referring individuals showing signs of hypo/hyperthermia to medical protective services.
• Providing year-round services (also helps prevent rush at one time of year).
• Operating both a heating and cooling program if one doesn't currently exist (even if the State doesn't think it needs one based on its climate).
• Making direct energy assistance payments to energy suppliers for current fills or meter reads.
• Operating a crisis program for cooling assistance, i.e. operate cooling shelters in high-heat areas. Target cooling assistance to the elderly and households with members who have breathing problems.
• Providing transportation for clients to heating/cooling shelters.
• Developing ice/water distribution systems.
• Linking benefits to fuel costs.

Establish Partnerships

States frequently mentioned establishing formal partnerships and other ways to collaborate with other federal programs; State and local social service agencies; local energy providers and suppliers; and national or local non-profit organizations with like missions, tasks, or target populations as a means for providing services to vulnerable populations.

The level of intensity of the collaboration can vary from a more informal partnership on an ad-hoc basis to formal contracts or cooperative agreements. Examples of partnership activities could include:

 

• Providing education to partner agencies about each program's services.
• Serving in advisory roles about development of education campaigns, program design, and emergency plans.
• Providing client referrals to partner programs.
• Providing intake functions for partner programs.
• Conducting program outreach for partner programs.
• Providing services to each other's Clients.
• Merging of multiple funding sources to accomplish a common goal.

At a minimum, these relationships can be helpful as a means for informing agencies and organizations of LIHEAP program opportunities, which in turn can pass on the vital information to the targeted population members they encounter. This will enable partner staff to proactively identify, educate, refer, and assist at-risk clients and ensure clients are able to access appropriate resources before a crisis occurs.

Partnerships also can be vital in terms of addressing emergency situations by having open communication and working together to best meet the needs of the clients. Collaboration partners also can combine funding sources in order to maximize the ability, and utilize the strengths, of both partners to complete the tasks at hand.

Federal Programs

One suggestion States made was for. LIHEAP agencies to form partnerships with other federally-funded programs that conduct like tasks or serve similar populations.

A primary federal program that has both a similar mission and common clients is the U.S. Department of Energy's Weatherization Assistance. Program (WAP), which enables low-income families to permanently reduce their energy bills by making their homes more energy efficient.5/ In fact, many States named the WAP as a potential or current partner. One State suggested that it would be effective to encourage a partnership with WAP at the federal and State level first, and then further develop this relationship at the local level. Another suggestion is to allocate a greater percentage of LIHEAP funds to the WAP, specifically to target converting vulnerable households using high risk fuel sources to a more energy-efficient heating source.

Another potential program with which to collaborate is the Temporary Assistance for Needy Families (TANF) program, which provides assistance and work opportunities to needy families by providing States block grants to develop and implement their own welfare programs.6/ It also is possible for States to use their TANF funds for home heating and cooling costs.7/ States may use TANF funds to provide low income households with assistance in meeting home heating and cooling costs to supplement assistance from LIHEAP. States also may use their maintenance-of effort (MOE) funds in this way as well, except as it relates to the LIHEAP leveraging program. Because of the MOE statutory and regulatory prohibition on double-counting, States may use their MOE funds to help eligible families with home heating and cooling costs, as long as the same funds claimed for TANF MOE purposes are not also used to get a share of the LIHEAP incentive funds under the LIHEAP leveraging program.

 

State and Local Government Agencies

Partnerships with other State and local government agencies, especially those that provide social, housing, or energy-related services to low-income, elderly, and disabled populations, will enable State LIHEAP agencies to connect a client to multiple assistance mechanisms. For example, these partnerships will teach LIHEAP staff how to conduct appropriate referrals to other government benefits and services. This will lead to the provision of wrap-around services in order to meet the holistic needs of a client, rather than just addressing one social service need, e.g. their home energy crisis, meanwhile neglecting their food supply, child care, domestic violence, drug rehabilitation, housing, medical, or aging needs.

One state provided an example of collaboration between two State government agencies to prevent loss of life from extreme indoor temperatures among vulnerable populations. The two State agencies are the LIHEAP grantee and the Department of Aging.8/ The Department of aging annually administers a grant for LIHEAP Outreach. This year, the department of aging issued a Notice of Funding Availability (NOFA) and awarded funds to the 12 "Area Agencies on Aging" (AAAs) based on a formula that considers poverty rates and populations of individuals age 60 or over. To receive LIHEAP Outreach funds, each AAA must develop and submit an outreach plan for targeting elderly and disabled persons in the counties they serve. The department of aging requires all its awarded AAAs to provide the following:

• Outreach, information and assistance in obtaining, completing and mailing energy assistance applications to individuals who are 60 years of age and older/or have disabilities, both in central locations and when needed, in the individuals' homes.
• Utilize their professional resources to identify potentially eligible utility customers, including information & referral networks, senior citizen centers, nutrition sites, case managers, and in-home service providers.
• Collaborate with community service organizations that represent retirees, minorities, ethnic groups, .or persons with disabilities and coordinate their outreach activities.
• Conduct public relations and educational activities that explicitly promote LIHEAP and other Energy Assistance programs and the availability of individual assistance with the application process at central locations, and, when needed, in individuals' homes.

Local Energy Providers and Suppliers

Partnerships with local energy providers and suppliers can ensure a State's ability to help LIHEAP recipients both proactively and in times of crisis. This relationship is especially important when working on behalf of at-risk customers facing service interruption. Examples of ways to collaborate with local energy providers and suppliers include:

 

• Asking energy providers to print health, safety, and LIHEAP assistance information on energy bills.
• Asking energy providers to send LIHEAP assistance information and applications to clients with payment problems.
• Asking energy providers to help identify and refer at-risk clients to the LIHEAP agency
  to eliminate the pending threat of termination before termination becomes necessary.
• Entering into cooperative agreements with electric/utility companies to not terminate services for households identified as vulnerable during the cold weather months and to agree to make other payment arrangements instead.

National and Local Non-Profit Organizations

Similarly, States recommend establishing partnerships with national and local non-profit organizations that provide related services to LIHEAP target populations. For example, partnerships with social service organizations, community-based organizations, and other emergency providers could help local governments and non-profits develop plans during heat emergencies, i.e. for cooling centers, temporary shelters, and distribution of water and ice.

An example of such a partnership has occurred between one State's LIHEAP agency and an organization of statewide food banks. The LIHEAP agency partnered with the non-profit organization to increase program outreach for the LIHEAP/TANF program since many of the food bank customers are families with children: For the first program quarter, 481,794 children were served  by the non-profit organization. During the winter heating months, a LIHEAP application was placed in every box or bag of groceries distributed. During this same quarter, over 190,000 persons over the age of 60 were served. The non-profit organization also convened a "Heat or Eat Summit" to educate social service professionals and community members on the LIHEAP program and its importance and relationship to emergency food providers.9/

Another example is a partnership that occurred between one State's LIHEAP agency and a local non-profit organization that serves persons with breathing-related disabilities. The program began by distributing air conditioners to those in need and expanded to become an additional provider of LIHEAP services for both the summer and winter programs. The non-profit organization accepts regular LIHEAP applications via appointments and walk-ins, as well as via home visits for elderly or disabled homebound individuals. The non-profit organization also conducts outreach and public relations for LIHEAP through media and targeted marketing efforts. The nonprofit organization utilizes staff for public speaking and to provide the information to faith, senior, and health communities.10/

 

Appendix A – Examples of Community-Based,
Home Energy-Related Health and Safety Programs

ACF requested examples of home energy-related health and safety programs operating at the community level from the LIHEAP Clearinghouse.11/ The Clearinghouse provides LIHEAP training and technical assistance and facilitates information flow across grantees and stakeholder organizations.

Footnotes

1/The Human Services Amendments of 1994 (Public Law 103-252) added section 2607B(b) to the LIHEAP statute to establish the Residential Energy Assistance Challenge Option Program (REACH). REACH funds are awarded on a competitive basis to LIHEAP grantees that submit qualifying plans for EMS approval. Innovative plans are implemented through local community-based agencies to help LIHEAP eligible households reduce their energy vulnerability.

2/NEADA is the primary educational and policy organization for the State and tribal directors of LIHEAP. For more information on NEADA, go to: http://www.neada.org

3/ NEADA's 2005 National Energy Assistance Survey is available at: http://www.neada.org/

4/Source: April 27, 2006 letter from the Director of the State LIHEAP agency in response to LIHEAP request for State input. (back to text )

5/For more information about the WAP, go to: http://www.eere.energy.gov/weatherization/  

6/For more information about TANF, go to:/programs/ofa/tanf/index.html  

7/See Section 404(a)(1) of the Social Security Act, as an appropriate use of Federal TANF funds at: http://www.socialsecurity.gov/OP_Home/ssact/title04/0404.htm  

8/Source: April 27, 2006 letter from the Director of the State LIHEAP agency in response to LIHEAP request for State input. (back to text )

9/Source: April 27, 2006 letter from the Director of the State LIHEAP agency in response to LIHEAP request for State input. (back to text )

10/Source: April 27, 2006 letter from the State LIHEAP agency in response to LIHEAP request for State input. (back to text )

11/Submitted by the LIHEAP Clearinghouse on June 27, 2006. LIHEAP Clearinghouse.(back to text )