To save lives, we need answers now
What is the best way to protect elderly and disabled tenants of public and subsidized housing from COVID-19? We can find answers where someone has developed a practical, effective solution.
Chelsea Housing Authority
Let’s consider the approach of the Chelsea Housing Authority (CHA) as a case in point. Everything they do seems to flow from the motto of Paul Nowicki, Director of Operations, “We’re here to help.”
Chelsea is one of the poorest communities in the Commonwealth, but it is rich in diversity. A city of 2.1 square miles, directly north of Boston and Logan International Airport, Chelsea has 39,690 residents based on 2019 census estimates, and a total that community leaders say is close to 45,000.
Chelsea residents provide the low-paid but essential workforce that supports our core institutions, including facilities that serve the metropolitan area—hospitals, restaurants, hotels, warehouses, grocery stores; and a variety of services including personal care, cleaning, maintenance, delivery, and more.
In the early days of the COVID-19 epidemic, Chelsea was hit hard, like other cities made up of minorities, immigrants, and the poor. Latinos make up 67% of the city, and 45% of residents are foreign-born, including immigrants from Central America.
People in Chelsea are vulnerable for many reasons: they live in multi-generational families, in cramped housing, without full integration into the supporting networks of health care, good schools, and transportation. They fear to take food stamps and other benefits because of their immigration status, or are excluded by the denial of governmental services to new immigrants and the undocumented, and the threat of deportation if they reach out for help.
In March and April, 2020, Chelsea was inundated with cases of COVID. Social service agencies were overwhelmed and could not keep up with the need for food and other essential help. City leaders reached out for help, desperate to protect their people. Fortunately, one of the top hospitals in the nation, Mass General Hospital (MGH) had a stake in the community. They offered free COVID testing for all, regardless of insurance or immigration status. Chelsea community organizations came together to provide material, social, and spiritual support for families who had been struggling to survive, and with the impact of COVID, faced extreme hardship.
Best practices in Chelsea housing
Chelsea’s civic leadership—the city council, manager, and the many city and volunteer agencies—can be proud of the network of community leaders and their housing authority. Surrounded by a tsunami of COVID, they have worked together to protect and support their tenants.
Good management depends on good leadership at all levels of the municipal community. And good management depends on a flow of information. In a pandemic, housing managers need to know if anyone in their buildings is infected, and in the absence of data from the Department of Public Health or Chelsea Health Department, managers and tenants must improvise. They rely on networks including tenants within the housing facilities, networks of community agencies and organizations, and all the agencies of the city, as well as their personal, life-long networks of friends and relatives.
The Chelsea Housing Authority (CHA) took early steps to deal with the threat of COVID. From March 12, the CHA started to educate residents on wearing a mask, distancing, and other precautions. On March 20, the first case was diagnosed in one of the elderly buildings.
“Once people realized someone in the building had it, that really hit home,” according to Al Ewing, the CHA director. “Plus we took steps to address it and let people know it was a serious, serious situation. When we were able to get that message to everyone in the buildings, they saw the seriousness.” Chelsea Record
By the middle of April, 2020, there were 474 cases and 14 deaths in Chelsea, one of the highest infection rates in the Commonwealth. Extensive testing in the elderly buildings found a total of 11 cases out of 384 tested, under 3%. (The housing facilities and the infections/number tested were: Margolis 3/113; Bloomingdale Street, 5/139; Union Park 3/132) Considering that there were more than 2,000 cases in Chelsea out of an estimated population of 4,500—about a 4% rate of infections—CHA leadership felt lucky.
Through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the CHA received almost $480,000, which they used for enabling remote staffing, cleaning, PPE, and other costs related to COVID, related to preparation, prevention, and response to COVID. CHA purchased masks. MGH provided testing and care kits, masks, hand sanitizer, & soap. Managers improvised outdoor meeting places.
Information and communication: essential to trust
Management has to integrate inputs from every part of the system, and when relating to tenants, managers need to combine two styles: a compassionate approach and an assertive, interventionist approach. Communication and transparency are important elements in creating trust among tenants and management. Paul Nowicki, the Director of Operations at the Chelsea Housing Authority had served as an elected city councilor, as had Matthew Frank, the Supportive Services Manager. Nowicki and Frank know what happens in Chelsea! And they can reach out for help with a phone call. These managers at CHA are native to Chelsea, which means they bring their life-long personal and kin networks with people in all aspects of Chelsea government and service, from city hall to the fire and police departments and the senior center.
Management receives weekly reports of police and fire responses to CHA buildings. Nowicki said that we would like to have that kind of cooperation with the Chelsea Health Department and the state Department of Public Health.
CHA leadership attends the ongoing meetings of “Healthy Chelsea,” comprising MGH, neighborhood developers, CHAPA, and officials from Revere and Winthrop. This creates and extends networks for sharing information and resources.
To gather information within the housing authority, the management team builds a network of relationships and uses multiple channels, formal and informal. To reach out to tenants, they use message boards, robo calls, and printed notices, all in English and Spanish. They use Facebook and update their own website on a daily basis as needed. They encourage reports of infection or other issues from anyone, investigate every concern, and act when appropriate. The senior center does outreach calls to help people deal with isolation and depression. Management makes continuing efforts to stay in touch, to establish a presence, and encourage trust.
Management may get reports from tenants, including about a cluster of COVID cases on one floor. They reached out to management and maintenance staff and to other tenants to narrow down on the location. Then they called households, and when they identified someone who is infected, they offered support, including meals delivered, mental health support options, and more. They are also on the lookout for any bullying that might impact the infected individual.
Several Chelsea police officers have apartments in the housing authority buildings, and they walk through the building night and day, an important program for security and oversight.
To minimize the chance for infection to spread within a building, maintenance staff do cleaning of high-touch surfaces twice a day. An outside contractor does deep cleaning. To assure continuity of operations, the staff was split into two teams that operated on alternate days, so that an infection in one team would not prevent essential services.
Although public health best practices can significantly reduce the risk of infection, many people resist compliance with the mandates on masking and social distancing. They claim that personal “rights” can reject social responsibility; this attitude poses a problem throughout society, and can create a risk threatening the health and life of many tenants. Since the threat of eviction is virtually the only sanction available to the landlord, management must be prepared to use it. Paul Nowicki explains his approach to enforcing compliance.
“The message is the same for everyone, but the tone will vary. Some people just need a reminder or they don’t have a mask. We may talk to family members. We explain that we want to protect all the tenants from infection. And we set an example, always wearing a mask, and carrying a box of masks to hand out to anyone we meet. By getting a person to wear a mask, we help them experience success. A few people claim a right not to wear a mask, and believe that nothing can be done to them. In that case, I take an assertive tone and explain that, since not wearing a mask is contrary to the state mandate, and since this threatens the well-being of other tenants, management can go to court and move for immediate eviction.”
What does it take?
We can have healthy community in public housing for the elderly and disabled if all the stakeholders are working together towards that goal—civic leaders, housing authority, management, social workers, and tenants. Within the housing situation, Novicki tries to find a balance between the stress caused by the pandemic including the isolation necessary to prevent the spread of COVID.
This requires formal and informal communication within the housing authority, but also with the backbone of agencies and services that holds the municipality together.
In January, 2020, the city manager brought together many city and volunteer community organizations. In March, a phone network was begun that enables community organizations to share information and coordinate their efforts.
The culture of the municipality and the leadership determine the potential for good in the lives of tenants. The citizens elect their leaders, including the majority of each local housing authority board, and they appoint and oversee the management. Thus, the dominant ideology of the community affects the quality of life for tenants in public housing. In subsidized housing, a distant landlord may prefer to have their properties isolated from the surrounding municipality.
The leadership in Chelsea public housing exemplifies a respect for tenants, a value that reflects the civic culture of mutual aid and responsibility.
Cautions for community organizing
However, any close-knit web of relationships can be a conduit for infection. What in normal times would be a healthy community supporting social interaction, can in a time of epidemic enable an infection to find new victims.
Furthermore, a close-knit community can be toxic. A community network that is not motivated by respect for all can have negative effects. In some public and subsidized housing facilities, ineffective leadership provides poor oversight over a series of ineffective and/or abusive facility managers. The lack of good leadership in housing developments enables bullying, mobbing, and assaults among residents and smoking and drug use in some apartments. In these circumstances, very little is done to assure the safety of tenants from COVID.
Has the Chelsea Housing Authority done a good job of protecting tenants from COVID? How can we evaluate the success of these efforts? Leading with trust combines compassion and assertiveness. We found that good management uses a flexible combination of these approaches for any type of social control issue, from smoking, to bullying, and it now appears that these apply also to COVID-related issues.
One method of management to maintain community norms is compassionate: establishing trust and improving communication and understanding. Another method is assertive: intervening to stop inappropriate behavior by warnings and sanctions. Community Norms, Social Distancing & Bullying
Some of the other methods that make a difference include:
communication, listening as well as speaking
collaboration among landlord, management, staff, and tenants; establishing a shared understanding of rights and responsibilities
acting to prevent bullying and mobbing
education and reinforcement with reminders
follow-up on concerns and complaints
assertive intervention: action to enforce rules
provide support and remedies
Using this baseline, we believe, based on interviews with Chelsea Housing Authority managers and from media reports, that the Chelsea Housing Authority has adopted good practices to encourage and support tenants to protect themselves and their neighbors. They are supported by networks of city workers, agency staff, and community volunteers. Based on news reports, there is a positive, supportive community in Chelsea. So it looks like there should be success in protecting tenants from COVID in the Chelsea Housing Authority.
Data needed to control COVID
Whenever people meet, assemble, and interact, the air that they breathe and exhale can carry and transmit COVID virus. Therefore, the ability of society to control COVID is by controlling if and how people interact.
The experience in the City of Chelsea (and in many other places) demonstrates how the lack of public health information has allowed the spread of disease.
Timely distribution of disease and death information should be made available to better protect elderly and disabled tenants of public and subsidized housing from disease and death. The problem is statewide due to policies of the Department of Public Health and local health departments. For example, Cambridge faces similar challenges in getting information.
In Cambridge, the housing authority is frustrated by the lack of official data on COVID illness and deaths impacting their tenants. They believe that elderly and disabled tenants are at enhanced risk.
The executive director of the Cambridge Housing Authority, Michael Johnston, reported that at least 9 public housing tenants had died of COVID. “Seven of the nine lived in developments for elderly tenants and younger disabled residents,” Johnston said.
“One thing we can say with certainty is that our elderly/disabled housing is home to some of the city’s most vulnerable residents, and the governor should have included them in Phase 1 of the Covid vaccine distribution plan,” Johnston said.
There are other barriers to getting timely information about infection because 35% of infected persons show no symptoms, and elderly people do not always display the typical symptoms. There are delays between the appearance of symptoms and testing, and further delays before the test results are available. Thus, people who are infected can be infecting numerous other people.
Managers resort to formal and informal social networks to get information that, like any rumor, may or not be valid. Management is able to act, but they lack the full range of information needed for the most effective response.
Effective management practices
What are the strategies that can be adopted by the landlord of a public housing facility? One approach is to urge everyone to act as if everyone were infected, and therefore each person should follow the same protocols: masking, distancing, hygiene. Even if some people fail to comply, the extent of community exposure can be reduced; but even a single infected and unmasked person can cause disease and death.
The ability of a housing manager and community is limited by the failure of the Commonwealth to publish site-specific reports of illness and death related to COVID. Inaccurate or delayed information leads to lags in response, defeating the effort to control. An effective disease control system measures the disease in the community, with sufficient detail and speed to support timely intervention. Leading indicators should be monitored, i.e., rapid testing results rather than word-of-mouth reports.
Frequent testing with rapid results can lead to an early intervention, and a rapid reduction in infections. Enforcement of rules and protocols for masking and distancing can reduce infections.
To improve their ability to respond, housing managers should have access to:
The results of frequent rapid testing of all tenants and staff
Next-day access to site-specific data on infections and deaths in housing, ideally with the confidential identification of the patient(s).
Priority for all tenants in elderly/disabled housing to receive vaccination.
Evaluating the Chelsea Housing Authority
Chelsea Housing Authority management uses a range of informal methods to gather information. They enforce basic protocols, including by the threat of eviction. But they lack timely identification of infections, information which would enable efforts to limit further infections and provide support and assistance to patients. Although data on disease and death related to COVID is held by the Department of Public Health and the Chelsea Health Department, it is not released. In the absence of data on infection and death among the elderly and disabled tenants, it is difficult to evaluate the success of the Chelsea Housing Authority in protecting tenants from COVID. We can compare estimates of disease and death in the Chelsea Housing Authority, with the rates of the City of Chelsea during 2020.
The CHA disease rate was 2.9%, compared to 16% for the City of Chelsea. The CHA death rate among tenants in elderly/disabled units was 1.5%, compared to 4.8% for all the City. This suggests that the CHA did a good job of keeping the infections and deaths below the rates for the City.
COVID cases and deaths in Chelsea during 2020
Chelsea Housing Authority
City of Chelsea
City of Chelsea
Death rate in elderly/disabled units:
The rates of disease and death are based on estimates of disease and death in the CHA among tenants compared to the total number of public housing tenants; public health reports of disease and death are compared to the total number of Chelsea residents. And the death rate is based on deaths among 408 elderly/disabled.
These figures must be viewed as unverified estimates, we have been able to do a solid job of fact checking; they cannot be used to confirm if the Chelsea Housing Authority has in a measurable way protected tenants from COVID.
How does the CHA compare with other housing facilities?
We see a lower infection rate and a typical death rate, using very crude measures.
In an opportunity sample of housing facilities in a number of municipalities, based on informal estimates by people in a position to observe, and by our projected estimates of annual outcomes, the annual COVID infection rate ranges from 6% to 15%. A projected 2%-4% of the tenants would die in a year.
These are very crude estimates and our difficulty in trying to grasp the extent of the problem only demonstrates the unsatisfactory state of COVID surveillance in multi-unit dwellings in Massachusetts. The Department of Public Health should be doing this work and making the data available to support efforts to cut down on transmission.
Note: These are some of the materials used in preparation of this report. They are presented without ordering so that this can be made available now; I have COVID and regret any inconvenience. For a more comprehensive evaluation, I would have interviewed tenants and civic leaders to assure an accurate picture of the Chelsea Housing Authority. We are grateful for the help and cooperation we have received.---JH
Cristina Alonso and Patrice Basada, Harvard T.H. Chan School of Public Health, Boston University School of Public Health, Academic Public Health Volunteer Corps, Data Analysis Report to the City of Chelsea COVID positive cases: March 3, 2020, through August 9, 2020. October 2020. https://www.chelseama.gov/sites/g/files/vyhlif396/f/news/final_data_analysis_report_city_of_chelsea_unlinked.pdf
City of Chelsea, COVID-19 Cases Report Among Chelsea Residents from March to August, 2020. https://www.chelseama.gov/covid-19-cases-report
Massachusetts Department of Public Health, Weekly COVID-19 Public Health Report, Thursday, December 31, 2020 https://www.mass.gov/doc/weekly-covid-19-public-health-report-december-31-2020/download
Public charge rule has impact, activists help. https://www.theatlantic.com/politics/archive/2020/05/immigrants-sick-co…
Examples of tenant & management efforts
Hebrew SeniorLife: https://www.hebrewseniorlife.org/covid-19/resources-senior-care-organiz…
2Life Communities Protocols: https://www.2lifecommunities.org/covid-19-protocols-and-procedures
CDC: Preventing the Spread of COVID-19 in Retirement Communities and Independent Living Facilities https://www.cdc.gov/coronavirus/2019-ncov/downloads/guidance-retirement…
COVID-19 DHCD Website, provides guidance for several categories of housing https://www.mass.gov/info-details/covid-19-dhcd-website
Alert: A Public Health Crisis Threatens Lives of Elderly & Disabled https://stopbullyingcoalition.org/masks
Working Together Against COVID-19 in Multifamily Housing
Little Red Hen Survey https://tinyurl.com/y6t68h8u
Information: Empowered With, Fearful Without
For the Chelsea Housing Authority, estimates provided by persons familiar with the circumstances. We have not received official confirmation from the Chelsea Housing Authority, or through public records requests to the City of Chelsea. A public records request for statewide data submitted to the state Department of Public Health was rejected with no results provided.
Public Health Report Data, December 31, 2020, 6268 Count and Rate of Confirmed COVID-19 Cases and Tests Performed in MA by City/Town, January 1, 2020 – December 29, 2020: Chelsea https://www.mass.gov/doc/weekly-covid-19-public-health-report-december-…
The most recent census estimates for the population of Chelsea is 39,690 persons on July 2, 2019. Persons 65 years and over make up about 9.5%. https://www.census.gov/quickfacts/fact/table/chelseacitymassachusetts/PST045219 People who work in the community consider the population to be closer to 45,000; we have used the 2019 census estimate.
Public Health Report Data, December 31, 2020,6268 Count and Rate of Confirmed COVID-19 Cases and Tests Performed in MA by City/Town, January 1, 2020 – December 29, 2020: Chelsea
Chelsea Public Housing
The Chelsea Public Housing Authority is responsible for 1,828 units: CHA, 914; State, 560; Federal, 354.
Elderly/disabled housing in Chelsea
As of December 30, 2020: 408 tenants in 418 units for elderly and disabled persons, in December, 2020.
201 Family Members who are Elderly
71 Family Members who are disabled
136 Family Members who are both elderly and disabled Total: 408
Margolis Apartments (Federal Elderly/Disabled 16-4) - A 152- unit thirteen-story brick structure with two elevators serving its elderly and/or disabled residents. 260 Clark Ave
Buckley Apartments (State Elderly/Disabled 667-2) - Located at 14 Bloomingdale Street has 210 one-bedroom apartments first occupied in 1972. The building is an eight-story brick structure with three elevators serving elderly and/or disabled residents. One apartment has been set aside for an on-site clinic and office.
Union Park Apartments (State Elderly/Disabled 667-1) - Seven, two-story structures with a total of 56 one-bedroom apartments first occupied in 1969. These units are located at Sixth, Walnut, Orange and Spruce Streets. Each building has two addresses: 242 Walnut and 30 Sixth; 38 Sixth and 40 Sixth; 44 Sixth and 46 Sixth; 32 Sixth and 34 Sixth; 230 Walnut and 232 Walnut
Source: CHA and http://www.chelseaha.com/publicHousing.aspx