Transcript Special Needs Child Care Consultation Study
Losing Hold of the American Dream: Connections between Home Foreclosures and Health
April 11, 2012 Cyleste Collins, Ph.D.
Research Assistant Professor, Mandel School of Applied Social Sciences Faculty Associate, Center on Urban Poverty and Community Development & Schubert Center for Child Studies Case Western Reserve University 1
Outline
• • • • Foreclosures in Ohio Recent research on the relationship between home foreclosures and health Preliminary findings from interdisciplinary alliance pilot study on families’ experience with home foreclosures Implications 2
Ohio Foreclosure Filings, 1995-2011 Number of Filings
100 000 90 000 80 000 70 000 60 000 50 000 40 000 30 000 20 000 10 000 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Source: Policy Matters Ohio 2012; Ohio Supreme Court, Policy Matters Ohio review of filings in U.S. district courts. Data include federal filings beginning in 2004 and ending in 2008. 3
Foreclosures in 2011
• • • • • • Cuyahoga County: highest rate in state, nine filings per 1,000 people and 11,544 foreclosures One foreclosure filing for every 71 housing units More than 500,000 underwater mortgages, 8% of mortgages are seriously delinquent or in foreclosure The loan-to-value ratio in Ohio is more than 76 percent, (mortgage holders have less than 25 percent ownership in their home mortgages) More than one in three homes is under water Foreclosures are taking longer to process, an average of 674 days • Source: Policy Matters Ohio Report: Home Insecurity 2012: Foreclosures
and Housing in Ohio
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Foreclosure Per 1,000 Population Top 10 Counties, 2011 Counties 2010 Population 2011 Filings Filings per 1,000 Population Cuyahoga Coshocton Preble Montgomery Lucas Hamilton Lake Ashtabula Butler Knox
1,275,709 36,901 42,270 535,153 441,815 802,374 230,041 101,497 368,130 60,921 11,544 317 330 3,924 3,237 5,834 1,609 708 2,544 421 9.02
8.59
7.81
7.33
7.33
7.27
6.99
6.98
6.91
6.91
Source: Ohio Supreme Court, U.S. Census Bureau. The population data is based on 2010 population because 2011 population data was not yet available as of the date of this report.
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Effects of Foreclosure
• • Major stressor for families who’ve often already experienced one or more initial precipitating event(s) (e.g., job loss, divorce, health problems, etc.) Residential mobility and instability have negative effects, related to detrimental outcomes for children and families 6
Effects of Foreclosures on Families
• • Residential instability and/or homelessness, frequent school changes, increases in homeless and doubled-up children in schools (Coulton, 2009) Increased family turbulence, inconsistent rules/schedules/routines (Kingsley, Smith, & Price, 2009) all have implications for academic success, cause concern about mental health issues (Coulton, 2009) 7
Behavior/Mental Health Issues
• • • • • Children Diminished self image affects behavior and emotions (Lovell & Isaacs, 2008) Multiple behavior issues, including violence (Davis & Shinn, 2009) Emotional distress, experiences of loss (Vidmar, 2008) Children seeing selves as financial and emotional burden on parents (Vidmar, 2008) Parents (Kingsley, Smith, & Price, 2009) – – – – – Decreased self-esteem Decreased confidence in parenting ability Increased fear More marital problems Increased addiction Multiple school performance issues 8
Neighborhood/Community Issues
• • Fiscal stress/deterioration of services, smaller tax base for area school systems (Kingsley, Smith, & Price, 2009; Lovell & Isaacs, 2008) Families who move often face new neighborhoods with – Changes in lifestyle – – – More crime, social disorder Worse school systems Fewer community resources and activities for youth (Been et al., 2010; Kingsley, Smith, & Price, 2009; Vidmar, 2008) 9
Physical Health Issues
• • Financial troubles decrease amount of money available for health insurance, medications, nutritious foods, and health care, threatening overall health (Davis & Shinn, 2009) Foreclosure associated with significant increases in (Currie & Tenkin, 2011): – suicide attempts – heart attacks – stroke – non-elective visits (i.e. unscheduled visits for urgent or emergency care) and for conditions including urinary tract infections, gastro intestinal problems, chest pain and dysrhythmias – Effects strongest for Hispanics – Largest estimated effects on heart attack and stroke among blacks 10
• Incidence of hospitalizations for non accidental head trauma to infants has increased during the recession according to studies at University Hospitals and the University of Pittsburgh 11
Homeowners in default or foreclosure
• • • Medical issues – Higher rates of major depression, hypertension, and heart and renal disease – poorer mental health – more physical symptoms Medical issues often a reason for undergoing foreclosure – Owing money for medical expenses/bankruptcies – Homeowner or family member medical issues Use of medical services – Do not fill prescriptions because of cost – Less likely to have a primary care physician or outpatient visit – More likely to visit the emergency department • Sources: (Pollack & Lynch, 2009; Pollack, Kurd, Livshits, Weiner, & Lynch, 2011; Pollack, Lynch & Cannuscio, 2010; Shardell, Asch & Lipman, 2011; Libman, Fields & Seagert, 2012) 12
• •
Broken Homes, Broken Dreams: What Happens to Families after Foreclosure
Interdisciplinary Research Team – Case Western Reserve University (CWRU) Faculty • Cyleste Collins, Ph.D. & Claudia Coulton Ph.D., Center on Urban Poverty and Community Development, Jill Korbin, Ph.D. & Gabriella Celeste, J.D., Schubert Center for Child
Studies
• David Rothstein, M.A., Policy Matters Ohio Project endorsed by the CWRU Social Justice Alliance and funded by the CWRU Office of the Provost 13
Research Questions
1. What experiences lead up to the foreclosure? (Open-ended story beginning with when and how mortgages obtained up to and including the foreclosure) 2. What resources—formal and/or informal, including social networks—did they call upon in dealing with their foreclosure experience?
3. What has been the meaning and impact of foreclosure for themselves and their families, including on their health? 14
Project Summary
• • • Pilot study Recruitment via housing counseling agencies, Legal Aid, snowball sampling Key Informants – Family member who lived with a child <18 at the time faced foreclosure (N=29) – Service providers who work with families undergoing foreclosure (N=16) • • • •
Sample
84% female 68% African American Approximately half owned homes in the city of Cleveland 80% had household incomes < $50K at time of home purchase 15
In-depth interviews
• • • Conducted in participant’s home, workplace, local library, or at the housing counseling agency that referred them Participants compensated with $50 gift card, $25 for referrals Took about one hour to complete 16
Participants’ Reactions to Interviews: A Note on the Fieldwork
• • • Very emotional; most cried when discussing their experiences Many participants suspicious at first, but by the end of the interview, they thanked me for giving them an opportunity to tell their story Most were eager to have an opportunity to help others through their story 17
(Some) Reasons for Facing Foreclosure
• • • • • • • Losing job or having hours cut Spouse/partner losing job or having hours cut Death of a spouse (one to suicide after job loss) Birth of a child with medical issues Leaving a job to take care of an ailing spouse or parent Excessive medical expenses Taking out large loans on the home for home repairs (sometimes very large loans) 18
• • • •
Overview
Attempts to Avoid Foreclosure – All had attempted to work with their banks (requesting modifications to the terms of their loans) with little success – – Most sought housing counseling and/or legal assistance Many had filed for bankruptcy Respondents expressed a feelings of powerlessness, frustration, and injustice at their banks’ inability and/or unwillingness to work out loan modifications Respondents expressed extreme anxiety about their situations, not knowing whether they would have to give up their home Those who had already moved as a result of foreclosure were in many ways in a better place psychologically (small N) 19
Feelings about Facing Foreclosure
• • • • • • Shame, embarrassment (hid their situation from their children, other family, friends) Anxiety (what will happen to us?) Feeling like a failure Weary, exhausted, worn down by the process Angry Sad 20
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Self-reported effects on own and health of family members
I’ve aged 20 years in the last two years so, I’ve never felt worse and it’s my fault... You know, Medicaid covered the kids but I’m not going to go into debt. • [My daughter] has pediatric Graves [disease]… She’s got a lot of autoimmune concerns and so we’ve got to watch her. [My son] is probably going to end up in special needs because he’s below 100% of his class as far as cognitive [issues go]- so he may end up there too. …he’s going to get tested today too for some other stuff when we go see the doctor.
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• • the biggest part of it was with me and, you know, being diagnosed with the Graves Disease. And I thought- and it comes on by stress cause it lays dormant until something in your life triggers it. And I was just running, running, running. Always sick and, you know, and my daughter said to me, and I actually sing, and she said and I couldn’t sing for a while- I had to step away from that. And she said, ‘Ma something’s wrong with you.’ And I said, ‘No, it’s not- that’s the way you get… when I got to the doctor they said you are really sick. And my heart was palpitating, but it just pushed me right over the edge into, you know, a place where I couldn’t see myself anymore. I was just running trying to keep my head out of the chaos, but I wasn’t winning. …And after they gave me the treatment and I went to bed and I slept, and I slept, and I slept, and I slept and I slept cause I hadn’t been sleeping. And I’d just say on now, I can see. …It really shakes the rest of the rest of everything else around you. So it’s hard to bring other things into perspective when you shake the room where a person sits. And it affects a lot of things.
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…Everything was going good as far as eating but the stress, losing sleep, not being able to sleep, waking up just as tired as when you went to bed, not being able to sleep, tossing and turning wondering…for me the biggest thing was are they going to put a big sign up in our front yard for our neighbors to know…?.
…it puts a strain on families, it puts a strain on the relationship between parent and children, it puts a strain on our marriage even though it did not cause divorce or separation because we have a good external support group for that. But through the process I had to increase my depression medication and in the 4 th year, 4 th or 5 th year I had a quadruple bypass. 23
• …I’ve been ill. My daughter’s been ill. We’re survivors, but it’s only by the grace of God that all of us survived, and until, I keep saying until we educate people and tell them what to eat, what not to eat and what to do and get early detection for certain health ailments that can be corrected and try to not make people feel so bad because they’re poor. That’s another thing, the way you talk to somebody or how you greet someone, just because they look like a million dollars don’t mean they feel like a million dollars… 24
On Experiences with Health Care
• …if you have to choose between who goes to the clinic first and you’re on a limited income, or you go to somewhere and if you don’t get a morning appointment and you get an evening appointment, you might really just get really upset and don’t go at all ‘cause the clinics are running over. The people, the healthcare system, the people are waiting on them, but people got kids to go back and pick up. I try to get all my appointments first thing in the morning, so everybody there is feeling real good, the day just began.
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On The Burden of Medical Costs
• • • Well when I had, I had my daughter in 2010…we’re like obviously above the income qualifications for WIC and she’s a lactose-intolerant baby, but her milk is like $30 a can. So it was like an extra $400 a month just for that. Right prior to that, my husband who has a 13 year-old child as well, you know with child support, so it’s $400 extra a month. So living check to check, you can’t live check to check. …my son is ADHD and ODD. Prescriptions are like $34 just for his meds, and I fought to get him on the meds and it’s helped dramatically, but all these extra costs. I’m like every time I get a little bit in savings, you guys, it’s like gone again. So yeah, medical costs is becoming the big one in our house now.
My husband is always stressed. [He] now is working seven days a week sometimes, sometimes 12 hours a day, …and then he has to maintain medical for all the children...
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On The Burden of Medical Costs
I’m trying to find ways around. My son has problems now, too, but my husband has diabetes, rheumatoid arthritis, scoliosis, …bipolar disorder… And then also glaucoma so he’s like going to a lot of specialists for a lot of that stuff and that’s expensive- that’s $40 bucks each time he goes and plus the medicine and everything once [he gets] the prescription. You know, even though we have coverage it’s still- it adds up. And so that kind of- you know, he was going through a point where he was in the hospital …the mental ward of the hospital what was it- three times or four times? I think it was three different times and then there- so four times within a year. That’s like ongoing care he needs for the diabetes and the glaucoma and stuff like that that you know that stuff he needs you always gotta keep up with that. …You know you can be refused treatment. So I’ve got to keep up with their bills… 27
• •
Making decisions about who gets treated/what gets treated
So [my husband,] he doesn’t take his eye drops, he doesn’t take his glaucoma, the only thing he keeps up on is diabetes and then sometimes he’ll go about a week without that if I can’t get it. But he doesn’t take anything for the arthritis anymore, and then he isn’t gonna take for his head, you know, for his bipolar. We just try to manage and deal with it and with his anger on how everything works and just try to leave the house when he gets too whatever, and take the kids and go. So the only thing he really takes on a regular basis is his diabetes medication. And we just keep hoping that his eyes and everything don’t get worse.
And the other thing [is, my teenage son,] he’s his very hard of hearing. He’s not deaf, but he’s hard of hearing in both ears, where he needs hearing aids in both ears. I have medical insurance, but our insurance doesn’t cover the hearing aids so it’s $3,000 ($1,500 hundred a piece) for him. So we’re trying to go through places with charities and stuff trying to find- so it’s frustrating for him cause he can’t hear. And his dad yells at him for not being able to hear… 28
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Stress Effects of the Foreclosure Experience
According to my doctor, because of all the stress, now I’m on medication for my heart and my blood pressure… • The doctor gave me medication for depression- but I didn’t take it. …but I do have high blood pressure and high cholesterol so I do take something for that. Figure it’s all I need. Keep that down- keep me from having a stroke. I went to the doctor last time my blood pressure was 220/ 128 or something- they wanted to put me in the hospital and I said, ‘I don’t think so- just give me something.’ 29
• • •
On Food
One thing, when you have a limited income, you choose to sometimes eat unhealthy foods. Let’s be realistic. It’s more easier. It’s more faster and it’s damn sure a lot cheaper to buy three burgers than to make three burgers. It might sound crazy, but you’ve got to outweigh the odds. …Some people don’t have cooking utensils and that really took me for a loop. I didn’t know some people didn’t have things to cook with. So it’s cheaper for some people to go and buy themselves something to eat than try to fix them. Then a lot of people don’t know how to cook. You would be surprised how many people can’t cook WIC is helping, but it’s only so much cereal you can eat a day. You would like some vegetables, a piece of meat and not a cheap cut. I’m not saying people shouldn’t eat fish and chicken, which they should, but I mean nobody wants to buy all the dark meat all the time. Nobody tells them what the cholesterol is, and nobody teaches the kids to read the labels on the can. Nobody even teaches them to come and cut coupons. 30
Cultural Consonance and Health
• • Research by medical anthropologist Dressler & colleagues indicates that an individual’s inability to participate in a culturally-defined model of a “good life” results in psychosocial stress and psychological distress Their research indicates that poor health outcomes are a result in part of low “cultural consonance” 31
Stressors acute chronic Resistance resources coping social support The Stress Process Physiologic Psychologic Health Outcomes
Mediating Factors in the Stress Process (Dressler) Stressors X Resources
Appraisal of threat
Physiologic Response Cultural Dimensions of the Stress Process -Sociocultural structuring of factors -Cultural definitions of salient events
Understanding the Role of Culture in Health Research • • Sociocultural systems perspective – – Culture as the total way of life of a community Psychosocial stressors are generated and affect health within the sociocultural context Culture-as-meaning perspective – Culture consists of shared meanings – Conflicting meanings may be stressful – Culture has a direct influence on health
Meaning of the Experience
• “this is up there next to death. This causes tremendous [stress]- I mean from what I’ve hear, and thank god it hasn’t been me, but relationships have been ruined because of this. Having a quadruple bypass surgery, like, I went through and the doctor telling me this is so stress related... You know, it’s not like you can say, …‘Oh, I’m just going to put it out of my head and not think about it and everything is going to be fine.’ I mean, a big part of who you are. So, I mean, I hope that as you interview other people, I hope they’re able to express this it’s a mental, emotional devastating experience.” 35
Coping
• • • • • Prayer Exercise Church Talking with others about experience Seeking help 36
Significance
• There are at least two key pieces that are significant with regard to understanding the impact of foreclosure on health 1. The established psychophysiological effects of stress on health 2. Loss of social status 37
Implications
• • • • Experiencing foreclosure may exclude people from full realization of shared cultural goals This is likely a highly stressful situation on a number of different levels – Personal – Social interaction Resulting stresses are associated with worse health Homeowners facing foreclosure might benefit from coordinated, affordable health and social services Shardell, Asch, & Lipman (2011)
Future Research
• • • • Larger N Longitudinal work examining long term effects What are the cultural models of home ownership?
– How are these models distributed; has the foreclosures crisis changed the meaning of the American Dream, and for whom? Are effects of foreclosure different/less severe for non parents and/or those not living in families, and those in higher income categories?
Center on Urban Poverty and Community Development
seeks to address the problems of persistent and concentrated urban poverty and is dedicated to understanding how social and economic changes affect low-income communities and their residents. The Center views the community as a key point of leverage for addressing economic and social disparities and restoring the viability of cities.
Cyleste C. Collins, Ph.D.
Research Assistant Professor Center on Urban Poverty and Community Development Mandel School of Applied Social Sciences Case Western Reserve University 10900 Euclid Avenue Cleveland, Ohio 44106-7164 Tel: (216) 368-1875, Fax: (216) 368-5158, E-mail: [email protected], Website: http://povertycenter.cwru.edu, http://neocando.cwru.edu
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