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 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.Special Medical Needs Shelters
These shelters may be activated in addition to the above or in combination with (or sometimes called) the Special Needs Shelters. These shelters will serve those who require skilled nursing care, professional assistance with medications or vital signs readings, professional oversight that is more comprehensive than regular shelters but that does not require hospitalization, and medical evaluation and stabilization after a disaster event.
Individuals appropriate for sheltering within a Special Needs Shelter are:
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.
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 for assistance from the American Red Cross, the local health department, and others if needed. All shelters are operated under established Red Cross guidelines.
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:
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.
The American's With Disabilities Act requires that public facilities and buildings make a reasonable effort to be accessible to those with disabilities. This includes emergency shelters and programs.
Since most public facilities are accessible and since they are usually the most appropriate choice for an emergency shelter, it is often not an issue. However, sometimes a shelter may be opened in a non-public building. There are resources to help local government and state government ensure that they meet federal guidelines.
Those with disabilities who would normally be accommodated in a General Shelter, may be sheltered in a Special Needs Shelter under some circumstances. That would be the decision of State Emergency Management, in conjunction with local Emergency Management and county government.
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:
- Bed-confined people
- Comatose patients
- Dialysis patients requiring more than 3 dialysis visits weekly
- Paralyzed people
- People in the end stage of Alzheimer's
- People with advanced senile dementia
- People with chronic incontinence
- People with unstable Gran Mal seizure
- People requiring a catheter
- People requiring complex dressings and continual changes
- People requiring intravenous feeding or medications
- Recently discharged surgical patients (except outpatient surgery)
- Severe respiratory cases (oxygen or ventilator dependent)
- Severely mentally disturbed people (potentially violent)
- Severely retarded people
- Unstable cardiac patients
- Unstable insulin dependent people
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:
- Moderately mentally ill persons (non-violent)
- People with HIV/AIDS that are moderately to severely symptomatic
- People with severely reduced mobility
- Significantly retarded persons
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:
- asthmatics
- colostomy patients
- diabetics on insulin (self-administered)
- dialysis patients requiring one or two dialysis visits weekly
- heart patients with mechanical devices
- hemophiliacs
- people in a non-walking cast
- people on special diets
- people with artificial limbs
- people with epilepsy
- people with HIV/AIDS asymptomatic to mildly symptomatic
- people with mild to moderate muscular diseases
- people with significant speech impediments
- people with urinary catheters
- visually or hearing impaired people
- wheelchair-mobile individuals
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.
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:
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.
Special Needs Shelter contact information for 2009:
| County | Agency and Contact Information |
| Chatham | Chatham County Council on Aging 365 NC Hwy 87 North Pittsboro, NC 27312 919-542-4512 919-542-5191 FAX Contact: Angel Dennison angel.dennison@chathamcouncilonaging.org |
| Durham | Durham County Department of Social Services 220 East Main Street Durham, NC 27702 919-560-8628 919-560-8120 FAX (Adult Services) Contact: Chris Ivy chivy@dss.co.durham.nc.us |
| Johnston | Johnston County Public Health 517 N. Bright Leaf Blvd. Smithfield, NC 27577 919-989-5226 919-989-5208 FAX Contact: Steve Strickland Steve.Strickland@johnstonnc.com |
| Lee | Lee County EMS and DSS 530 Carthage Street Sanford, NC 919-718-4690 (DSS) 919-775-8279 (EM) 919-718-4634 FAX Contacts: (EM) Jim Groves jim.groves@sanfordnc.net (DSS) Brenda Potts brendapotts@leecountync.com |
| Moore | Moore County DSS PO Box 938 Carthage, NC 28327 910-947-7415 910-947-6544 Contact: Alona Sloan sloan@moorecountync.gov |
| Orange | Orange County Department of Social Services 300 West Tryon Street Hillsborough, NC 27278 919-245-2884 919-644-3362 FAX Contact: Felicia McLean-Torry ftorry@co.orange.nc.us Renee Bynum 919-245-2881 |
| Wake | Wake County DSS 10 Sunnybrook Road #301 Raleigh, NC 27620 919-212-9394 919-250-3984 Contact: Lynda Muriera lynda.muriera@co.wake.nc.us |
| State | Division of Social Services Albemarle Building 8th Floor 325 N. Salisbury St. Raleigh, NC 27601 919-733-3055 919-334-1018 FAX Contact: Chris Davis chris.davis@dhhs.nc.gov |
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:
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