Philadelphia Persons with Disabilities & Disasters Emergency Preparedness Discussion

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sebbm010

Health Medical

Philadelphia University

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Readings

FEMA's guidance on disabled persons and inclusion in general duty shelters http://www.fema.gov/pdf/about/odic/fnss_guidance.pdf

#-FEMA IS 20.12 - Diversity Awareness

Discussion Board 

From the readings and the material this week, briefly describe local resources that can aid a jurisdiction in making a shelter compliant with ADA requirements.

State how you could make members of the community more sensitive to the accessibility needs of others.

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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 5 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. 7 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. 10 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 11 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. 12 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. 13 14 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. 15 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 17 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) 19 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 20 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 48 86 'HSDUWPHQW RI -XVWLFH &LYLO 5LJKWV 'LYLVLRQ 'LVDELOLW\ 5LJKWV 6HFWLRQ -XO\   ADA Checklist for Emergency Shelters $PHULFDQV ZLWK 'LVDELOLWLHV $FW LL 7KH $'$ DXWKRUL]HV WKH 'HSDUWPHQW RI -XVWLFH WR SURYLGH WHFKQLFDO DVVLVWDQFH WR LQGLYLGXDOV DQG HQWLWLHV WKDW KDYH ULJKWV RU UHVSRQVLELOLWLHV XQGHU WKH $FW 7KLV GRFXPHQW SURYLGHV LQIRUPDO JXLGDQFH WR DVVLVW \RX LQ XQGHUVWDQGLQJ WKH $'$ DQG WKH 'HSDUWPHQW¶V UHJXODWLRQ +RZHYHU WKLV WHFKQLFDO DVVLVWDQFH GRHV QRW FRQVWLWXWH D OHJDO LQWHUSUHWDWLRQ RI WKH VWDWXWH 'LVFODLPHU 5HSURGXFWLRQ RI WKLV GRFXPHQW LV HQFRXUDJHG $GGLWLRQDO FRSLHV RI WKLV SXEOLFDWLRQ PD\ EH REWDLQHG YLHZHG RU GRZQORDGHG IURP WKH 3XEOLFDWLRQV VHFWLRQ RI WKH $'$ :HEVLWH ZZZDGDJRY RU E\ FDOOLQJ WKH $'$ ,QIRUPDWLRQ /LQH DW  YRLFH   77<  5HSURGXFWLRQ 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. 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Explanation & Answer

Attached.

Running head: EMERGENCY PREPAREDNESS

Discussion: Persons with Disabilities and Disasters (Emergency Preparedness)
Student’s Name
Institutional Affiliation

1

EMERGENCY PREPAREDNESS

2

Discussion: Persons with Disabilities and Disasters (Emergency Preparedness)
From the readings and the material this week, briefly describe local resources that can aid
a jurisdiction in making a shelter compliant with ADA requirements.
There are numerous local resources that can be used to provide shelter that is compliant
with the ADA requirements to children and adults whether they have a disability or not. Besides
ensuring that the design of the shelter meets ADA...


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