Monday, March 10, 2008

FEMA's New Mass-Care Responsibilities

The GAO recently released a report on the changes FEMA has made to its mass-care delivery system under the new National Response Framework (NRF).

Hurricane Katrina redefined "mass care." It resulted in a virtual diaspora of Gulf Coast residents, who scattered far and wide - many of them seeking shelter in places far from the Gulf, and some of them never returning home.

The concept of serving disaster victims through local sheltering facilities was obliterated by Katrina's size and scope. As a result, the NRF has changed the responsibilities for mass care. The recent report outlined the changes:

FEMA's New Responsibilities

The NRF made a key change to the prior 2004 National Response Plan (NRP) by shifting the primary agency responsibility for coordinating federal support for mass care under the sixth emergency support function (ESF-6) from the Red Cross to the Federal Emergency Management Agency (FEMA)...

DHS and the Red Cross agreed that the mass care primary agency role in the NRF should be shifted from the Red Cross to FEMA in large part because the primary agency needs to be able to direct federal resources, which the Red Cross cannot do. ... After Katrina, the Red Cross could not go directly to federal agencies for resources to fulfill requests for assistance, but instead had to request these items through FEMA, which then directed the appropriate federal agencies to supply the needed materials or services. This resulted in confusion about roles and led to duplicative requests.
This only makes sense. As lead agency, FEMA has the authority to task other organizations to meet the needs of disaster victims. For example, if there's a need for the military to build a tent city to house disaster victims, FEMA can go directly to the Defense Coordinating Officer (DCO) with such a request. The Red Cross can't.

The Problem of Documenting Shelters

People's generosity can sometimes serve as an obstacle to an organized response. There are always logistical challenges of handling donations such as clothes and canned goods. But even beyond that, there are challenges associated with the establishment of ad hoc shelters that spring up when churches and other civic organizations throw open their doors to house refugees.

With the widespread reach of Katrina, this problem was more significant than it had ever been:

After Katrina, local voluntary organizations—such as churches—played a critical role in providing mass care. At one point after Katrina, nearly as many evacuees were staying in shelters operated by chuches and other small nonprofits as were staying in Red Cross shelters.

Collecting data on unplanned shelters was a significant challenge after Hurricane Katrina. There was no centralized system in place for collecting and reporting these data after Hurricane Katrina and, as a result, these data often went unreported, according to FEMA and Red Cross officials. Because government and voluntary organizations did not know where many of these people were staying, this led to problems planning for and delivering needed resources.
The idea under the NRF is to establish a National Shelter System (NSS) which will catalog all the shelter facilities in each state. But this is no easy task:
[T]he NRF includes expectations for the development of a shelter database to be used for collecting and reporting shelter data. Although FEMA and the Red Cross have developed an initial database for collecting and reporting shelter data, FEMA is still working to develop a federal shelter database that will track demographic data on shelter populations. Second, officials in some states we contacted were concerned about their ability to collect and report complete information from shelters. In particular, state officials were concerned about collecting data from unplanned shelters, which are usually opened by organizations with no disaster response experience. ... These shelters are likely to open if designated shelter sites are overcrowded, evacuees are unable to reach designated sites, or the designated sites are affected by the disaster. Officials from some states told us that they do not have a mechanism in place to collect data from the small, independent organizations that typically open these shelters.

FEMA is still working to develop a federal
National Shelter System [NSS] that will be owned and housed at FEMA.... FEMA officials told us that the federal NSS will be finished in spring 2008.... In addition, many states still need to enter data into the system in preparation for disasters. FEMA officials said that as of November 2007, no more than four states had inserted shelter location data and, as a result, most of the data in the system is on Red Cross shelters. The accuracy of the shelter data is contingent upon states reporting information into the system and updating it frequently, according to FEMA officials. ...FEMA officials told us that it will take 2 to 3 years to fully implement the federal NSS, because of training and time needed for states to collect, input, and verify data.
Capabilities Planning

Related to the challenge of documenting shelter facilities is the need to identify gaps in the mass-care system. FEMA has a start, but it's far from complete:
[T]he Post-Katrina Act specifically requires that FEMA identify gaps in mass care capabilities at the state level. In response, FEMA has undertaken a gap analysis initiative that examines, by state, the gaps in disaster preparedness. This initiative, which began in 2007, has begun identifying gaps in hurricane-prone states along the Eastern seaboard and Gulf Coast. A FEMA official responsible for these efforts told us that the initial gap analysis had been completed in 18 high-risk states as of December 2007. Eventually, FEMA plans to roll this initiative out in every state, and to make it all-hazards rather than hurricane-specific.
People with Disabilities

Given that estimates of the number of people with disabilities in the U.S. are as high as 20 percent of the entire population and 72 percent of people over age 80, there is a significant need to provide mass-care for this population in a disaster situation.

After Katrina, many disabled people ran into obstacles in their quest to find care, resulting in a broad re-examination of the emergency response system and its ability to assist people with disabilities.
FEMA has taken several steps to help improve planning for the disabled population. For example, FEMA developed a consistent definition of the term “special needs” that is used in the NRF. ... Through a working group of stakeholders, FEMA developed a definition of special needs that refers to those who may have additional needs before, during, or after an incident in one or more of the following functional areas: maintaining independence, communication, transportation, supervision, and medical care.

FEMA is also developing guidance for states as they plan for serving disabled populations. One such initiative has been developing guidance on collecting data on disabled populations...
But more needs to be done:

[FEMA and the National Council on Disability (NCD)] have met several times to discuss how coordination would occur, most recently in October 2007. However, as of January 2008, the agencies had not agreed to specific action steps for how they would coordinate. ...However, FEMA has generally not coordinated with NCD, as required by the Act.

The Red Cross - still a key agency in providing services, even if it's no longer the lead agency for ESF-6 - has changed its intake processes to reflect the need for serving people with disabilities:
The Red Cross, in partnership with the Department of Health and Human Services, has developed a shelter intake form to address this problem after future disasters. The form provides a series of questions for shelter workers in general shelters to ask incoming evacuees. The form will allow shelter managers to identify disabilities and determine whether the shelter can meet the individual’s needs, according to officials from the Red Cross and the Department of Health and Human Services.

Red Cross told us that it has prepositioned items that will improve shelter accessibility for individuals with mobility impairments in key warehouses across the country. These items included 8,000 cots that are designed for easy transitions from a wheelchair, commode chairs, and shower stools.

And yet...

Red Cross headquarters officials told us that some local chapters are still not fully prepared to serve individuals with disabilities after disasters. These officials said that, although the Red Cross has taken steps to educate their employees and volunteers since Katrina, it has been difficult to encourage chapters to prepare for and implement accessibility policies. Red Cross headquarters officials said that Red Cross chapters have considerable autonomy within the organization.
Reimbursement for Organizations

A final area of concern: Whether changes to the Public Assistance reimbursement program have been effectively communicated.

Many shelters outside the disaster zone were not reimbursed in the wake of Katrina, because reimbursement was not available for, say, a shelter in Colorado to take in citizens of Louisiana and Mississippi. The need for such a situation hadn't been anticipated.

The rules were changed, but many organizations have found the reimbursement process so cumbersome that they've simply walked away and eaten the cost on their own:
Voluntary organizations faced limitations in the scope of program coverage and communication difficulties while trying to obtain reimbursement under the Public Assistance program after Katrina. The Public Assistance reimbursement program was not designed for a disaster of Katrina’s magnitude because it only offered reimbursement to voluntary organizations in the disaster zone, even though evacuees dispersed throughout the country. FEMA has since changed its regulations so that after future disasters voluntary organizations serving evacuees outside of declared disaster zones can be reimbursed.

This change contributed to confusion among voluntary organizations about the Public Assistance program after the hurricanes. Many officials from voluntary organizations told us that changing reimbursement policies caused confusion and made it difficult for them to get reimbursed, and that in some cases they gave up on seeking reimbursement.

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