Guidance on Planning for
Integration of Functional
Needs Support Services in
General Population Shelters
November 2010
This guidance was created for FEMA by
BCFS Health and Human Services, San Antonio, Texas; www.bcfs.net; 1-800-830-2246
2
Guidance on Planning for
Integration of Functional Needs
Support Services in General
Population Shelters
Contents
Page
Section
7
1. Purpose
7
2. Disclaimer
8
3. Scope
8
3.1. Definition
8
3.2. FNSS Planning
9
3.3. Premise
10
3.4. Legal Foundation for FNSS Guidance
12
3.5. Legal Authorities and References
13
15
4. FNSS Guidance
4.1. Key Considerations in Planning for Shelter Set-Up
15
4.1.1. Planning in Advance for FNSS
16
4.1.2. Stakeholder Coordination
17
4.1.3. Planning Shelter Capacity
17
4.1.4. Identifying Shelter Sites/Facilities
18
4.1.5. Evaluating the Shelter
18
4.1.6. Selecting the Shelter
19
4.1.7. Equipping and Supplying the Shelter
21
4.1.8. Locating Services
23
4.1.9. Staffing the Shelter
24
4.1.10. Assessment Teams
25
4.1.11. Shelter Layout
25
4.1.12. Shelter Intake
27
4.2. Key Considerations in Planning for Shelter Operations
28
4.2.1. Dietary
28
4.2.2. Service Animals
30
4.2.3. Communication
31
4.2.4. Bathing and Toileting Needs
32
4.2.5. Quiet Area
32
4.2.6. Mental Health Services
32
4.2.7. Medical and Dental Services
34
4.2.8. Medication
35
4.2.9. Transportation Services
37
4.3. Key Considerations in Planning for Transition/Recovery
37
4.3.1. Transitioning Back to the Community
38
4.3.2. Closing the Shelter
40
5. Acronyms
41
6. Glossary
44
7. Operational Tools
45
8. Appendices
Acknowledgements
FNSS Review Panel Members that helped direct and
define this guidance document
FEMA
•
•
•
•
•
•
•
•
Mass Care Section
Office of Disability Integration and Coordination
Volunteer Agency Liaison
Faith Based Office
Office of Chief Council
Region I
Region VI
Region X
HHS
• ESF 8 Office of the Assistant Secretary for Preparedness and Response ASPR
• ESF 6 Administration for Children and Families
DHS
• Office for Civil Rights and Civil Liberties
DOJ
• Disability Rights Section, Civil Rights Division
American Red Cross
• Direct Services
• Mass Care
• Disaster Health Services
National Council on Disability
National Council on Independent Living
National Disability Rights Network
Center for Disability and Health Policy
Rhode Island Department of Health
• Center for Emergency Preparedness & Response (CEPR)
Florida Statewide Disability Coordinator,
Division of Emergency Management
California Emergency Management Agency,
Office for Access and Functional Needs
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6
Functional Needs
Support Services
Guidance on Planning for Integration of Functional
Needs Support Services in General Population
Shelters
1. Purpose
The purpose of this document is to provide planning guidance that can be incorporated into existing
shelter plans to State emergency managers and shelter planners to meet access and functional needs
in general population shelters. This document provides guidance to assist emergency managers
and shelter planners in understanding the requirements related to sheltering children and adults
with functional support needs in general population shelters. Functional Needs Support Services
(FNSS) and the guidance provided are designed to assist in the planning and resourcing of sheltering
operations whether government, NGO, faith- or private-based to meet the access and functional
needs of children and adults. These guidelines identify methods of achieving a lawful and equitable
program through the delivery of FNSS for children and adults.
2. Disclaimer
This guidance is not designed to establish local government as the single shelter operator or
establish a new “tier” of sheltering. It is not intended to establish new legal obligations, alter existing
obligations, or constitute a legal interpretation of the statutes that are the basis of the guidance
materials. The guidance is not meant to duplicate or cover all requirements found in existing or
potential shelter plans or SOP’s. This is simply a resource for integrating FNSS into the general
shelter planning process and/or existing documents. Listing an agency or organization’s processes/
procedures as an operational tool in this guidance does not constitute a recommendation or
endorsement of the resource. In addition, information presented in an operational tool may have been
summarized, modified and/or combined with other cited sources.
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3. Scope
This guidance has been developed to support local, tribal, State and Federal governments to integrate
children and adults with and without disabilities who have access and functional needs into every
aspect of emergency shelter planning and response. It is intended to be used in conjunction with
general population shelter Standard Operating Procedures (SOP) to ensure that all shelter residents
benefit equally from programs, services, and activities. It provides a context for FNSS integration in
light of other existing plans and describes a process to use in any planning effort. These guidelines
are scalable and can be applied to urban, suburban, and rural localities with multiple or limited
resources.
Children and adults with disabilities have the same right to services in general population shelters
as other residents. Emergency managers and shelter planners have the responsibility of planning
to ensure that sheltering services and facilities are accessible. The decisions made in the planning
process determine whether integration or segregation occurs during response. Although the FNSS
guidance is geared toward emergency managers and shelter planners, it is a document that can be
utilized as a shelter planning tool in local communities.
Throughout this document “State” is used to refer to a U.S. State, tribal government, U.S. territory
and the District of Columbia.
3.1. Definition
Functional Needs Support Services (FNSS) are defined as services that enable individuals to maintain
their independence in a general population shelter. FNSS includes:
• reasonable modification to policies, practices, and procedures
• durable medical equipment (DME)
• consumable medical supplies (CMS)
• personal assistance services (PAS)
• other goods and services as needed
Children and adults requiring FNSS may have physical, sensory, mental health, and cognitive and/or
intellectual disabilities affecting their ability to function independently without assistance.
Others that may benefit from FNSS include women in late stages of pregnancy, elders, and people
needing bariatric equipment.
3.2. FNSS Planning
Planning for FNSS in general population shelters includes the development of mechanisms that
address the needs of children and adults in areas such as:
• Communication assistance and services when completing the shelter registration process and
other forms or processes involved in applying for emergency-related benefits and services
including Federal, State, tribal, and local benefits and services
• DME, CMS, and/or PAS that assist with activities of daily living
• Access to medications to maintain health, mental health, and function
• Available sleeping accommodations (e.g., the provision of universal/accessible cots or beds
and cribs; the placement, modification, or stabilization of cots or beds and cribs; the provision
and installation of privacy curtains)
• Access to orientation and way-finding for people who are blind or have low vision
8
• Assistance for individuals with cognitive and intellectual disabilities
• Auxiliary aids and services necessary to ensure effective communication for persons with
communication disabilities
• Access to an air-conditioned and/or heated environment (e.g. for those who cannot regulate
body temperature)
• Refrigeration for medications
• Availability of food and beverages appropriate for individuals with dietary restrictions (e.g.,
persons with diabetes or severe allergies to foods such as peanuts, dairy products and gluten)
• Providing food and supplies for service animals (e.g., dishes for food and water, arrangements
for the hygienic disposal of waste; and, if requested, portable kennels for containment)
• Access to transportation for individuals who may require a wheelchair-accessible vehicle,
individualized assistance, and the transportation of equipment required in a shelter because of
a disability
• Assistance locating, securing, and moving to post-disaster alternative housing, which includes
housing that is accommodating to the individual’s functional support needs (e.g., accessible
housing; housing with adequate space to accommodate DME; or housing located in close
proximity to public transportation, medical providers, job or educational facility, and/or retail
stores)
• Assistance with activities of daily living such as:
◦◦ eating
◦◦ taking medication
◦◦ dressing and undressing
◦◦ transferring to and from a wheelchair or other mobility aid
◦◦ walking
◦◦ stabilization
◦◦ bathing
◦◦ toileting
◦◦ communicating
3.3. Premise
Historically, resource gaps have existed in planning for and meeting access and functional needs
in general population shelters. Many times this has resulted in disparate treatment and the denial
of full and equal services. The intent of this planning guidance is to ensure that individuals are not
turned away from general population shelters and inappropriately placed in other environments (e.g.,
“special needs” shelters, institutions, nursing homes, and hotels and motels disconnected from other
support services). Addressing these gaps benefits the entire community and maximizes resources.
9
3.4. Legal Foundation for FNSS Guidance
The Stafford Act and Post-Katrina Emergency Management Reform Act (PKEMRA), along with
Federal civil rights laws, mandate integration and equal opportunity for people with disabilities in
general population shelters.
To comply with Federal law, those involved in emergency management and shelter planning should
understand the concepts of accessibility and nondiscrimination and how they apply in emergencies.
The following are key nondiscrimination concepts applicable under Federal laws, and examples of
how these concepts apply to all phases of emergency management.
1. Self-Determination – People with disabilities are the most knowledgeable about their own
needs.
2. No “One-Size-Fits-All” – People with disabilities do not all require the same assistance and do
not all have the same needs.
• Many different types of disabilities affect people in different ways. Preparations should
be made for people with a variety of functional needs, including people who use mobility
aids, require medication or portable medical equipment, use service animals, need
information in alternate formats, or rely on a caregiver.
3. Equal Opportunity – People with disabilities must have the same opportunities to benefit from
emergency programs, services, and activities as people without disabilities.
• Emergency recovery services and programs should be designed to provide equivalent
choices for people with disabilities as they do for people without disabilities. This
includes choices relating to short-term housing or other short- and long-term disaster
support services.
4. Inclusion – People with disabilities have the right to participate in and receive the benefits of
emergency programs, services, and activities provided by governments, private businesses,
and nonprofit organizations.
• Inclusion of people with various types of disabilities in planning, training, and evaluation
of programs and services will ensure that all people are given appropriate consideration
during emergencies.
5. Integration – Emergency programs, services, and activities typically must be provided in an
integrated setting.
• The provision of services such as sheltering, information intake for disaster services, and
short-term housing in integrated settings keeps people connected to their support system
and caregivers and avoids the need for disparate services facilities.
6. Physical Access – Emergency programs, services, and activities must be provided at locations
that all people can access, including people with disabilities.
• People with disabilities should be able to enter and use emergency facilities and access
the programs, services, and activities that are provided. Facilities typically required to be
accessible include: parking, drop-off areas, entrances and exits, security screening areas,
toilet rooms, bathing facilities, sleeping areas, dining facilities, areas where medical care
or human services are provided, and paths of travel to and from and between these areas.
7. Equal Access – People with disabilities must be able to access and benefit from emergency
programs, services, and activities equal to the general population.
• Equal access applies to emergency preparedness, notification of emergencies, evacuation,
transportation, communication, shelter, distribution of supplies, food, first aid, medical
care, housing, and application for and distribution of benefits.
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8. Effective Communication – People with disabilities must be given information that is
comparable in content and detail to that given to the general public. It must also be accessible,
understandable and timely.
• Auxiliary aids and services may be needed to ensure effective communication. These
resources may include pen and paper; sign language interpreters through on-site or video;
and interpretation aids for people who are deaf, deaf-blind, hard of hearing or have
speech impairments. People who are blind, deaf-blind, have low vision, or have cognitive
disabilities may need large print information or people to assist with reading and filling out
forms.
9. Program Modifications – People with disabilities must have equal access to emergency
programs and services, which may entail modifications to rules, policies, practices, and
procedures.
• Service staff may need to change the way questions are asked, provide reader assistance to
complete forms, or provide assistance in a more accessible location.
10. No Charge – People with disabilities may not be charged to cover the costs of measures
necessary to ensure equal access and nondiscriminatory treatment.
• Examples of accommodations provided without charge to the individual may include
ramps; cots modified to address disability-related needs; a visual alarm; grab bars;
additional storage space for medical equipment; lowered counters or shelves; Braille
and raised letter signage; a sign language interpreter; a message board; assistance in
completing forms or documents in Braille, large print or audio recording.
See FEMA: IV. Non-discrimination Principles of the Law; http://www.fema.gov/oer/reference/
principles.shtm
The Americans with Disabilities Act of 1990 (ADA), the Rehabilitation Act of 1973 (RA), and the
Fair Housing Act (FHA), their regulations and agency guidance, as well as State counterparts, among
others, define the scope of FNSS. These hallmarks of equal opportunity for people with disabilities
include:
• The implementation and execution of a general policy of nondiscrimination on the basis of
disability
• Sheltering persons with disabilities in the most integrated setting appropriate to the needs of
the person, which in most cases is the same setting people without disabilities enjoy
• Reasonable modifications of policies, practices, and procedures to ensure nondiscrimination,
with reasonableness judged in light of nondiscrimination principles applied in emergent
circumstances
• The provision of auxiliary aids and services to ensure effective communication, with primary
consideration of the aid or service given to the person with a disability
• Elimination of eligibility criteria, discriminatory administrative methods, paternalistic safety
requirements, and surcharges where discrimination results
• The selection of accessible sites for the location of general population emergency shelters,
the construction of architecturally compliant mass care shelters and elements, and required
physical modifications to ensure program accessibility in existing facilities
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3.5. Legal Authorities and References
ADA Best Practices Tool Kit for State and Local Governments, Chapter 7, Emergency Management
under Title II of the ADA (2007), Addenda 1-3, and the Introduction to Appendices 1 and 2 (Attached
as Exhibit 1); Titles II, III, and V of the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 1210112103, 12131-12134, 12181-12188, and 12201-12213, as amended by the ADA Amendments Act
of 2008. Nondiscrimination on the Basis of Disability in State and Local Government Services,
28 C.F.R. pt. 35. Nondiscrimination on the Basis of Disability by Public Accommodations and in
Commercial Facilities, 28 C.F.R. pt. 36. The Americans with Disabilities Act Title II Technical
Assistance Manual (1993) and Supplement (1994). The Americans with Disabilities Act Title III
Technical Assistance Manual (1993) and Supplement (1994).
Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. §§ 794, as amended. Enforcement of
Nondiscrimination on the Basis of Handicap in Programs or Activities Conducted by the Federal
Emergency Management Agency, 44 C.F.R. pt. 16. Enforcement of Nondiscrimination on the Basis
of Handicap in Programs or Activities Conducted by the Department of Justice, 28 C.F.R. pt. 39.
Nondiscrimination on the Basis of Handicap in Programs or Activities Receiving Federal Financial
Assistance, 45 C.F.R. pt. 84 (Department of Health and Human Services). Nondiscrimination on
the Basis of Handicap in Programs or Activities Receiving Federal Financial Assistance, 34 C.F.R.
pt. 104 (Department of Education). Nondiscrimination Based on Handicap in Federally Assisted
Programs and Activities of the Department of Housing and Urban Development, 24 C.F.R. pt. 8.
Title VIII of the Civil Rights Act of 1968 (“Fair Housing Act”), as amended, 42 U.S.C. §§ 3601-3631.
Discriminatory Conduct Under the Fair Housing Act, 24 C.F.R. pt. 100.
The Architectural Barriers Act of 1968, as amended, 42 U.S.C. §§ 4151-4157. Construction and
Alteration of Public Buildings, 41 C.F.R. pt. 101-19.
The Homeland Security Act of 2002, 6 U.S.C. §§ 101-557, as amended.
The Robert T. Stafford Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§ 5121-5206, as
amended. Federal Disaster Assistance, 44 C.F.R. pt. 206.
The Post-Katrina Emergency Management Reform Act, 6 U.S.C. § 761(d), as amended.
Emergency managers and shelter planners are encouraged to investigate their applicable State laws.
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4. FNSS Guidance
This document outlines common scenarios that general population shelter planners and operators may
encounter during emergencies and disasters, and presents guidance on providing an integrated, nondependent, nondiscriminatory environment, so people with and without disabilities may benefit from
the same sheltering program.
The operational tools in this document are excerpts and examples taken from various agency and
jurisdictional documents throughout the United States. While they are not meant to dictate a State’s
policies or procedures, they do present ideas and practices that can be adapted to fit each State’s
specific needs.
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4.1. Key Considerations In
Planning For Shelter Set-Up
4.1.1. Planning in Advance for FNSS
The importance of advanced planning in developing and implementing FNSS in general population
shelters cannot be overstated. Throughout the document this principle will be repeated again and
again to emphasize that FNSS cannot wait to be identified and put into place once an emergency or
disaster occurs.
Often, it is assumed that during a disaster, children and adults requiring FNSS must be housed
in a medical special needs shelter. Children and adults with access and functional needs do not
necessarily have medical conditions and typically do not require the care that medical shelters
provide. Diverting to medical shelters can result in the separation of individuals with disabilities
from those associated with them such as family, friends, neighbors and caregivers. In addition,
inappropriate placement can jeopardize the health and safety of the entire community by creating
unnecessary surges on emergency medical resources.
A one-size-fits-all approach to shelter planning does not work. (See FEMA: IV.Non-discrimination
Principles of the Law; http://www.fema.gov/oer/reference/principles.shtm).
Under the Americans with Disabilities Act (ADA), children and adults with disabilities are entitled to
equal opportunity to participate in programs, services, and activities in the most integrated setting.
Historically, shelter facilities may not have met requirements under the Standards for Accessible
Design, 28 CFR Part 36 (adopted from ADA Architectural Guidelines). Newly constructed or
recently altered facilities are more likely to fully comply with standards for accessible design. The
decision to open a shelter that violates Federal laws and ADA standards brings with it significant
challenges to appropriately and safely shelter children and adults with and without disabilities who
have access and functional needs.
State, tribal and local governments are responsible for maintaining plans to support emergency
response. Emergency managers and shelter planners should incorporate the planning considerations
addressed in this guidance into their existing plans.
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Operational Tool #1 Planning Guidance
Comprehensive
Preparedness Guide 101
A Guide for All-Hazard
Emergency Operations
Planning
The FEMA Comprehensive Preparedness Guide, CPG 101
provides general guidelines on developing Emergency Operations
Plans (EOPs). It promotes a common understanding of the
fundamentals of planning and decision making to help emergency
planners examine a hazard and produce integrated, coordinated,
and synchronized plans. This guide helps emergency managers in
State, territorial, local, and tribal governments in their efforts to
develop and maintain a viable all-hazard EOP.
Source
http://www.fema.gov/pdf/about/divisions/npd/CPG_101_V2.pdf
4.1.2. Stakeholder Coordination
All levels of government, working closely with the private sector, share the responsibility of
providing emergency shelter care to children and adults who need assistance. All citizens expect
their State and local governments to keep them informed and to provide assistance in the event of an
emergency or disaster.
In developing plans that will meet the needs of people requiring FNSS, emergency managers and
shelter planners should collaborate with all relevant stakeholders including:
• People requiring FNSS
• Agencies and organizations that provide FNSS
• Agencies and organizations that advocate for the rights of people requiring FNSS
• DME, CMS, PAS, and communication providers
Emergency managers and shelter planners can obtain assistance in identifying stakeholders by
accessing www.disability.gov.
The operational tools in this document are excerpts and examples taken from various agency and
jurisdictional documents throughout the United States. While they are not meant to dictate a State’s
policies or procedures, they do present ideas and practices that can be adapted to fit each State’s
specific needs.
Operational Tool #2 Stakeholder Coordination
16
Sample State
Guidance to Address
Functional Needs
The New Hampshire Functional Needs Guidance includes the names
and contact information for direct service providers and advocacy
organizations that work with functional needs populations, such as faithbased organizations, home-healthcare providers, Meals on Wheels, etc. In
addition, the document suggests that the State and local agencies that may
be of assistance include the: Developmental Disabilities Council, Area
Agencies, Governor’s Commission on Disability, Granite State Independent
Living, Northeast Deaf and Hard of Hearing Services, NH Association
for the Blind, NH Brain Injury Foundation, Community Action Programs,
Community Mental Health Centers and NH Office of Minority Health.
Source
New Hampshire Functional Needs Guidance – Support Document to the
State Emergency Operations Plan
http://www.nh.gov/safety/divisions/hsem/stateemergplan/index.html
4.1.3. Planning Shelter Capacity
When anticipating and planning for shelter capacity, emergency managers and shelter planners
should:
• Be familiar with and committed to meeting ADA requirements for general population care
shelters
• Know the demographic profile of their community and understand the type of assistance that
may be required by various populations during an emergency or disaster
• Establish a rigorous public education program with an emphasis on personal preparedness.
(The program should include information in accessible formats and languages to reach the
entire community)
• Collaborate with stakeholders (see section above on Stakeholder Coordination)
• Ensure that emergency plans are a “living document” and are updated with a predetermined
frequency, as well as after any major event
• Establish mutual-aid agreements and memorandums of understanding with neighboring
communities that can provide additional emergency resources in the event that local shelters
are destroyed or damaged
Operational Tool #3 Planning Shelter Capacity
Sample of Available
Information Regarding
the Estimated Number of
Children and Adults in Texas
who have a Disability or
have Difficulty Performing
Self-care Activities
In Texas, there are an estimated 2,962,000 people, age 5 and older,
who have a disability. Texas also has an estimated 579,000 people,
age 5 and older, who have difficulty performing self-care activities.
This website presents the disability prevalence data by State or the
entire U.S. and is broken down by disability type, age, gender, race,
ethnicity, family income, benefit recipiency, employment, and living
arrangement.
Source
Center for Personal Assistance Services, University of California,
San Francisco, California
http://www.pascenter.org
Note: Click on Need for PAS, click on Disability Prevalence Data
from the Current Population Survey (2008-2009)
4.1.4. Identifying Shelter Sites/Facilities
Federal and State laws require that children and adults with disabilities have equal opportunity
to access emergency programs and services. An assumption might be made that if a building is
designated as a shelter, it will meet the needs of all individuals as long as it provides a safe place to
eat, sleep, and take care of personal hygiene needs. However, without modifications, some shelters
are not appropriate to support the integration of FNSS. Emergency managers and shelter planners
should ensure that all general population shelters meet ADA requirements, including the standards for
accessible design and State accessibility codes.
Operational Tool #4 Locating the Shelter
Priority Site Selection
Facilities that have been built or altered since 1992 are more likely to
comply with the architectural requirements of the ADA
Source
ADA Best Practices Toolkit Chapter 7, ADA Checklist for
Emergency Shelters
www.ada.gov/pcatoolkit/chap7shelterchk.pdf
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4.1.5. Evaluating the Shelter
Individuals who have the responsibility of selecting shelter sites are often not trained in what
constitutes an accessible facility. They need information to assist them in evaluating a building
to determine if it is accessible or can be made accessible expeditiously with few modifications
and minimal expense. There are individuals in nearly every community who have experience in
evaluating accessibility (e.g., ADA Consultants, ADA accessibility inspectors, disability-related
organizations).
Preliminary analysis of each potential shelter will expedite the elimination of any building with
extensive barriers.
Operational Tool #5 Evaluating the Shelter-Site Selection Tool
ADA Checklist for
Emergency Shelters
Shelters need accessible:
• Entrances
• Routes to all services/activity areas
• Routes within toilet rooms
• Passenger drop off and pick up areas
• Parking
• Sidewalks and walkways
• Shelter entrances, hallways, and corridors
• Check in/information areas
• Sleeping areas
• Restrooms, showers, and toilet stalls, including portable toilets
• Public telephones
• Drinking fountains
• Eating areas
• Medical first aid areas
• Recreation areas
The checklist provides instructions on taking measurements of the shelter.
Source
www.ada.gov/pcatoolkit/chap7shelterchk.pdf; ADA Checklist for
Emergency Shelters; Appendix 1
4.1.6. Selecting the Shelter
State codes and standards must, at a minimum, meet the Federal requirements, but can be more
comprehensive. The ADA and other Federal laws, including the Stafford Act, the Rehabilitation
Act, the Fair Housing Act, and the Architectural Barriers Act, provide affirmative obligations
and prohibitions of discrimination on the basis of disability. No State or local government, or its
contractors, may, by law, policy, or contract, provide services below those standards without violating
Federal law. This does not mean that a State or local government cannot enact laws and ordinances
or provide services, obligations, and prohibitions that extend beyond these standards to ensure greater
access. A common example would be to provide twice as many as the required number of accessible
parking spaces and access aisles.
Since most States and communities have additional codes and standards related to accessibility,
emergency managers and shelter planners should be sure to identify and comply with these
requirements as well.
18
If selected as an emergency shelter, a facility with inaccessible features must be made accessible
before use as a shelter (reference Operational Tools #4 and #5 and Appendix 1).
Plans should include strategies to provide power for services that require a back-up power system in
an emergency or disaster. It is important to determine if a facility has a source of emergency power
generation.
Operational Tool #6 Florida Shelter Selection Checklist
Checklist for
Emergency
Shelters
Checklist for emergency shelters reflecting Florida code
Source
Americans with Disabilities Act/Florida Accessibility Code
Statewide Disability Coordinator
Telephone : 850-413-9892
http://www.floridadisaster.org/documents/ada/emergencyshelterchecklistflorida.pdf
Operational Tool #7 San Jose California Shelter Assessment Checklist
Checklist for Assessing
Emergency Shelters
San Jose California tool for assessing an emergency shelter
Source
San Jose Office of Emergency Services
http://www.sanjoseca.gov/emergencyservices
Note: Click on San Jose Disaster Shelter Annex for Vulnerable
Populations, click on Annex D
4.1.7. Equipping and Supplying the Shelter
Post-Katrina Emergency Management Reform Act (PKEMRA) requires that children and adults
with and without disabilities who have access and functional needs must be able to access the same
programs and services as the general population.
Despite best efforts and advance planning, some persons will arrive at the shelter without the durable
medical equipment (DME) and/or medications they require.
Prior to an emergency or disaster, emergency managers and shelter planners should:
• Include in the State plan a process for locating, purchasing, and storing as much of the supplies
and equipment as possible and practical to meet the needs of children and adults with and
without disabilities who have access and functional needs
• Develop provider agreements with the private sector to ensure that necessary equipment and
supplies that have not been purchased and stored will be available during an emergency or
disaster
• Develop agreements with area contractors to maintain equipment (e.g., generators, oxygen
concentrators)
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Emergency managers and shelter planners should include in the planning process people with
expertise and experience in dealing with the logistical requirements of providing the resources
necessary to set up and operate a general population shelter that includes children and adults with and
without disabilities who have access or functional needs.
Operational Tool #8 Durable Medical Equipment (DME) List
DME (for children and adults)
Sample DME list
Source
FEMA: Durable Medical Supply Sample List; Appendix 3
Operational Tool #9 Consumable Medical Supplies (CMS) List
CMS (for children
and adults)
Sample list of Consumable Medical Supplies using a planning estimate
based on 100 person shelter population for one week
Source
FEMA: Consumable Medical Supply Sample List; Appendix 4
Operational Tool #10 Communication Devices
Communication Devices
(not inclusive)
•
•
•
•
•
•
•
•
•
Hearing aids
TTY/TDD Phones
Cap Tel Phones (for captioning)
Computer Assisted Real time Translation
Hearing aid batteries of different sizes (including batteries for
cochlear implants
Synthesizers used with PCs for text-to-speech
Screen Readers
Screen Magnification Programs
Scanning Systems for Low Vision Users
Source
Guidance on Planning and Responding to the Needs of People with
Access and Functional Needs, California Emergency Management
Agency, Office for Access and Functional Needs
www.oes.ca.gov/
Click on Office for Access and Functional Needs
Source
BCFS; www.bcfs.net/fnssrecommendations
Operational Tool #11 Resources for Assistive Technology
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Reuse of Assistive
Technology
There is at least one Federally-funded program in every State that engages
in the reuse of assistive technology. These programs are also connected to
other entities in the State that reuse assistive technology so they can serve as a
central point of contact for emergency managers and shelter planners.
Source
http://www.resnaprojects.org/nattap/at/statecontacts.html
(contact information only)
Source
http://www.resnaprojects.org/nattap/at/statecontacts.html#al
(contact information)
Operational Tool #12 Legal Authority-DME, CMS, Communication Devices
Legal Authority
Federal agencies may, on the direction of the President, provide assistance
essential to meeting immediate threats to life and property resulting from a
major disaster including:
• Medicine, durable medical equipment, communication devices, goods,
and other consumables
• Emergency medical care, emergency mass care emergency shelter, and
provision of food, water, medicine, durable medical equipment
In any emergency, the President may:
• Assist State and local governments in the distribution of medicine, food,
and other consumable supplies, and emergency assistance
Federal authority for provision of PAS can be found in the reference below.
Source
Sections 403 (a) (2) and (3) (B) and 502(a) (7) of the Robert T. Stafford
Disaster Relief and Emergency Assistance Act, 42 U.S.C. §§ 5121-5206, as
amended. Federal Disaster Assistance, 44 C.F.R. pt. 206.
http://www.fema.gov/about/stafact.shtm
Many children and adults with and without disabilities who have access and functional needs depend
on battery-powered wheelchairs and scooters for mobility. The batteries in these mobility aids must
be recharged frequently or they will stop functioning. Without these mobility aids, individuals will
lose their ability to move about, they may be unable to participate in some services offered by the
shelter, and they may need to depend more heavily on assistance from caregivers.
4.1.8. Locating Services
State plans should include arrangements for services that are necessary to provide sufficiency of
care in order to maintain level of function for children and adults with and without disabilities who
have access and functional needs in a general population shelter. Emergency managers and shelter
planners should arrange for services ahead of time through the use of provider agreements. The
following are examples of some types of services that should be available in a general population
shelter:
• Power Generation
◦◦ Redundant source of power even in the event of a long-term power outage. Some facilities
may have no source of emergency power generation, while others may have only a
limited source. Emergency managers and shelter planners should take whatever steps are
necessary to see that there is a plan for providing an alternate source of power in the event
of an outage and mechanical service contracts/services for emergency repairs.
• Medical Providers
◦◦ Physicians, Registered Nurses, Licensed Vocational Nurse, EMT’s and Paramedics
◦◦ Psychiatrists and Dental providers
◦◦ Emergency veterinary service provider
◦◦ Access to dialysis treatments (this includes providing access to transportation to and from
the dialysis facility and a meal(s) if a resident is not at the shelter during meal time(s))
• Communications providers
◦◦ Interpreters (Spanish, sign language, etc.)
◦◦ Television with captioning
◦◦ Information technology/computer services
◦◦ TTY - TDD
21
•
•
•
•
•
◦◦ Computer Assisted Real time Translation (CART)
◦◦ Note taking
Food service providers
◦◦ Special diets
◦◦ Caterer
Transportation providers
◦◦ Para transit services
◦◦ Public transportation
Shelter Maintenance providers
◦◦ Service for accessible portable toilets, hand washing units, showers, etc.
◦◦ Disposal of bio-hazard materials, such as needles in sharps containers
DME providers
◦◦ Oxygen providers
CMS providers
Operational Tool #13 Locating Services
22
Support
Services
Staff and resources to:
• Replace prescribed medications
• Obtain DME and CMS
• Assist persons in maintaining their usual level of independence (personal
assistance with activities of daily living, older adult non-acute medical and
chronic conditions, etc.)
• Provide support to persons with intellectual, cognitive, and mental health
conditions
• Provide interpreters and/or other communication support to assist persons who
require communication assistance deaf or hard of hearing and blind or low
vision, speech disabilities, language/cultural differences
• Provide assistance to individuals who have conditions that affect mobility
• Provide assistance to children and adults with chronic but stable respiratory
conditions (heart disease, asthma, emphysema, allergies, etc.)
• Provide assistance to children and adults with temporary limitations (postsurgery, injuries, pregnancy, etc.)
• Provide assistance to children and adults who require dialysis
Source
Guidance on Planning and Responding to the Needs of People with Access and
Functional Needs, California Emergency Management Agency, Office for Access and
Functional Needs
www.oes.ca.gov/
Note: Click on Office for Access and Functional Needs
Source
BCFS; www.bcfs.net/fnssrecommendations
Operational Tool #14 Documenting Service Providers
Service Provider
Contact Information
Form used to document names, vendor number, addresses and telephone
numbers of service providers including:
Communications Providers
• Interpreters (Spanish, sign language, etc.)
• Television with captioning
• Information Technology/Computer Services
• TTY-TDD
• Computer Assisted Real time Translation (CART)
• Note taking
Medical Staffing Services
• On-site nursing services
• Emergency medical services
• Emergency dental services
• Pharmaceutical services
Resource Suppliers
• O2
• Dialysis
• Constant power source
• Blood sugar monitoring
Food Services
• Special diets
• Caterer
Personal Assistance Services
Transportation Services
• Para transit Services
• Public Transportation
Service Animals
• Emergency veterinary services
Shelter Maintenance Services
• Servicing of accessible portable toilets, hand washing units, etc.
• Disposal of bio-hazard materials
FNSS equipment
• Durable Medical Equipment
Source
BCFS; www.bcfs.net/fnssrecommendations; FORM: Contact Information
for Shelter Services Providers; Appendix 2
4.1.9. Staffing the Shelter
Emergency managers and shelter planners should integrate people with expertise regarding access and
functional support needs into the staffing plan. Agencies in the stakeholder group are often a good
resource for providing shelter staff with appropriate experience (reference section on Stakeholder
Coordination).
Operational Tool #15 Staffing the Shelter
Personal Assistance
Services
Guidance for providing personal assistance service in general population
shelters that include children and adults with access or functional needs
Source
BCFS; www.bcfs.net/fnssrecommendations in conjunction with FEMA;
www.fema.gov; Guidance on Providing Personal Assistance Services;
Appendix 5
23
4.1.10. Assessment Teams
Prior to a disaster or emergency, there should be a plan for the activation of a shelter assessment team
to assess the needs of children and adults who have access or functional needs. An entity may want
to develop a process to credential these teams. One example of a team is the California Functional
Assessment Service Team (FAST) described below. The FAST training is a DHS-approved course.
Operational Tool #16 Assessment Teams
Functional
Assessment
Service Team
(FAST)
The FAST responds to the needs of people in a shelter who have access or
functional needs. The purpose of the FAST program is to conduct assessments
of people with these needs as they arrive at the general population shelters. The
assessment evaluates the functional needs a person has and determines resources
necessary to support these needs in the general population shelter.
The FAST may be deployed as shelters are opened and remain in service until
they are no longer needed. They can also transfer to another shelter as needed,
or request to deploy to shelters as jurisdictions become aware of their existence
during major events.
FAST consists of trained government employees and personnel from communitybased organizations and non-governmental organizations ready to respond and
deploy to disaster areas to work in shelters. The FAST members should have
extensive knowledge of the populations they serve, their needs and available
services and resources including housing, benefit programs and disaster aid
programs. They assist in meeting essential FNSS so people can maintain their
usual level of independence during disasters and emergencies. FAST frees
up other emergency resources to focus on emergency incidents rather than on
mitigating complications.
FAST planning includes:
• Training teams
• Establishing a Memorandum of Understanding with individuals or
organizations that will participate in the FAST
• Maintaining contacts at the State, tribal, regional, and local level
Source
Guidance on Planning and Responding to the Needs of People with Access and
Functional Needs, California Emergency Management Agency, Office for Access
and Functional Needs
www.oes.ca.gov/
Note: Click on Office for Access and Functional Needs
DHS approved FAST course (CA-049-REST)
http://www.dss.cahwnet.gov/dis/PG1909.htm
Homeland Security Grant Program and Emergency Management Program Grant
funds can be used to implement this program (California Department of Social
Services).
24
4.1.11. Shelter Layout
Cots and other furniture items are placed in such a way that routes are accessible to people who use
wheelchairs, crutches, or walkers. Protruding objects in ANY area where people walk throughout
the shelter should be eliminated. Accessible routes should connect the sleeping quarters to the food
distribution and dining quarters, bathrooms, and activity areas (reference Chapter 7 Addendum 2:
The ADA and Emergency Shelters: Access for All in Emergencies and Disasters).
Operational Tool #17 Shelter Layout
Estimating Shelter
Capacity
Source
• 20 square feet per person should be available for short-term
or evacuation shelters and up to 40 square feet per person for
sheltering longer than 72 hours
• People who use wheelchairs, lift equipment, a service animal, and
personal assistance services can require up to 100 square feet
Sheltering People with Disabilities, Draft Space and Layout
Considerations Universal Access Committee, Feb, 2007
www.ct.gov/demhs/lib/demhs/space__layout_considerations.pdf
4.1.12. Shelter Intake
Individuals are not required to provide information about their disability or access or functional
needs, but the opportunity to provide that information must be given. Emergency managers and
shelter planners should include in their plans specific strategies for complying with the legal mandate
that people with disabilities must be able to access the same programs and services as the general
population. An individual request for an accommodation, based on disability, should be provided
even if not requested during the initial intake.
25
26
4.2. Key Considerations
In Planning For Shelter
Operations
Segregating children and adults with and without disabilities who have access or functional needs and
those with whom they are associated from general population shelters to “special needs” shelters is
ineffective in achieving equitable program access and violates Federal law. People with disabilities
are entitled by law to equal opportunity to participate in programs, services, and activities in the most
integrated setting appropriate to the needs of the individual. Additionally, children and adults with
and without disabilities who have access and functional needs should not be sheltered separately from
their families, friends, and/or caregivers because services they require are not available to them in
general population shelters.
27
4.2.1. Dietary
Plans should include provisions to ensure meals and snacks are provided to all shelter residents,
including children and adults with specific dietary needs and restrictions (e.g., people with diabetes
or severe allergies to common food ingredients and baby formulas). Plans should also include a
process for responding quickly to unanticipated, but legitimate, dietary needs and restrictions that are
identified when a resident is admitted to the shelter. It is critical that information about any special
dietary needs or restrictions be obtained, documented, and communicated to the entity responsible for
meal and snack preparation immediately. Food preparation may need to be adjusted (e.g., food may
need to be pureed) to meet resident needs.
Operational Tool #18 Dietary-Agreement
Resources
for Meeting
Dietary Needs
Develop a memorandum of agreement or contract with a local organization(s)
that has demonstrated capacity to provide meals and snacks to large populations
including:
• Hospitals
• Local restaurants or cafeterias
• Schools
• Non-profits with a feeding crew
Source
BCFS; www.bcfs.net/fnssrecommendations
Source
Multi Agency Feeding Plan; http://www.nvoad.org/index.php/rl/doc_download/8multi-agency-feeding-plan.html
In order to meet all the needs of all people in the shelter, menus that are low sodium, low fat and low
sugar should be developed for general population shelters and should include specific instructions
regarding what to purchase in order to prepare each meal. Organizations contracting to prepare meals
and snacks should also anticipate and be prepared to provide meals for persons with other dietary
restrictions (e.g., vegetarian, gluten-free meals, kosher meals, meals for people who are allergic to
peanut oil and by-products).
Operational Tool #19 Dietary-Menu
One Day Menu for General Menu for general population shelters, including modifications for
Population Shelter
persons who are diabetic, require reduced sodium, pureed diets and
infants and children
Source
BCFS; www.bcfs.net/fnssrecommendations; One Day Menu for
General Population Shelters Providing Functional Needs Support
Services; Appendix 6
4.2.2. Service Animals
Under the ADA, a service animal is any animal that is individually trained to provide assistance to a
person with a disability. Most people are familiar with dogs that guide people who are blind or have
low vision, but there are many other functions that service animals perform for people with a variety
of disabilities. Examples include alerting people who are deaf or hard of hearing to sounds; pulling
wheelchairs; carrying or retrieving items for people with mobility disabilities or limited use of arms
or hands; assisting people with disabilities to maintain their balance or stability; alerting people to,
and protecting them during, medical events such as seizures; and working or performing tasks for
28
individuals with psychiatric, neurologic, or intellectual disabilities, such as waking up a person with
depression, assisting a person with Alzheimer’s in way-finding, retrieving misplaced objects for
persons with traumatic brain injury, protecting a child with autism from self injury, or orienting an
individual with schizophrenia to their environment.
Many emergency shelters do not allow residents or volunteers to bring their pets or other animals
inside, but shelters must make exceptions to “no pets” or “no animals” policies to allow people with
disabilities to be accompanied by their service animals. Service animals are not pets and are therefore
not subject to restrictions applied to pets or other animals.
While dogs are the most common type of service animal, other types of animals can also be service
animals. There are also no limitations on the size or breed of dogs that can be used as service animals.
Many service animals are easily identified because they wear special harnesses, capes, vests, scarves,
or patches. Others can be identified because they accompany individuals with visible disabilities and
the functions they perform can also be readily observed. When none of these identifiers are present,
shelter staff may ask only two questions to determine if an animal is a service animal:
(1) “Is this a service animal required because of a disability?”
(2) “What work or tasks has the animal been trained to perform?”
If the answers to these questions reveal that the animal has been trained to work or perform tasks
or services for a person with a disability, it qualifies as a service animal and must be allowed to
accompany its owner anywhere other members of the public are allowed to go, including bathrooms,
areas where food is served, and almost all areas where medical care is provided. Questions about the
nature or severity of a person’s disability or ability to function may not be asked. The ADA also does
not permit shelter staff to question a person’s need for a service animal or exclude a service animal
on the grounds that shelter staff or volunteers can provide the assistance normally provided by the
service animal. Under the ADA, shelter staff may not require a license, certification, ID tag, medical
certificate, or any other type of documentation for a service animal.
Operational Tool #20 Service Animals Definition
ADA Best Practices Tool
The ADA and Emergency Shelters: Access for All in Emergencies
Kit, Chapter 7 Addendum 1 and Disasters, pages 6-7
Source
http://www.ada.gov/pcatoolkit/chap7shelterprog.pdf
In addition to the requirements set out in the ADA, the shelter may be covered by the Fair Housing
Act (FHA). The FHA affords individuals with disabilities the right to use service animals in housing.
Plans should direct that, prior to an emergency or disaster, the following issues be addressed:
• Areas where animals can be housed, exercised, and toileted should be identified and
communicated in alternative accessible formats in each general population shelter
• A reliable source for food and supplies (water bowls, leashes, collars) for the animals should
be located and agreements be made to ensure that these items are available
29
4.2.3. Communication
Effective communication is essential during an emergency or disaster. Children and adults with
and without disabilities who have access or functional needs should be given the same information
provided to the general population using methods that are understandable and timely. The ADA
states that a public entity shall take appropriate steps to ensure that communication with applicants,
participants, and members of the public with disabilities are as effective as communication with
others. Effective communication requirements also apply to private and non-profit entities providing
sheltering services.
Plans should direct that, prior to an emergency or disaster, the auxiliary aids and services necessary to
meet the communication needs of all persons in the shelter are identified and immediately available.
Where possible, emergency managers and shelter planners should already have contracts and/or
memorandums of agreement in place with the vendors who can provide these items and services.
Operational Tool #21 Communication-Strategies
General
Assign volunteers ahead of time to provide one-on-one assistance
to residents who need help in providing and receiving effective
communication throughout the sheltering process (e.g., completing forms)
Blind and Low Vision Provide Braille, large and high contrast print, audio recording, readers
Deaf or Hard of
Hearing, Speech
Disability
Provide qualified sign language or oral interpreter; augmentative
communication device; post message in central location; have notepads,
pens and pencils
Intellectual Disability
Present information slowly, use simple language and speak in short
sentences
Source
FEMA: Accommodating Individuals with Disabilities in the Provision of
Disaster Mass Care, Housing and Human Services
http://www.fema.gov/oer/reference/index.shtm
Source
Chapter 7 Addendum 2: The ADA and Emergency Shelters: Access for
All in Emergencies and Disasters
http://www.ada.gov/pcatoolkit/chap7shelterprog.pdf
Operational Tool #22 Communication-Devices
Communication
Devices
All communication devices must be accessible to people with access or
functional needs
Telephone
Access to teletypewriter (TTY or TDD or CapTel)
Television
Accessible captioning
Computers
Equipment and programs that make computers accessible to people who
are deaf, blind, those who have intellectual or mobility disabilities
Source
BCFS; www.bcfs.net/fnssrecommendations
In each case, the type of auxiliary aid or service required depends on several factors, including
the length, complexity and importance of the communication and the person’s language skills
and history. For example, it is no help to have an American Sign Language (ASL) interpreter
available to communicate with deaf residents if the resident uses Signed English or other forms of
communication.
30
4.2.4. Bathing and Toileting Needs
Whenever bathing and toileting facilities are available in a general population shelter they must
include accessible bathing and toileting facilities for children and adults. If a shelter does not have
accessible facilities or if there are very limited accessible facilities available, plans should include
ways this limitation will be addressed. This can include agreements with private contractors to
provide these facilities.
Operational Tool #23 Bathing and Toileting Ratios – Red Cross
Portable Accessible Showers,
Toilets, and Sinks
Red Cross ratio: The American Red Cross recommends that, on
average, there should be one toilet for every 20 persons in the
shelter. Count only those facilities that will be accessible to shelter
residents and shelter staff.
Source
American Red Cross Mass Care Standards and Indicators,
Version 011-072209
Many emergency managers and shelter planners look for specific ratios regarding the number of toilet
rooms, showers, and baths to provide at an emergency shelter. In the context of the ADA Standards,
the obligation will depend on what type of toilet facility is provided (e.g., a single-user toilet room, a
toilet room with stalls).
Generally, each toilet room with stalls must have at least one fully accessible, standards-compliant
water closet/stall (see 28 C.F.R. pt. 36, App. A, ADA Standards for Accessible Design §§ 4.1.2(6),
4.16, 4.17, 4.18, 4.19, 4.22, Figs. 29, 30, 31, and 32). This includes appropriate side and rear
grab bars, sufficient clear floor space, the toilet seat must be between 17-19 inches from the
finished floor, and the centerline of the toilet must be 18 inches from the side wall, among several
other requirements. For further explanation and a tool to determine adequacy to meet the ADA’s
requirements, see ADA Best Practices Toolkit, Chapter 7 Addendum 3: ADA Checklist for Emergency
Shelters: www.ada.gov/pcatoolkit/chap7shelterchk.htm.
If there are six or more water closets/stalls in a toilet room, then one of the stalls, in addition to the
accessible stall, must be an ambulatory stall with parallel grab bars and an outward swinging door
(see 28 C.F.R. pt. 36, App. A, ADA Standards for Accessible Design §§ 4.22.4, 4.26, and Fig. 30(d)).
When portable toilet units are clustered together at emergency shelters, at least 5% of each cluster
must be accessible portable toilet units, identified by the International Symbol of Accessibility (see 28
C.F.R. pt. 36, App. A, ADA Standards for Accessible Design § 4.1.2(6)).
Standards also exist for the provision of baths and showers when provided. None of these
requirements prohibit, and emergency managers are encouraged to include, more accessible facilities
than required or mandated by Federal law, so long as they are otherwise standards-compliant.
31
4.2.5. Quiet Area
Plans should include a strategy for providing a quiet area within each general population shelter. The
stress that is created during and after an emergency or disaster is increased as a result of the noise and
crowded conditions of a shelter. Without access to a quiet room or space, some people (e.g., elderly
persons, people with psychiatric disabilities and parents with very young children, children and adults
with autism) will be unable to function in a shelter environment (see Chapter 7 Addendum 2: The
ADA and Emergency Shelters: Access for All in Emergencies and Disasters: http://www.ada.gov/
pcatoolkit/chap7shelterprog.pdf ).
4.2.6. Mental Health Services
Because there are differences in State and local laws, rules and regulations related to the provision of
mental health services, it is important that, early in the planning process, emergency managers and
shelter planners seek guidance from people with disabilities and others with access and functional
needs and appropriate State and local authorities regarding these matters.
Emergency managers and shelter planners should include people with expertise regarding children
and adults with and without disabilities who have access and functional needs in the mental health
staffing plan. Agencies in the stakeholder group are often a good resource for shelter staff with
appropriate experience (reference section on Stakeholder Coordination).
Ideally, plans should include a directive to pre-identify a licensed mental health professional(s) who
will be present in a general population shelter at all times. If that is not possible due to a lack of
resources, then plans should provide that a licensed mental health professional is on call to a shelter at
all times. Where possible, a psychiatrist should also be on call at all times.
Operational Tool #24 Mental Health Services
Sources for
Mental Health
Services
Sources include colleges and universities (faculty and students), mental health
organizations, social services agencies, and places of worship.
The New Jersey Division of Mental Health Services (DMHS) within the New
Jersey Department of Human Services (NJDHS) has over 120 contracted
community mental health provider agencies.
Substance Abuse and Mental Health Services Administration (SAMHSA) has
the contract to provide mental health counseling in emergency situations.
Source
BCFS; www.bcfs.net/fnssrecommendations
Source
http://www.samhsa.gov/dtac/
4.2.7. Medical and Dental Services
Because there are differences in State and local laws, rules, and regulations related to the provision of
medical and dental care, it is important that, early in the planning process, emergency managers and
shelter planners seek guidance from appropriate State and local authorities regarding these matters.
32
Children and adults with and without disabilities who have access or functional needs who require
medical services may not be excluded from a general population shelter. Plans should direct that,
at a minimum, medical care that can be provided in the home setting (e.g., assistance in wound
management, bowel or bladder management, or the administration of medications or use of medical
equipment) is available to each general population shelter.
Plans should be in place for addressing medical and dental care decisions at all times. This could
include making contracts/agreements prior to an emergency or disaster for the personnel and
supplies necessary to set up and staff a first aid station at each shelter site. Having these plans in
place is intended to prevent inappropriate transfers to medical facilities. This will benefit the whole
community by maximizing resources and limiting medical surge.
A comprehensive list of emergency medical and dental services in the area should be maintained at all
times.
Operational Tool #25 Medical Station
Onsite Medical Staff
• Provide OTCs
• Implement methods to minimize contagion
• Make referrals for emergency medical and dental treatment
Medical Station
Staff with a minimum of 1 RN and 1 paramedic at ratio of 1:100 shelter
residents at all times
Oncall Medical Staff
Maintain on call physician and psychiatrist 24/7
Source
BCFS; www.bcfs.net/fnssrecommendations
Operational Tool #26 Disaster Health Response and Care
Services
• Perform health assessments and referrals
• Implement infection control methods and perform illness and injury
surveillance
• Facilitate replacement of medications, CMS and DME
Shelter Staffing
Staff with 1 licensed health professional (minimum licensure is EMT) at
ratio of 1:100 shelter residents at all times
Source
American Red Cross; www.redcross.org
Plans should also include a requirement to document any medical care provided at the shelter and a
strategy for accomplishing these efforts.
Operational Tool #27 Medical Services-Form
Resident Health Care
Record
Form to document a resident’s visit to the first aid station and any offpremises medical or dental care
Source
BCFS; www.bcfs.net/fnssrecommendations; FORM: Resident Health Care
Information; Appendix 7
In the event of a medical or dental emergency, plans should direct shelter staff to call 911 and refer
residents for medical or dental care, as appropriate.
33
4.2.8. Medication
Because there are differences in State and local laws, rules, and regulations related to the storage,
preparation, administration, documentation, and disposal of medications, it is important that, early in
the planning process, emergency managers and shelter planners seek guidance from appropriate State
and local authorities regarding these matters.
The fact that a person has or requires medications is not a basis for excluding him/her from a general
population shelter. Plans should include procedures for obtaining, storing, dispensing, documenting,
and disposing of medications in a general population shelter.
Plans should ensure that shelter residents have access to medications. One way to accomplish this is
to have contracts or agreements in place with a pharmacy(s) to make medications available to shelter
residents. This will minimize the time a resident has to go without necessary medications.
Operational Tool #28 Medication
Filling Prescriptions
When a pharmacy(s) is part of a chain of pharmacies, the pharmacist may
be able to obtain information about a shelter resident’s medications by
checking records kept in a centralized location away from the community
where the emergency or disaster occurred.
Storage
As a rule, residents are responsible for safeguarding, storing, and
administering their own medication. If that is not practical (due to need for
refrigeration, concerns regarding drug security, or the ability of the resident
to self-medicate), residents’ prescription medications should be kept in a
locked container used exclusively for that purpose at the first aid station.
Disposal
If medications are kept in the first aid station, staff should return all
resident medications, including those that have been discontinued or have
passed the expiration date, when the resident is discharged from the shelter.
Needles or hypodermic syringes with needles attached must be disposed of
in bio-hazard containers.
Source
BCFS; www.bcfs.net/fnssrecommendations; FORM: Medication
Administration Record; Appendix 8
Operational Tool #29 Medication-Emergency Prescription Assistance Program (EPAP)
34
Program Description
EPAP, a joint program of FEMA and the Department of Health and
Human Services, provides an efficient way for pharmacies to process
claims for prescription medications and limited DME for individuals
who have no insurance coverage and are from an area declared as
a disaster by the President. Claims for individuals with private
insurance, employer-sponsored coverage, public insurance, or other
third party coverage are not eligible for payment under the EPAP.
Services Provided
Provides a 30-day supply of essential pharmaceutical and DME lost as
a direct result of the disaster or as a secondary result of loss or damage
caused while in transit from the emergency site to the designated
shelter facility.
Participating Pharmacies
Any enrolled pharmacy in the U.S. and its territories
Source
http://www.hhs.gov/aspr/opeo/epap/index.html
Sections 403 (a) (2) and (3) (B) and 502(a) (7) of the Robert T. Stafford Disaster Relief and
Emergency Assistance Act, 42 U.S.C. §§ 5121-5206, as amended. Federal Disaster Assistance, 44
C.F.R. pt. 206.
http://www.fema.gov/about/stafact.shtm
4.2.9. Transportation Services
Children and adults with and without disabilities who have access or functional needs may require
transportation services while in shelters and for re-entry into the community. Emergency managers
and shelter planners should see that plans include strategies to ensure that accessible vehicles,
ambulances, and drivers are available to the shelter.
Accessible vehicles should be able to transport wheelchairs, scooters, or other mobility aids, as well
as equipment and supplies (e.g., portable oxygen, portable toilets, communication devices, service
animals). Even if accessible public or private transportation is ordinarily available, there should be a
contingency plan for transporting people if this transportation is disrupted.
Contingency plans for hazards occurring during a sheltering event should include readily available
resources for transporting people with access and functional needs, as well as their life sustaining
equipment, to alternative shelter sites.
Operational Tool #30 Transportation Services
Transportation Accessible
Resources
Potential accessible resources include:
• Local school districts with lift-equipped school buses
• Community EMS services
• Vans from places of worship
• Local assisted living facility vans
• Local community and public transit vehicles
• Para transit services
• Dial-a-Ride
• Fixed route buses
• Area agencies on aging
• Regional center vendors
• Taxi systems
• Non-medical emergency services
• Adult day health care vehicles
• Airport car rental shuttle buses
• Airport shuttle buses
• Older adults center vendors
• Health care center vendors
Source
Guidance on Planning and Responding to the Needs of People with
Access and Functional Needs, California Emergency Management
Agency, Office for Access and Functional Needs
www.oes.ca.gov/
Click on Office for Access and Functional Needs
Source
BCFS; www.bcfs.net/fnssrecommendations
35
Plans should include:
• An agreement or contract with transit providers in place prior to an emergency or disaster
• A pre-determined process for reimbursing transit providers for their services
Note that transportation providers may have prearranged agreements with multiple entities that would
result in insufficient services if an emergency affected an entire State or region.
Operational Tool #31 Transportation Services - Form
36
Transportation Request
Form to request resident transportation for:
• Appointments and activities while living at the shelter
• Returning home or to temporary house at discharge
Source
BCFS; www.bcfs.net/fnssrecommendations; FORM: Transportation
Request Information; Appendix 9
4.3. Key Considerations In
Planning For Transition/
Recovery
4.3.1. Transitioning Back to the Community
In order for children and adults who have access or functional needs to transition back to their
community, it is important to provide them a reasonable amount of time and assistance to locate
suitable housing when they cannot return to their former homes. In the past, shelters have sometimes
required people needing FNSS to move to hospitals, nursing homes, or other institutions because
they could not quickly locate suitable housing or the supportive services needed to live on their
own. As a result, people who once lived independently in their own homes have found themselves
institutionalized soon after an emergency or disaster occurred.
To comply with ADA requirements and assist people in avoiding unnecessary institutionalization,
emergency managers and shelter planners should include strategies for children and adults with
functional support needs in their plans to have the time and assistance required to:
• Return to their homes, or
• Locate new homes in the most integrated setting that is appropriate to their needs
Organizations providing direct services to people with disabilities and others with access or functional
needs should be included in all local assistance and disaster recovery efforts to:
• Promote coordination with one other
• Maximize resources
• Eliminate duplication
Operational Tool #32 Transitioning Back to the Community
Gap Analysis Tool for:
• Re-entry
• Demobilization
Source
• Trigger point established for when to return children and adults
• Transport plan for individuals unable to get home from
transportation assembly points
• Trigger points established for when to demobilize transit resources
• Procedure established to check-out emergency evacuation
resources
• Procedure established to debrief demobilizing personnel
• Procedure established to debrief children and adults
• Demobilization procedures reviewed at least annually
Guidance on Planning and Responding to the Needs of People with
Access and Functional Needs, California Emergency Management
Agency, Office for Access and Functional Needs; www.oes.ca.gov/
Note: Click on Office for Access and Functional Needs
Every effort should be made to move residents back to the least restrictive environment.
37
Operational Tool #33 Transitioning Back to the Community - Recovery
Possible Recovery
Needs
Source
• Short- and long-term housing and wrap-around housing
(Accessible)
• Communication
• Replacement of DME and assistive technology
• Personal assistance services
• Transportation
• Financial assistance
Guidance on Planning and Responding to the Needs of People with
Access and Functional Needs, California Emergency Management
Agency; www.oes.ca.gov/
Note: Click on Office for Access and Functional Needs
Operational Tool #34 Transitioning Back to the Community - Re-entry
Re-entry Planning
Strategy
Prior to an emergency/disaster:
• Locate and document all available accessible hotel/motel rooms in
the community
• Develop contracts/agreements with these entities to reserve
resources for people with access or functional needs
• Determine a process for reimbursing businesses for these resources
Source
BCFS; www.bcfs.net/fnssrecommendations
4.3.2. Closing the Shelter
It is important to remember that shelters are temporary and every effort should be made to close the
shelter by identifying and using the resources necessary to return residents to suitable housing that
continues to meet their access and functional needs. The goal is to always support individuals toward
self sufficiency.
Operational Tool #35 Closing the Shelter
Considerations when
Closing a Shelter
Consider:
• Impact of the emergency or disaster on the home or environment of
a person with access or functional needs (e.g., a person’s home is not
damaged but rest of the neighborhood is gone, power out, etc.)
• The urgency of the need to return the shelter to normal conditions
• Availability of accessible transportation resources
Source
Kansas Statewide Emergency Management; http://www.srskansas.org/
Note: Click on SRS Statewide Emergency Management, click on Assisting
Individuals with Functional Needs During Evacuation and Sheltering, scroll
down to Functional Needs Shelter Deactivation
Recovery is typically the longest and most difficult part of an emergency or disaster for all residents
of a community. It is further complicated when people with disabilities and others with access
or functional needs do not have access to personal assistance services, service animals, friends,
neighbors, neighborhood businesses and even family members.
38
Operational Tool #36 Closing the Shelter- Discharging Residents
Considerations when
Discharging a Resident
Requiring FNSS
Form documenting a resident’s discharge from the facility including
confirmation that a resident is discharged to his/her home:
• Determined by police or other emergency management personnel
in his or her community that he/she can return
• Contacted his or her landlord or neighbor to determine whether his
or her house is habitable
• Confirmed that any prior in-home services are restored (e.g.,
Meals on Wheels, Mental Heath Authority, Personal Assistance
Services)
• Confirmed access to businesses necessary to return home (e.g.,
grocery store, pharmacy
Source
BCFS; www.bcfs.net/fnssrecommendations; FORM: Resident Discharge
Information; Appendix 10
Emergency managers and shelter planners can do little to counter some of the conditions people with
FNSS face during the recovery phase. They can, however, develop strategies so that the most critical
services and functional needs are restored or addressed as a priority during this phase.
Operational Tool #37 Closing the Shelter- Recovery
Recovery Plan
Considerations
Source
• Making allowances at blockades, shelters, and other impacted
areas for access to people providing personal assistance services,
home health aids, visiting nurses, interpreters, support or service
animals, and other individuals crucial to immediate functional
needs of individuals
• Identifying the impact an interruption in utility services would
have on children and adults with and without disabilities who have
access and functional needs
• Planning for accessible shelter and appropriate temporary housing
needs
• Addressing how people with disabilities and others with access or
functional needs who are employed by businesses that are able to
open soon after a disaster will get to work
• Involving representatives of the functional needs community in
“after action reviews” or “hot wash reports” in order to capture the
true impact of the disaster and to improve plans for the future
New Hampshire Functional Needs Guidance – Support Document to the
State Emergency Operations Plan http://www.nh.gov/safety/divisions/
hsem/stateemergplan/index.html
Ideally, emergency managers and shelter planners should include the infrastructure needed to support
recovery in the State plan long before an emergency or disaster occurs.
39
5. Acronyms
40
ADA
Americans with Disabilities Act
AED
Automated External Defibrillator
ASL
American Sign Language
CART
Computer Assisted Real time Translations
CBO
Community-Based Organization
CDC
Centers for Disease Control and Prevention
CMS
Consumable Medical Supplies
DME
Durable Medical Equipment
DRA
Disability Related Assistance
EPAP
Emergency Prescription Assistance Program
FAST
Functional Assessment Service Teams
FEMA
Federal Emergency Management Agency
FNSS
Functional Needs Support Services
ICP
Incident Command Post
IMT
Incident Management Team
OTC
Over-the-counter Drugs
PAS
Personal Assistance Services
SOP
Standard Operating Procedures
TDD
Telecommunications Device for the Deaf
TTY
Teletypewriter
VOAD
Voluntary Organizations Active in Disasters
6. Glossary
Access
The ability to fully use, enjoy, and integrate into any programs, services, activities, goods,
facilities, privileges, advantages, or accommodations provided by a public or private (for-profit or
not-for-profit) entity, any contracted entity, or entity that provides emergency services, including
sheltering, for individuals with disabilities as defined by the ADA Amendments Act of 2008, P.L.
110-325, and those associated entities. Access may include modifications to programs, policies,
procedures, architecture, equipment, services, supplies, and communication methods.
Access and Functional Needs
Those actions, services, accommodations, and programmatic, architectural, and communication
modifications that a covered entity must undertake or provide to afford individuals with
disabilities a full and equal opportunity to use and enjoy programs, services, activities, goods,
facilities, privileges, advantages, and accommodations in the most integrated setting, in light
of the exigent circumstances of the emergency and the legal obligation to undertake advance
planning and prepare to meet the disability-related needs of individuals who have disabilities as
defined by the ADA Amendments Act of 2008, P.L. 110-325, and those associated with them.
Access and functional needs may include modifications to programs, policies, procedures,
architecture, equipment, services, supplies, and communication methods. Examples of “access
and functional needs” services may include a reasonable modification of a policy, practice, or
procedure or the provision of auxiliary aids and services to achieve effective communication,
such as: (1) an exception for service animals in an emergency shelter where there is a no pets
policy; (2) the provision of way-finding assistance to someone who is blind to orient to new
surroundings; (3) the provision of transferring and toileting assistance to an individual with a
mobility disability; and (4) the provision of an interpreter to someone who is deaf and seeks to fill
out paperwork for public benefits.
Action Plan
A plan developed by a case manager and resident(s) to assist and support that individual or family
in obtaining transitional or permanent living arrangements.
Cap Tel
A communication system that provides written captions of everything a caller says on a built-in
display.
Consumable Medical Supplies (CMS)
Medical supplies (medications, diapers, bandages, etc.) that are ingested, injected, or applied and/
or are one time use only.
41
Disability
The term “disability” has the same meaning as that used in the ADA Amendments Act of 2008,
P.L. 110-325, as incorporated into the ADA. See http://www.ada.gov/pubs/ada.htm for the
definition and specific changes to the text of the ADA. State laws and local ordinances may also
include individuals outside the Federal definition.
Durable Medical Equipment (DME)
Medical equipment (e.g., walkers, canes, wheelchairs, etc.) used by persons with a disability to
maintain their usual level of independence.
First Aid Station
Dedicated section in the shelter where residents receive first aid and/or referrals for emergency
medical, mental, or dental health care.
Functional Needs Support Services (FNSS)
Services that enable children and adults to maintain their usual level of independence in a
general population shelter. FNSS includes reasonable modifications to policies, practices, and
procedures, durable medical equipment (DME), consumable medical supplies (CMS), personal
assistance services (PAS), and other goods and services as needed. Children and adults requiring
FNSS may have physical, sensory, mental health, and cognitive and/or intellectual disabilities
affecting their ability to function independently without assistance. Others who may benefit from
FNSS include women in late stages of pregnancy, elders, and those needing bariatric equipment.
Least restrictive environment
The opportunity for adults and children with disabilities and others with access or functional
needs to be with non-disabled peers to the greatest extent possible. These individuals should
have access to the general shelter activities or any other programs and services that non-disabled
persons can access. Generally, the less opportunity a person with a disability has to interact with
non-disabled persons (peers), the more the shelter (placement) is considered to be restricted.
Medical Staff
Licensed or certified physicians, registered nurses, licensed vocational nurses, emergency medical
technicians, and paramedics.
Mental Health Professional
A person who is licensed to provide counseling.
Personal Assistance Services
Services that assist children and adults with activities of daily living (e.g., bathing, toileting,
eating, etc.).
Service Animal
Any animal that is individually trained to provide assistance to a person with a disability.
42
Shelter
A temporary facility which provides housing and basic services until persons can return home or
obtain temporary or permanent house elsewhere.
Staff
People who are assigned a position in the shelter and who may or may not be paid for their
services.
Universal cot
A Universal/Accessible cot that meets the following recommended criteria:
• Height – 18”-19” without [below] the mattresses
• Width – minimum 27”
• Weight capacity – 350+ pounds
• Flexible head position
• Rails, if any, must be positioned or moveable in such a way as to allow for wheelchair
access (No IV pole)
Volunteers
Persons who are assigned staff positions in a shelter and meet the qualifications of that position
but are not paid for their services.
43
7. Operational Tools *
Operational Tool #1
Operational Tool #2
Operational Tool #3
Operational Tool #4
Operational Tool #5
Operational Tool #6
Operational Tool #7
Operational Tool #8
Operational Tool #9
Operational Tool #10
Operational Tool #11
Operational Tool #12
Operational Tool #13
Operational Tool #14
Operational Tool #15
Operational Tool #16
Operational Tool #17
Operational Tool #18
Operational Tool #19
Operational Tool #20
Operational Tool #21
Operational Tool #22
Operational Tool #23
Operational Tool #24
Operational Tool #25
Operational Tool #26
Operational Tool #27
Operational Tool #28
Operational Tool #29
Operational Tool #30
Operational Tool #31
Operational Tool #32
Operational Tool #33
Operational Tool #34
Operational Tool #35
Operational Tool #36
Operational Tool #37
Planning Guidance
Stakeholder Coordination
Planning Shelter Capacity
Locating the Shelter
Evaluating the Shelter - Site Selection Tool
Florida Shelter Selection Checklist
San Jose California Shelter Assessment Checklist
Durable Medical Equipment (DME) List
Consumable Medical Supplies (CMS) List
Communication Devices
Resources for Assistive Technology
Legal Authority - DME, CMS, Communication Devices
Locating Services
Documenting Service Providers
Staffing the Shelter
Assessment Teams
Shelter Layout
Dietary - Agreement
Dietary - Menu
Service Animals - Definition
Communication - Strategies
Communication - Devices
Bathing and Toileting Ratios - Red Cross
Mental Health Services
Medical Station
First Aid Station
Medical Services - Form
Medication
Medication - Emergency Prescription Assistance Program (EPAP)
Transportation Services
Transportation Services - Form
Transitioning Back to the Community
Transitioning Back to the Community - Recovery
Transitioning Back to the Community - Re-entry
Closing the Shelter
Closing the Shelter - Discharging Residents
Closing the Shelter - Recovery
* Operational Tools – The operational tools in this document are excerpts and examples taken from
various agency and jurisdictional documents throughout the United States. While they are not meant
to dictate a State’s policies or procedures, they do present ideas and practices that can be adapted to fit
each State’s specific needs.
44
8. Appendices
Page
Appendix
47
Appendix 1
ADA Checklist for Emergency Shelters
115
Appendix 2
FORM: Contact Information for Shelter Services Providers
117
Appendix 3
Durable Medical Supply Sample List
118
Appendix 4
Consumable Medical Supply Sample List
125
Appendix 5
Guidance on Providing Personal Assistance Services
155
Appendix 6
One Day Menu for General Population Shelters Providing Functional
Needs Support Services
156
Appendix 7
FORM: Resident Health Care Information
158
Appendix 8
FORM: Medication Administration Record
160
Appendix 9
FORM: Transportation Request Information
162
Appendix 10
FORM: Resident Discharge Information
45
46
Appendix 1
ADA Checklist for Emergency Shelters
For the 508 compliant version of the ADA Checklist for Emergency Shelters
go to http://www.ada.gov/pcatoolkit/chap7shelterchk.htm
47
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Getting to the Emergency Shelter .................................................. 11
A. Passenger Drop-Off Areas .................................................... 11
B. Parking ................................................................................... 14
1. Typical Issues .................................................................. 14
2. Parking Spaces Checklist ............................................... 15
3. Temporary Solutions for
Emergency Sheltering - Parking ................................... 18
Step Two: Ada Checklist For Emergency Shelters ............... 11
Selecting Sites to Survey for Accessibility ..................................... 7
A. Accessible Entrance ............................................................. 7
B. Accessible Routes To All Service/Activity Areas ................. 8
C. Accessibility within Toilet Rooms......................................... 10
Step One: Accessible Shelter Quick-Check Survey ............ 7
G. Completing the Survey and Checklist .................................. 5
H. After Completing the Survey and Checklist ........................ 6
A. Evaluating the Physical
Accessibility of Emergency Shelters .................................... 1
B. Conducting Accessibility Surveys ........................................ 2
C. Getting Started ...................................................................... 2
D. Tools Needed .......................................................................... 3
E. Taking Measurements ........................................................... 3
1. Sloped Surfaces .............................................................. 3
2. Using the Tape Measure .................................................. 4
3. Measuring Door Openings.............................................. 5
F. Taking Photographs ................................................................ 5
ADA Checklist for Emergency Shelters ............................... 1
L. Availability of Electrical Power ............................................ 56
M. Single-User or “Family” Toilet Room ................................. 57
N. Health Units/Medical Care Areas ........................................ 62
O. Accessible Portable Toilets ................................................... 63
Other Issues ............................................................................ 56
G. Sleeping Areas ....................................................................... 40
H. Restrooms and Showers ....................................................... 42
Toilet Stalls ......................................................................... 46
I. Public Telephones ................................................................. 50
J. Drinking Fountains ............................................................... 52
K. Eating Areas .......................................................................... 54
Living at the Emergency Shelter ........................................... 40
C. Sidewalks and Walkways...................................................... 19
1. Typical Issues for Individuals
Who Use Wheelchairs, Scooters,
or other Mobility Devices ............................................... 19
Accessible Ramp Features ......................................... 21
Temporary Solutions For Emergency
Sheltering - Ramps ..................................................... 22
2. Typical Issues for Individuals Who
Are Blind or Have Low Vision ........................................24
Temporary Solutions For Emergency
Sheltering - Protruding Object Hazards ................... 26
D. Entering the Emergency Shelter .......................................... 27
Building Entrance ............................................................... 27
E. Hallways and Corridors ........................................................ 30
1. Typical Issues for Individuals Who Use
Wheelchairs, Scooters, or Other Mobility Devices ....... 30
2. Typical Issues for People Who are Blind
or Have Low Vision ........................................................ 37
F. Check-In Areas ........................................................................ 39
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