Achieving Lead Safe Housing in Cleveland

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Achieving Lead Safe Housing in Cleveland

 

Founded in 1796, the city of Cleveland hit its peak population of 915,000 in 1950, becoming the 7th largest city in the United States. It is no surprise, then, that approximately 90 percent of the city's housing stock was built before 1978, and some of it long before then. Cleveland's older housing stock is important in its long struggle with lead poisoning because most children, the demographic most vulnerable to lead poisoning, are exposed to lead through lead-based paint in homes built before the United States banned lead paint in 1978. In 2022, the Cleveland Clinic, the region’s premier center for medical research and health care, declared lead poisoning prevention its top community priority and committed $50 million to the Lead Safe Cleveland Coalition (LSCC).

Lead: An Irreversible Poison

Lead is a toxic heavy metal that accumulates in the bones and teeth. It impacts the cardiovascular, renal, hepatic, skeletal, and reproductive systems, but its neurological effects in children, including intellectual disabilities, developmental delays, and behavioral disorders, are particularly acute. No level of exposure is considered safe. Children under age 6 are especially vulnerable to lead poisoning because they are more likely to ingest lead and absorb more ingested lead than adults do. In the United States, some lead exposure occurs through lead leaching into the water through old pipes or through the leaded fuels still in use in aeronautic and marine applications; however, dust and flakes from lead paint in older buildings are the nation’s primary source of lead exposure.

Most of Cleveland’s older housing stock predates the national ban on lead paint in residences, making the toxic substance a chronic problem for the city. Data from 2018 show that the percentage of children under age 6 with elevated blood lead levels was 4.4 percent in Ohio compared with only 2.6 percent for the nation as a whole. Two years later, in 2020, the city of Cleveland tested a cohort of children under age 6 and found that 9.4 percent had elevated blood lead levels.

Addressing Lead in Housing

Despite the city’s multiple attempts over the years to address the problem, a lack of resources stymied these efforts, and rates of childhood lead exposure remained elevated, as did public awareness of the crisis. In 2015, the Cleveland Plain Dealer published a series of exposés on the city’s lead poisoning problem, which further increased public concern.

During this time, Cleveland Clinic physicians partnered with other representatives of regional healthcare organizations on the Healthy Homes Advisory Council. Doctors on the council worked to improve methods for promptly detecting elevated blood lead levels, educate families about the signs and risks of lead poisoning, and ensure prompt and appropriate treatment. For example, the council promoted capillary testing for blood lead levels, which permits faster testing with a smaller blood sample. This clinical work, explained Cleveland Clinic physician and American Academy of Pediatrics fellow Dr. Roopa Thakur, would eventually become integrated into the City of Cleveland Lead Screening and Testing Commission, a city body that works closely with the LSCC’s Policy Committee. The Cleveland Clinic is also piloting a medical-legal partnership at its main clinic to help families impacted by lead and other housing issues that affect health as they navigate relationships with landlords and other entities.

In 2019, the national nonprofit Enterprise Community Partners convened LSCC, a community organization with more than 500 institutional and 140 individual members dedicated to addressing lead poisoning in Cleveland. The Cleveland Clinic is LSCC’s largest donor, having contributed $52.5 million, and its physicians serve on many of the coalition’s seven working committees. The city of Cleveland is another primary donor to LSCC and a key implementation partner.

The centerpiece of the LSCC’s work is the Lead Safe Certification program. In May 2019, the coalition made 33 policy recommendations pertaining to lead safety, screening, testing, intervention, and treatment to the Cleveland City Council. The council took these recommendations under advisement and adopted one on an emergency basis in July of that year, passing an ordinance that requires owners of rental units built before 1978 to obtain Lead Safe Certification from the city’s Department of Building and Housing every 2 years.

To obtain the certification, the property owner must submit a report or audit from a lead clearance technician indicating that the unit either has no existing lead hazard or had an existing hazard but was made safe. The owner may either remediate the hazard — usually (but not always) lead paint — with interim controls or permanently remove it. Interim controls are means of rendering a hazard temporarily inert or inaccessible so that the home is safe to occupy. An interim control process for a windowsill painted with lead paint, for example, would include wet sanding, the application of lead-free paint, and a thorough cleanup. Permanent lead removal measures would include replacing lead supply pipes in a house with PVC piping.

The certificate program began in March 2021 and rolled out in eight phases by ZIP Code. Ayonna Blue Donald, vice president of the Ohio market of Enterprise Community Partners, explained that, although LSCC offers assistance to homeowners, renters were the coalition’s first priority because they have less control over their living situations than homeowners do.

The Lead Safe Certification program is facilitated and enforced by the city’s Department of Building and Housing, which also administers the rental registry that makes the program possible. Although failing to register a rental unit or obtain Lead Safe Certification is a misdemeanor offense, Donald estimated that only approximately half of the city’s 90,000 rental units are registered. This shortfall is attributable in part to corporate landlords headquartered outside of Ohio that ignore the requirement. The department is exploring ways to bring these landlords into compliance, Donald said.

The cost of making a dwelling lead safe can range from hundreds to thousands of dollars. The Lead Safe Home Fund offers grants, loans, and incentives for landlords and homeowners that are administered by LSCC partner CHN Housing. Some options have additional requirements — for example, to receive the maximum $12,000 grant award, non-resident landlords must agree to a small, temporary cap on annual rent increases. Other applicants must simply meet the income limit of no more than 120 percent of the area median income. All Lead Safe Home Fund programs are open to both landlords and homeowners, except for one: a $750 incentive payment for landlords who achieve a lead-free unit.

According to Donald, LSCC has set funds aside for a future program that provides relocation assistance for tenants. In addition, Environmental Health Watch, an LSCC partner, runs the Lead Safe Resource Center, where people can learn more about lead, attend training sessions on lead remediation, and become certified as lead clearance technicians.

Cleveland has not yet reached its ambitious goal of certifying all rental units; as of March 2023, it had passed 20,067 units and failed 2,834 units, totaling nearly a quarter of the city’s rental stock. “We’re only in the first cycle of our program,” Donald said. “There’s still a lot of work to be done, but I am optimistic.”

More Progress To Be Made

Homeowners are also eligible for remediation funds through loans and grants from LSCC’s Lead Safe Home Fund. In addition, LSCC has launched a pilot to test for and remediate lead contamination in daycare facilities. “So many children spend as much time in childcare centers as they do at home, and many of these buildings were built before 1978,” said Vickie Johnson, senior director of government and community relations at the Cleveland Clinic. “We’re very proud that our work has allowed the work to expand to other areas where children spend time.”