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Special Needs Shelters

As local aging services providers, you will be responsible for helping to assess local needs. Unless your agency is a Department of Social Services, responsibility for operating a Special Needs Shelter will not fall to you. However, you may be asked, as part of your county disaster response plan, to assist in some capacity. One way to assist is to help older adults and their caregivers to pre-plan for disasters and for you to know what individuals in your area will need special assistance and what type of assistance that will be.

The following information will guide you as you help your county plan for disaster events.

General Shelters vs. Special Needs Shelters

Who Are They For?

Who Is In Charge?

Who Decides If One Is Opened?

Site Selection for Special Needs Shelters

Levels of Support and Care

Special Needs Registries and Alert Systems

Durham County's Online Special Needs Registry

Local Contacts for Special Needs Shelters

Developing a Special Needs Disaster Plan

General Shelters vs. Special Needs Shelters

General Public Shelters
General public shelters activated under emergency conditions are available to anyone who is self-sufficient and needs no outside professional assistance in performing activities of daily living or is accompanied by a family member or other caregiver to assist with activities of daily living. Individuals not meeting the above criteria will either be referred to a Special Needs Shelter or to an appropriate health care facility. In NC, Special Needs Shelters are also called Special Care Shelters.

Special Needs Shelters
Some individuals will need assistance with medical care or personal care during evacuations and sheltering due to physical or mental impairments. If the level of care required is beyond the basic first aid offered in general shelters, these individuals would be referred to a Special Needs Shelter (unless an accompanying caregiver can provide the needed support in the general shelter). These shelters offer more specialized care by trained professionals. The level of care and resources may vary from jurisdiction to jurisdiction.

Who Are They For?
Individuals appropriate for sheltering within a Special Needs Shelter are:

• People with minor health or medical conditions that require physician-ordered observation, assessment, and maintenance;
• People with contagious health conditions that require minimal precautions or isolation which cannot be handled by the general public shelter staff;
• People with chronic conditions who require assistance with activities of daily living and do not require hospitalization;
• People with regular need for medications and for regular vital sign readings which requires professional assistance;
• People who are patients in nursing homes and/or residents in adult care homes who have medical and/or mental health needs that cannot be met within a public shelter.

Who is in Charge?
General public shelters, including Special Needs Shelters, are the responsibility of county government under NC General Statute 166-A and the American Red Cross under the terms of their Congressional mandate.

In North Carolina, responsibility for Special Needs Shelters typically falls to the county Department of Social Services.

The American Red Cross (ARC) manages the general population or public shelters. The level of care needed for Support Levels I and II exceed the Red Cross medical protocols. The responsibility for care of these residents rests with the facilities that provide pre-shelter care or with the Special Needs Shelters. Medical staff for Special Needs Shelters normally will be provided by the county public health department. The Red Cross will work with Special Needs Shelters after meeting their own health care responsibilities for general shelters, if needed and if capable of meeting identified needs.

The Red Cross will provide "Disaster Health Services" staff in all general public shelters. They will be available for consultation with other medical personnel in the temporary infirmary section set up in the general shelter.

The ARC will provide space and service within general shelters for the Support Level II individuals when Special Needs Shelters are not available or accessible and will make a determination regarding the need to retain or transfer those individuals when such action is in the best health interest of the person being sheltered.

ARC responsibilities for assistance with Special Needs Shelters should be defined as part of the county emergency response plan, including financial responsibilities and liability, if any. ARC guidelines will be followed in Special Needs Shelters but are not under the control of the ARC unless previously agreed upon.

One final note, however. The ARC will always provide a place of safe haven and shelter to those in need regardless of their medical condition. Responsibilities defined above will result in the highest level of health care during a disaster event. In cases where there is an absence of service or where local jurisdictions do not or cannot provide service or where the ARC determines (as part of their Congressional mandate) that service delivery in inadequate or not to ARC standards, ARC will implement the necessary actions to provide the safest haven for those needing emergency shelter regardless of the level of care needed.

The county Emergency Management Coordinator will keep the state Emergency Management team informed of Special Needs Shelters operations and needs.

Who Decides If One Is Opened?
State Emergency Management, in conjunction with both local Emergency Management and county government decide whether and when to open general shelters. Local agencies may be consulted before a decision is made to help determine need.

County government decides whether and when to open Special Needs Shelters. Generally, responsibility for the Special Needs Shelters falls to the county Department of Social Services. They may ask assistance from the American Red Cross, the local health department, and others if needed. All shelters are operated under established Red Cross guidelines.

Site Selection for Special Needs Shelters
Because individuals with pre-existing health conditions resulting in medical impairments have needs which exceed the basic first aid resources of a regular shelter, but do not require hospitalization and because their medical condition may be exacerbated or their health status may deteriorate due to the disaster situation, county officials are encouraged to consider making arrangements with available medical facilities to be designated as sites for Special Needs Shelters. Such facilities may include, but not be limited to:

• a large area within a hospital
• an adjunct hospital facility
  (outpatient surgery unit, wellness centers, etc.)
• rehabilitation centers
• infirmaries, primary care centers, large medical practice buildings
• health care facilities and certain adult care homes

In 1999, North Carolina passed SB34, the Emergency Shelter/Health Facilities Rules Waiver. This permits the temporary waiver of certain rules for certain licensed health care facilities that agree to and do provide temporary shelter or services during disasters and emergencies.

The least preferred site for a Special Needs Shelter is an area within a general shelter. When that is the choice, criteria for admission to the shelter may be altered based on the limitations of the facility.

North Carolina, as part of Emergency Management Legislation, exempts agencies or persons offering their resources as shelter locations from liability resulting from use.

Levels of Support and Care
There are many types of impairment or needs that are appropriate for Special Needs Shelters.

North Carolina has defined three levels of support for shelters, identifying specific types of needs. Each individual's needs and level of care will be determined on a case by case basis. Obviously, due to cost and staffing issues, individuals should be guided to a shelter that best meets their needs with the least amount of specialized support. Ideally, a known caregiver will accompany a person with special care needs to provide support. Individuals with such caregivers may be appropriate for a general shelter.

Support Level I

Who is Covered? Support Level I includes individuals requiring recurring professional medical care, special medical equipment and/or continual medical surveillance and who may need to be considered for admission into a hospital or nursing home. People in this support level include, but are not limited to: Severe respiratory cases (oxygen or ventilator dependent) Dialysis patients requiring more than 3 dialysis visits weekly Comatose patients Paralyzed people Severely mentally disturbed people (potentially violent) Bed-confined people People requiring intravenous feeding or medications Severely retarded people People in the end stage of Alzheimer's Unstable insulin dependent people People with unstable Gran Mal seizure People requiring a catheter People with chronic incontinence People with advanced senile dementia People requiring complex dressings and continual changes Unstable cardiac patients Recently discharged surgical patients (except outpatient surgery)

Appropriate Shelter Individuals in this level should be transferred to a Special Needs Shelter as soon as possible. Arrangements should be made by hospitals, nursing homes, adult care homes, and other group care facilities to relocate their patients or residents to a like facility to the extent possible. A registered nurse must be present at all times in the Special Needs Shelter.

Who Provides the Care? The care for persons in this Support Level will be provided by the agency or person normally responsible for pre-shelter care, except when an individual is admitted into a hospital or other facility, in which case care becomes the responsibility of that facility. People in this level are appropriate for a Special Needs Shelter. A public health nurse or other nursing or medical personnel shall be provided to Special Needs Shelters to provide appropriate health care services to those classified as Support Level I who do not have a pre-disaster health care provider group/agency/home or when the pre-disaster provider is not present for whatever reason and health care responsibility falls to the county government.

Support Level II

Who is Covered? Support Level II includes individuals requiring some medical surveillance or special assistance. They would include, but not be limited to: People with severely reduced mobility Moderately mentally ill persons (non-violent) Significantly retarded persons People with HIV/AIDS that are moderately to severely symptomatic

Appropriate Shelter People in this level may be appropriate for a Special Needs Shelter. Shelter residents may be accommodated in most public shelters in the temporary infirmary section, if one exists, for extended periods of time. Transfer to a more appropriate facility may be considered on a case by case basis. A registered nurse provided by the local public health department or another medical provider must be present at all times in the designated temporary infirmary or Special Needs Shelter.

Who Provides the Care? The care for persons in this Support Level will be provided by the agency or person normally responsible for pre-shelter care. These include but are not limited to nursing home staff, adult home care staff, home health or hospice care staff, public health staff, other special medical staff, friends or relatives who normally provide in-home care. A public health nurse or other nursing or medical personnel shall be provided to Special Needs Shelters to provide appropriate health care services to those classified as Support Level II who are not in the care of a health care provider group/agency/home or when the pre-disaster provider is not present and health care responsibility falls to the county government.

 

Support Level III

Who is Covered? Support Level III are people who are independent in the pre-shelter phase and are capable of performing activities of daily living. Some of these individuals may need limited special assistance or some surveillance due to pre-existing health problems. People in this support level include, but are not limited to: wheelchair-mobile individuals people with epilepsy people with mild to moderate muscular diseases diabetics on insulin (self-administered) heart patients with mechanical devices hemophiliacs people with artificial limbs visually or hearing impaired people people in a non-walking cast people on special diets asthmatics people with significant speech impediments colostomy patients people with urinary catheters dialysis patients requiring one or two dialysis visits weekly people with HIV/AIDS asymptomatic to mildly symptomatic

Appropriate Shelter Individuals in this Support Level should be able to stay in regular public shelters unless additional health problems arise. The shelter staff will have individuals able to provide the limited care that is necessary. If the care required exceeds the American Red Cross protocols, then other arrangements in a Special Needs Shelter, hospital, or other facility may be necessary.

Who Provides the Care? People in this Support Level may not require special care but may need surveillance and monitoring in order to detect potentially serious medical developments. Some people may need limited physical assistance.

 

Special Needs Registries and Alert Systems
A Special Needs Registry is a voluntary registration process that will identify individuals with special medical or transportation needs. The purpose is to help local Emergency Management and human services officials identify and assist individuals who need special assistance or sheltering during a disaster, due to conditions affecting physical or cognitive functioning.

Note: There will be some people who will have a disabling condition such that they will require assistance with evacuation or other special considerations during a disaster, but who could go to a general public shelter. They are appropriate for listing in the Special Needs Registry since they would still require assistance.

The registry would specify what the particular needs and requirements of the resident would be in the event of an emergency. The registry should include information such as:

• transportation
• need for dialysis
• need for refrigeration or electricity
• vision problems and whether a guide dog is used
• mobility problems and what devices are used
• hearing problems
• assistive devices used
• specific medical condition
• medications
• special diet
• current caregiver and whether that caregiver would be available
• physician
• intended plans during a disaster

Each county is responsible for its citizens. The county, in conjunction with local Emergency Management and human services agencies, should decide the type of registry to be made available, who will administer the program, who will maintain it, how it will work, and must develop privacy guidelines. These decisions should be part of the county emergency response plan.

In North Carolina, guidelines for development of Special Needs Registries and a sample format have been prepared for counties to use by the Special Needs Registry Work Group (1998), a sub-committee of the NC Special Needs Task Force, using definitions established in the 1997 Special Care Shelter Guidelines. To obtain a copy, contact your local Emergency Management.

Such registries should not be relied on as a substitute for pre-planning. Information can be used to plan what type of services to make available at Special Needs Shelters and they help counties to assess community needs which helps obtain the funding necessary to operate a Special Needs Shelter.

Another option for counties is an alert system, either automated or not. Again, a modified registry would be offered and the system or agency would notify a registrant of an impending disaster situation so they could begin emergency preparations and/or evacuation.

Local Contacts for Special Needs Shelters

Special Needs Shelter contact information for 2005:

Developing a Special Needs Disaster Plan
The American Red Cross frequently takes a lead role in disaster planning, even for Special Needs Shelters. Local Emergency Management, county government, and local agencies providing services should all be involved.

It is important that the plan for Special Needs Shelters include:

• an assessment of the special needs population that will potentially evacuate to a Special Needs Shelter
• identification of specific facilities to be activated as Special Needs Shelters
• identification of all group care facilities in the county and an indication of their emergency plans
• identification of the primary agency responsible for coordination of Special Needs Shelters
• identification of essential resources such as medical personnel, supplies, transportation needs, food and equipment necessary to support a Special Needs Shelter
• identification, as much as possible, of residents needing specialized care with an indication of the level of care needed and necessary supplies
• a public education plan
• a system of notification for the most frail residents living at home of potential threats and available options