Welcome to the FEMA Region VII Webinar on Functional needs Support Services FNSS

1. Welcome to the FEMA Region VII Webinar on Functional needs Support Services FNSS May 2, 2012

2. Administrative Details • Your phone is on mute. • Please post questions in the “chat room” • A copy of this presentation and additional resources are available to you in the “file share” section of the website Click Here

3. Greetings Jono Anzalone Regional Voluntary Agency Liaison for FEMA Region VII 816.283.7078 jono.anzalone@fema.dhs.gov Kam Kennedy American Red Cross Special Representative to FEMA Region VII 816.283.7250 kam.kennedy@associates..fema.dhs.gov Gay Jones • Regional Disability Integration Specialist for FEMA Region VII • 816.283.7535 • Gay.Jones@fema.dhs.gov Cory Fast • Mass Care Specialist for FEMA Region VII • 816.283.7579 • cory.fast@fema.dhs.gov

4. Purpose and Outcomes • Purpose: • To provide an overview of issues pertaining to Functional Needs Support Services (FNSS) in general population shelters. • Outcome: • To understand the benefits of integrating FNSS principles in emergency planning, be familiar with initiatives underway and aware of resources available as you move forward.

5. Defining FNSS • Services that enable children and adults to maintain their usual level of independence in general population shelters. These services include: • Reasonable modifications to policies, practices and procedures • Provisions for Durable Medical Equipment (DME) • Provisions for Consumable Medical Supplies (CMS) • Provision for Personal Assistance Services (PAS) • Other goods and services as needed

6. History of FNSS Guidance: What have we done and where are we going? • November 1, 2010 FNSS Guidance document released. • Contract awarded and signed to develop Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters and training to build state capacity for FNSS. • Disability Integration Specialists in each of the 10 FEMA Regions hired. • Procedural guide for Personal Assistance Services (PAS) in development for the States. • Readiness contract executed making Durable Medical Equipment (DME) available on nationally declared disasters. • Each Region recognized the need to assign an FNSS POC to help information flow to and from the States.

7. Regional Disability Integration Specialists • Preparing individuals and families and strengthening communities before, during and after a disaster by providing guidance, tools, methods and strategies to integrate and coordinate emergency management efforts to meet the access and functional needs of all citizens, including children and adults with disabilities. • Subject matter expertise

8. Disability Demographics • 56.4 million Americans (20% of the population) • 12% are children birth - 18 years old • 10% are 18 – 64 years old • 38% are over 65 years old • 11 million people over age 6 need personal assistance with everyday activities • Globally, there are 650 million people with disabilities

9. Disability Facts • 1.8 million unable to see printed words (10 million total) • 1 million are unable to hear conversations (30 million total with hearing loss to some degree from mild to profound) • 2.5 million have difficulty having their speech understood (431,000 are unable to have their speech understood) • 16.1 million have a cognitive, intellectual or mental health disability (over 7% of the population) • 3.3 million people over the age of 14 use a wheelchair and another 10 million have used a cane, crutches, or a walker to get around for 6 months or longer.

10. How Can we Help? • RDIS’s can provide resources and identify key disability organizations in your area to help in integrating people with or without disabilities who have access and functional needs in emergency planning. There is a difference in talking about what we think someone needs and actually having people at the table helping emergency managers to prepare and plan for those with access and functional needs.

11. What are we doing? • We are working with our Assistive Technology Programs to increase access to assistive technology devices and services (DME, sign language interpreters, limited language proficiency, etc) • Working to include assistive technology devices and services in Disaster Recovery Centers. • Working with a Kansas City FNSS group and we have people with disabilities on the committee who are assisting in identifying needs and resources.

12. Regional Disability Integration Specialists

13. Whole Community - Partnerships • National Council on Independent Living • July 2010 MOA • National Disability Rights Network • March 2011 MOA

14. Supporting People with Functional Needs—Key Principles ( Same as 7 Principles of the ADA) • Equal Access – People with functional needs must be able to access and benefit from the same emergency programs and services as the general population (access may require modification of programs, policies, and procedures related to building(s), equipment, services, supplies, communication methods, etc.). • Physical Access – Emergency programs, services and activities must be provided at locations all people can access. • Access to Effective Communication – People with functional needs must be given information that is comparable in content and detail to that given to the general public using methods that are accessible, understandable and timely.

15. Supporting People with Functional Needs—Key Principles (cont.) • Inclusion – People with functional needs have the right to participate in and receive the benefits of emergency programs, services, and activities provided by governments, private businesses, and nonprofit organizations. • Integration - Emergency programs, services, and activities typically must be provided in settings accommodating to all people whether they have functional needs or not. • Program Modifications - People with functional needs must have equal access to emergency programs and services, which may entail modifications to rules, policies, practices, and procedures. • No Charge - People with functional needs may not be charged to cover the costs of measures necessary to ensure equal access and nondiscriminatory treatment.

16. Legal Foundation for FNSS • The law mandates integration and equal opportunity for people with disabilities   • Stafford Act • Post-Katrina Emergency Management Reform Act (PKEMRA) • Federal civil rights laws

17. PKEMRA: Sec. 689. Individuals with Disabilities • This section required the Administrator to: • Develop standards to accommodate individuals with disabilities • Add individuals with disabilities to section 308 of the Stafford Act, which describes nondiscrimination policies in disaster assistance • Add durable medical equipment to section 403(a)(3)(B) as an essential service to saving lives

18. FNSS Legal Authority & References • Law, regulations and agency guidance define the scope of FNSS • Americans with Disabilities Act of 1990 (ADA) • Rehabilitation Act of 1973 (RA) • Title VIII of the Civil Rights Act of 1968 (Fair Housing Act), as amended

19. Shelter Selection • When a shelter that has inaccessible features is selected, a plan must be in place to make the shelter accessible before use • A shelter must comply with state and local codes and standards related to accessibility

20. Prior to an Emergency or Disaster • Include in State and Local plans a process for locating, purchasing, and storing as much of the supplies and equipment (DME and CMS) as possible and practical to meet the needs of children and adults with and without disabilities who have access and functional needs • Emphasis is not on stockpiling supplies pre-disaster • Develop agreements with area contractors to maintain equipment (e.g., generators, oxygen concentrators, etc.)

21. Prior to (cont’) • Develop provider agreements with the private sector to ensure that necessary equipment and supplies, that have not been purchased and/or stored, will be available during an emergency or disaster

22. Key Points • While planning and resource identification take time, FNSS Guidance does not require large outlay of capital: • FNSS is not another unfunded mandate • Plan…Plan…Plan • Homeland Security Grant Program • As new dollars are made available, purchase access and functional needs equipment (ex. universal cots) • Mass Care Planners to help with access and functional needs integration

23. The Role of Public Health • Release of Public Health Preparedness Capabilities: National Standards for State and Local Planning March 2011 • Section on Mass Care and Volunteer Management http://www.cdc.gov/phpr/capabilities/Capabilities_March_2011.pdf

24. Recent Court Cases Concerning FNSS • Unified Government of Wyandotte County • http://www.justice.gov/opa/pr/2010/April/10-crt-382.html • City and County of Los Angeles • http://www.ada.gov/briefs/calif_interest_br.pdf • US Court of Appeals – County of Dakota • http://www.ca8.uscourts.gov/opndir/10/11/093277P.pdf

25. Sheltering Philosophy • Shelters must be, first and foremost, places of comfort and safety • Shelters must be readily accessible to those affected • Shelter workers and managers must be strong advocates for their clients • Clients must remain proactive participants in recovery • Shelters must provide a safe and secure environment that accommodates the broadest range of needs in our communities

26. Red Cross—Vision for Accommodation • Safely accommodate individuals with access and functional needs in our congregate shelters by working with partners and increasing and sustaining capacity within the Red Cross. • Provide appropriate referrals to partners when reasonable accommodation is not possible.

27. Red Cross—Vision for Accommodation • Exceptions • Individuals who need: • Continuous medical supervision • Acute, life-sustaining medical care • Individuals who are a danger to themselves or others

28. Americans with Disabilities Act (ADA) Under the ADA, the Red Cross must: • Make reasonable modifications to its policies, practices and procedures when necessary to deliver shelter services to clients with access or functional needs • Provide auxiliary aids and services to ensure effective communication • Welcome people with service animals • Ensure that shelter facilities are physically accessible for people who use wheelchairs or other mobility devices.

29. Recommendations • Shelter Inventory • Community Planning • Response

30. Shelter Inventory • Over 56,000 Shelters in inventory • Agreements updated annually • Facilities physically surveyed every three years

31. Shelter Selection • Use the Shelter Facility Survey Form when selecting shelter locations • Determine what physical access modifications will be needed for each facility • When a shelter that has inaccessible features is selected, a community plan must be in place to make the shelter accessible before use.

32. Integrated Community Planning • Review current plans • Identify all stakeholders • Conduct community gap analysis • Identify resources • Establish relationships

33. Current Plans • Determine what FNSS planning is currently occurring in the community • Join or convene FNSS planning activities • Integrate existing special needs plan into general population sheltering plan

34. Response • Ensure Health Services/Disaster Mental Health (HS/DMH) staff are present in shelters • Identify and address individual client needs • Use Initial Intake and Assessment Tool during registration • Consult with HS/DMH to address needs • HS and DMH will work directly with client to determine resources and next steps

35. Response • Shelter Layout • Accessible routes in dormitories • 20 sq. ft. per person in short-term or evacuation shelters • 40-60 sq. ft. per person for sheltering longer than 72 hours • Individuals who use wheelchairs, lift equipment, service animals, and other personal assistance services can require up to 100 sq. ft.

36. Response Examples • Modify kitchen access policies • Modify sleeping arrangements • Assist with cutting food • Provide way-finding assistance to visually-impaired • Provide extra space for cots when necessary • Provide communication tools for individuals with visual, hearing or speech needs, and those with language/cultural requirements

37. Response • Embrace self-determination • People with access and functional needs are the most knowledgeable of their own needs and assistance requirements • Assist individuals in maintaining their usual level of independence

38. Summary of Red Cross Guidance • Ongoing shelter surveying • Selection of ADA compliant facilities in disaster when possible • Modification plan for non-compliant facilities • Work with partners to plan for FNSS

39. Red Cross Health Services New Concept of Operations • American Red Cross Disaster Health Services is moving away from a “Protocol-based” concept of operations to a “Scope of Practice” concept of operations

40. Protocols • Red Cross Disaster Health Services have used protocols for the past 30 years to guide health services provided in shelters • Protocols: • Extremely restrictive • Restricted nursing practices to first aid procedures • Hampered the ability of Red Cross nurses to provide adequate assistance to individuals with access and functional needs

41. Scope of Practice • Allows RNs, LPNs, EMTs and others with certifications to function within the scope of their licensure or certification • Allows RNs to delegate health care activities (as appropriate) • Will increase Red Cross’ ability to respond to access and functional needs in a shelter environment

42. Next Steps • State and Local Communities • Review of FNSS Guidance • Review Public Health Preparedness Capabilities • Plan review and resource identification • Outreach to stakeholders • FEMA and Red Cross • Continued communication regarding FNSS Guidance • Continued Stakeholder Outreach

43. Future Webinars • Tuesday, May 15, 2012 – 10am – 11am (Central) • Friday, June 22, 2012 - 2pm – 3pm (Central) Call-in Number: 1-800-320-4330, PIN 746583 Webinar: https://connect.hsin.gov/regionvii/

44. Resources • FNSS Guidance (posted on HSIN Connect) • Red Cross Guidance (Crossnet for Red Cross audience) • Office of Disability Integration and Coordination (ODIC) • http://www.fema.gov/about/odic/ • Development of Assessment Teams • Ex. California Functional Assessment and Service Teams (FAST) • http://www.dss.cahwnet.gov/dis/res/pdf/AppendixB.pdf

45. Remember: PLAN • Pull together stakeholders, providers, agencies and organizations to identify, assess and determine what FNSS the community requires. • Locate, purchase or contract for all necessary FNSS supplies, equipment and staff. • Act quickly to implement FNSS when an emergency or disaster occurs. • Negotiate to ensure all residents are returned to the most appropriate, least restrictive environment when the shelter closes.

46. Questions “Disasters are always inclusive. Response and recovery are not, unless we plan for it.” —June Isaacson Kailes—

47. Contact Information Jono Anzalone Regional Voluntary Agency Liaison for FEMA Region VII 816.283.7078 jono.anzalone@fema.dhs.gov Kam Kennedy American Red Cross Special Representative to FEMA Region VII 816.283.7250 kam.kennedy@associates.fema.dhs.gov Gay Jones • Regional Disability Integration Specialist for FEMA Region VII • 816.283.7535 • Gay.Jones@fema.dhs.gov Cory Fast • Mass Care Specialist for FEMA Region VII • 816.283.7579 • cory.fast@fema.dhs.gov