Resources: Establishing, Provisioning and Managing Special Needs Shelters

Have you been loosing sleep since reading report after report on the inadequacies of shelters to care for persons with special needs during the 2005 Hurricane season?  If so, you are not alone.  You may take comfort in knowing that you are among the distinguished company of many good and decent Emergency Managers across America.  During hurricane Katrina, I found myself asking “How can we call ourselves a great and compassionate Nation when we fail to care for the most vulnerable among us in the worst of times?”  The answer I arrived at was “we can’t.”

For the general population, we pretty much have the needed food, water, clothing and shelter items down pat.  However, what about the growing ranks of citizens with special needs, now estimated at one fifth of America’s population?  The challenges must be significant since we often can’t even agree on the definition of special needs populations.

Why don’t we forget about defining specific groups of special needs folks and let them self-identify? Instead, perhaps we should define specialty sheltering items and services available, and leave it at that.  We might want to just say, “Specific shelter locations for persons with special needs will be designated and advertised in regular communications with the general public and persons with disabilities advocacy groups.  Special Needs shelters will be provisioned with the following: medical and non-medical supplies and equipment, pharmaceuticals, nutritional products, and personal assistants and interpreters (which may be required during sheltering events by non-English speaking persons or persons with chronic diseases or physical, emotional or psychiatric disabilities).”

While that statement is easy to reduce to writing, the processes needed to determine which items should be stocked, how many of each item to stock and how to conserve the community’s investment in inventory (by avoiding product expiration in storage), are not as easy.  Recruiting sign language specialists, interpreters and medical assistants are also challenging tasks. Below are some suggestions which may be of value when planning special needs shelters:

  1. Select and plan for a shelter for Special Needs populations based on the experience of others.  The best advice one can heed is to communicate with shelter managers and support staff that have first-hand, “on-the-ground” experience from the 2005 hurricane season.  There are hundreds of persons who know the types of facilities and materials and services needs that were not met as well as the work-arounds that had to be employed.  The lessons they learned the hard way can help planners avoid repeating past mistakes.
  2. After designating the special needs shelter, get the word out.
    Public service announcements are a great way to get information out during community or statewide exercises.  In the PSA, consider specifying the types of services that will be provided in each special needs shelter and the personal items evacuees need to bring with them.  Another way to reach persons with special needs during a disaster is through advocacy groups.  Consider flyers, press releases and newsletters as good ways to publicize which shelters are designated to care for persons with special needs and the particular goods and services offered at each shelter location.  Advocacy groups should be brought into exercise planning as well as designating shelter locations for persons with special needs.  During exercises, your advocacy group partners can be invaluable in getting folks with special needs to the shelters providing the goods and services people require.
  3. Determine who will be the likely populations to show up at the shelter and anticipate what their needs will be.
    It may not be necessary to develop “qualifying criteria” for the shelter.  In the end, if a person self-identifies that he or she has special needs during disaster sheltering operations, the shelter manager will have to take those special needs seriously with or without a special qualification.  Some states are developing “registries” where persons with special needs can sign up in advance.  Due to privacy concerns, each State and Territory public health department should have involved specialists in patient confidentiality and the requirements of various Federal regulations regarding privacy. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has specific requirements regarding the privacy of a persons health records which may pertain to special needs shelters.

    Special Needs persons, including folks with disabilities and the elderly, will need a host of support services.  For example, in an evacuation, a person who was receiving wound care from home health professionals will need to know which shelter locations will be staffed and supplied to provide wound care.  A person who uses diabetes supplies and insulin may not have sufficient supplies to endure a lengthy stay in an evacuation shelter.

    Persons who rely on psychiatric medications did not receive adequate support during hurricanes Katrina and Rita according to the National Council on Disability (NCD). Their findings:  “THE NEEDS OF PEOPLE WITH PSYCHIATRIC DISABILITIES DURING AND AFTER HURRICANES KATRINA AND RITA”: POSITION PAPER AND RECOMMENDATIONS; National Council on Disability, July 7th, 2006.  Now I have read scathing indictments on Inspector General (IG) and the General Accountability Office (GAO) reports in the past, but nothing ever came close to the ones listed at:  http://www.ncd.gov/newsroom/publications/2006/peopleneeds.htm To make matters worse, the NCD is a federal policy agency, and there is little to suggest that significant progress has been made across America since 2005 in sustaining persons with psychiatric disabilities.
  4. Determine the specific supplies and equipment required by the special needs shelter.
    We know there are literally hundreds of reports, papers, studies and all manner of well intentioned works in the Public Domain regarding the subject of caring for folks with special needs.  I have been unable to find a single report or study that lists the processes that may help Emergency Managers decide what items to include, how to arrive a quantities of medical and non-medical supplies and equipment to manage and how to get the products and services to the right place at the right time.  I thought I’d step out into the discussion and list some concrete steps that my be taken by Emergency Managers who want to make the 2005 Hurricane season a horrible but non-recurring nightmare.

Recruit a subject matter expert (SME) team consisting of healthcare specialists in Disabilities, Emergency Medicine, Geriatric care, Psychiatric care and long term patient care.  Although nurse specialists will select most of the patient care items, it may be a good idea to recruit a physician as the SME team leader.    Prepare for success by selecting a strong leader for your formulary and special needs development team. A pharmacist will be the SME member who will extremely helpful in the standardization and cross referencing of medications.  The reality of life in a shelter operation will dictate a “lean formulary” and the pharmacist will be invaluable in areas of drug interactions as well as using standardized substitute drugs.   A respiratory therapist and a dietician (for special feeding items) would also be good choices as team members.

Last but not least, recruit a healthcare purchasing agent or a materials manager as the person who will provide sources for the various products on your formulary listings.  The SME team will need to concentrate on standardizing items in order to meet needs but keep the requirements lists manageable. The purchasing agent or healthcare materials manager can play a supporting role but you need a strong medical person as the formulary development leader, since many formulary choices will be difficult but essential.

Divide your formularies and services into categories, since this will make vendor selection and advocacy professional group reviewers tasks easier. Food and special feeding items, medical surgical supplies, medical equipment, pharmaceuticals, patient care and apparel and hygiene needs are some of the commodity categories SME teams will need to consider.  Just some categories of needs and products include:

A. Materials

  • Respiratory care
  • Wound care
  • Specialty care-Ostomy products
  • Pharmaceuticals-chronic care medications
  • Patient shelter hygiene supplies
  • Mobility items; wheelchairs (regular and wide), walkers, crutches, etc.
  • Special nutritional products, infant formula (including non-dairy), enteral feeding products (for persons who can’t swallow and have a feeding tube).
  • Specialty cleaning and care kits (tracheotomy, ostomy,)
  • Bariatric care (obese persons), bariatric beds, wheelchairs, special lifting devices (Hoyer lifts and associated equipment)

B. Services

  • Redundant notification systems to notify persons with disabilities that an emergency exists and all pertinent actions that need to be taken
  • Special assistants for the blind.
  • Special assistants for the deaf and hard of hearing including couriers for notification.
  • General services shelter volunteers

Select distributors for materials.  Most state and territorial Public Health agencies have separate vendors (often called prime vendors) for major product categories such as; vaccines, pharmaceuticals, medical supplies and medical equipment.  When allowable, it’s a good idea to piggy back onto existing state contracts for special needs shelters instead of letting new contracts.  This is because the shelter manager can leverage the jurisdictional purchasing power and often obtain existing jurisdictional contract pricing and terms.  Since the Public Health agency is normally the provider of supplies and equipment for special needs shelters, the additional materials can be added to the existing contract by using a contract amendment.  The public health purchasing agent can work with the state contracting officer on any contractual issues involving special needs shelter acquisitions, delivery and billing information.  The key in this area like all other emergency management functions is advance work.  Those Public Health agencies that wait to develop formularies and arrange contractual details until an actual disaster is underway will most likely be the ones calling FEMA immediately for help.  Also, in large scale disasters, there may be system-wide supply and equipment shortages.

Recruit and train special services staff.  Advocacy groups for persons with disabilities and other special needs people may be able to help the special needs shelter manager identify companies which provide services to persons with disabilities. Non-governmental organizations including the Red Cross, Salvation Army and Goodwill Inc. as well as faith-based congregations may be able to provide volunteers. Whether the persons who will staff the special needs shelters are paid or unpaid workers, the identification and training components must be accomplished beforehand in order to succeed.

Conclusion

The special needs of persons with disabilities and other vulnerable persons will exist whether or not State and Territorial Emergency Managers and Public Health Officers plan for the needs in advance.  Advance planning will make a difficult situation manageable.  The lack of advance planning will not only be a disgrace and will likely cause pain, suffering and perhaps deaths.

Throughout my career in healthcare, medical logistics and emergency management, I asked myself if my planning would be sufficient for my mother and sisters should they require sheltering in a disaster situation.  In the end, persons with special needs are indeed our community family.  Good enough doesn’t cut it for family and shouldn’t be “good enough” for our community members, especially the vulnerable.  Planning for and submitting our requirements and the associated budgetary figures to the appropriate funding authority may not result in all requirements being funded.  What it will do is demonstrate that you took the time to determine what is needed, you articulated the needs in writing to the funding authority and as funding was made available, you provided for the needs of our community, including our most vulnerable persons.

 
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