Report No. 004-12

TO: Chair and Members of the Board of Health
FROM: Graham L. Pollett, MD, FRCPC, Medical Officer of Health
DATE: 2011 January 19

Bed Bug Resource Program

Recommendations

It is recommended:

1)   That the Board of Health petition The Honourable Deb Matthews, Minister of Health and Long-Term Care, to include Bed Bug funding in the base budgets of Ontario Health Units; and further

2)   That Report 004-12 re Bed Bug Resource Program be forwarded to London City Council Community Services Committee 

Introduction

This report has been prepared in response to the following City Council resolution:

That the Middlesex London Health Unit be requested to provide a report to the appropriate standing committee of Council with respect to its action plan related to bed bugs, with said report to include, but not be limited to, matters such as: eradication, improved enforcement, guidance related to recommended treatment, as well as the related, projected costs; it being noted that the information should cover both the public and private sectors. (1/5SRC)

Background

In January 2011, funding became available for the 36 health units across Ontario to deal with bed bug infestations. The Province committed $5,000,000 in the form of one-time funding for the period, June 2011 to March 2012. The Health Unit submitted an application and was awarded a grant of $180,000 by the Ministry of Health and Long-Term Care (MOHLTC) to develop a Bed Bug Resource Program for the City of London and MiddlesexCounty. The funding is directed at two streams of activity: Education and Outreach and Supports for Vulnerable Populations.

The conditions of the funding are as follows:

• Funding must align with the activities and services detailed in the application for funding.
• Funding is intended to support activities in education and outreach to the public and stakeholders, to enhance awareness and knowledge in the identification, prevention and control of bed bug infestations; and/or supports to vulnerable populations impacted most negatively by bed bug infestations. Vulnerable population is defined as: individuals with physical, mental health or addiction issues; people living in poverty; the under-housed or homeless; or the frail and elderly.
• Each health unit is expected to collect data on the degree of infestations, and the populations and settings most impacted by bed bug infestations in their respective area.
• Throughout the funding period of June 2011 – March 2012, each health unit will submit two activity reports and two surveillance reports to the MOHLTC.

Start Up

In order to refine and implement the initiatives outlined in the approved funding proposal, the Health Unit hired a Health Promoter and began the task of forming a local Community Bed Bug Working Group (CBBWG). TheHealth Unit extended invitations for membership on the CBBWG to a number of community agencies and private groups such as: pest control companies, student housing groups, City and County social services and the London Middlesex Housing Corporation. The CBBWG now consists of 9 community agencies in addition to Health Unit staff. A list of the community partners and the CBBWG Terms of Reference can be found in Appendix A. The CBBWG has also been instrumental in identifying those community groups who are most in need of education and has assisted in the delivery of bed bug management strategies to community partners.

Education and Outreach

The Health Promoter, with the assistance of other health unit staff, has developed and is implementing a coordinated education and outreach campaign. An increase in public awareness of bed bugs and bed bug prevention and control is being achieved through the use of MOHLTC developed materials and information in the form of a website, brochures and digital resources. In addition to travelling throughout the community to do education and outreach, the Health Promoter is also assigned the task of responding to calls and concerns from members of the public.

A Bed Bug Hotline [519-663-2317 x 2847 (BUGS)] was created in response to the growing number of calls and to connect the public directly to the Health Promoter. The hotline was opened in June 2011 and the number of calls recorded has been consistently rising since then. Bed Bug related calls have been tracked and can be found in the graph attached as Appendix B.

The rising number of calls can be attributed in part to a major media campaign that began in late summer. With the help of the Health Unit Communications Manager, a London Transit Commission (LTC) Bed Bug Bus was designed and 10 LTC bus shelters throughout the city were equipped with bed bug awareness advertisements. To reach County residents, posters with similar messaging have been distributed to all 15 County libraries and all 5 municipal office buildings, all 4 London Health Sciences Centre locations, and all 53 London-Middlesex Housing Corporation (LMHC) buildings. This education and outreach campaign has given the public a real look at bed bugs and highlights the resources available to them to address their concerns. In addition, there has been coverage by local newspapers, radio and television stations. Examples of the media messages are attached as Appendix C.

Vulnerable Populations

The CBBWG has been very effective in fulfilling the requirement to provide supports to vulnerable populations. Staff members have been able to work with the other community stakeholders to provide vulnerable populations the services which they need. A large proportion of the funding received ($70,000) has been allocated to assist vulnerable populations who are often worst affected and are not financially equipped to properly address bed bug infestations. This funding is being distributed mostly to assist vulnerable populations with the cost of preparation services for treatment. The recipients, for various reasons, face significant barriers to being able to adequately prepare their dwellings to ensure effective bed bug treatment. Funding for preparation work can range from $1,000 for a light infestation to $2,500 for a heavy infestation.

In some special situations, the Health Unit will provide funding assistance for treatment services as well. For these instances, the Health Unit has secured a contract with a local pest control operator. However, funding for treatment services occurs on an exceptional basis only. In the majority of instances, the homeowner or landlord is responsible for treatment costs.

Eradication of Bed Bugs

With the provincial funding being one-time only, the local educational sessions are focused on helping identified target groups build capacity so that they are able to develop bed bug strategies that will continue to be effective into the future. An Integrated Pest Management (IPM) program has been developed by the MOHLTC to prevent high level infestations and unnecessary damage. An IPM program places emphasis on prevention through education and awareness as well as treatment. It requires the 
co-operation of landlords and tenants along with pest management services and support agencies when necessary. The Integrated Pest Management program is described in Appendix D.

Guidance of Treatment

The Integrated Pest Management Program also involves advising landlords and homeowners about how to hire a pest control company to treat their home. At www.bedbugsinfo.ca there is a PDF document entitled “Pest Control Info” specifically about pest control and the preparation necessary for treatment. This document, which is available in 24 languages, is attached as Appendix F. The Health Unit Bed Bug Hotline is available for homeowners and landlords to call if they have any questions about the guidelines described in IPM.

When staff members assess for funding situations, suggestions are provided based on IPM to the landlords regarding the best treatment options available. There are many variables in the cost of the treatment including the type and size of the dwelling. There are numerous companies in London and Middlesex which provide various treatments which include pesticides, heat, steam and diatomaceous earth. These companies may belong to one or more of the following professional associations: National Pest Management Association, Canadian Pest Management Association, Structural Pest Management Association of Ontario or Integrated Pest Management Association.

Progressive Compliance Strategy

Staff members have developed an agreement with staff of the City of London Property Standards Division, to take calls related to bed bugs and initiate the following procedure:

• Homeowners are provided with education and the appropriate websites on bed bugs, and advised to contact a pest management company. If the caller is a tenant, he/she is first advised to place their concerns in writing to the landlord and allow time for a response. Staff provide education and guidance to both the landlord and tenant to facilitate a solution being reached in a timely manner.
• The landlord is directed to hire a professional pest management company to investigate the unit, and other units where the problem may have spread. If necessary, Health Unit staff members obtain inspection reports from the pest control company already involved.
• If the landlord will not assist the tenant when a pest control company comes to investigate a potential infestation, a Public Health Inspector (PHI) will conduct an inspection to confirm or refute the presence of a bed bug infestation.
• If necessary, the Health Promoter and/or PHI will direct the owner to hire a professional pest management company to complete treatments.
• If the owner/landlord is uncooperative, and refuses to take the appropriate action of hiring a pest control company and incurring the associated costs, the matter is referred back to staff of the Property Standards Division of the City of London. Property Standards staff will then enforce section 4.10.1 of the Property Standards Bylaw, which states:

All buildings shall be kept free of rodents, vermin, and insects at all times and methods used for exterminating rodents or insects or both shall be in accordance with the provisions of the Pesticides Act, R.S.O. 1990, Chapter P.11, as amended and all regulations to enacted pursuant thereto.

To date, it has not been necessary to enforce the Property Standards Bylaw for this purpose. That is, through landlords being educated on IPM, and the rights of tenants in Ontario, the involved property owners have taken the necessary steps to properly treat the units.

It is the tenant’s responsibility to properly prepare his/her unit for a treatment once the landlord has made the arrangements. Most companies will provide preparation steps in writing, but there are also guidelines online at bedbugsinfo.ca. It is important for tenants to contact their landlord immediately when a barrier arises during the preparation, to ensure alternate arrangements can be made with the pest control company. If the pest control company arrives to treat a residence and the dwelling is unprepared for treatment, the landlord may still be billed. Landlords can apply to the Ontario Landlord and Tenant Board for an order to evict a tenant if the tenant consistently interferes with the landlord’s action to deal with bed bugs. A document called “Tenant Rights in Ontario Regarding Bed Bugs” (Appendix G) is available at bedbugs.ca outlining the rights of both parties and who is responsible for paying the fee.

Need for Ongoing Funding

As indicated at the beginning of this report, the funding provided by the MOHLTC is one time for a one year period. This initiative has been important in establishing a public education campaign regarding prevention and treatment strategies as well as providing a source of funds for the treatment of exceptionally difficult situations. However, there is still a need for ongoing education and support. For this reason it is recommended that the Board of Health petition the Minister of Health and Long-Term Care, the Honourable Deb Matthews to include Bed Bug funding in the base budget of Ontario Health Units on an ongoing basis.

Summary

The MOHLTC has provided the Health Unit with time limited funding to address the issue of bed bugs. Health Unit staff members have implemented a comprehensive program which includes prevention, early identification and treatment components. A local advisory committee has been established to assist in the delivery of the bed bug initiative. Health Unit staff have developed a close working relationship with City of London Property Standards Division staff as part of the Bed Bug Program implementation process. There is need for ongoing funding to be able to continue to address the control of this difficult pest.

Appendix E: LMHC Tenant Bed Bug Meeting Statistics; MLHU Bed Bug Information Sessions/Events

Graham L. Pollett, MD, FRCPC
Medical Officer of Health