Personal Assistance Services

1. Personal Assistance Services Planning for Emergencies and Disasters August 2012

2. “FEMA’s mission is to support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve  our capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.”

3. FEMA’s Role in a Disaster • Always in support of the State • Always by request • Domestic

4. National Preparedness Goal: A secure and resilient Nation with the capabilities required across the whole community to prevent, protect against, mitigate, respond to, and recover from the threats and hazards that pose the greatest risk. • National preparedness is the shared responsibility of our whole community. Every member contributes, including individuals, communities, the private and nonprofit sectors, faith-based organizations, and Federal, state, and local governments.

5. All Hazards Preparedness

6. Whole Community: Participation of the whole community requires: • equal access to preparedness activities and programs without discrimination • meeting the access and functional needs of all individuals • consistent and active engagement and involvement in all aspects of planning.

7. The WHOLE Whole Community: For inclusive planning to be successful, individuals who are often underrepresented or excluded must be actively involved. This includes: individuals who are from diverse cultures, races and nations of origin; individuals who don’t read, have limited English proficiency or are non-English speaking, individuals who have physical, sensory, behavioral and mental health, intellectual, developmental and cognitive disabilities, including individuals who live in the community and individuals who are institutionalized, older adults with and without disabilities, children with and without disabilities and their parents, individuals who are economically or transportation disadvantaged, women who are pregnant, individuals who have chronic medical conditions, those with pharmacological dependency, and the social, advocacy and service organizations that serve individuals and communities such as those listed above.

8. Office of Disability Integration and • Coordination • Mission Statement In accordance with Federal civil rights laws and regulations, provide guidance, tools, methods and strategies to integrate and coordinate emergency management inclusive of individuals with access and functional needs.

9. Current/Recent Initiatives • Functional Needs Support Services Guidance • Personal Assistance Services Guidance • National Preparedness Goal • Frameworks and Interagency Operating Plans • Disability Working Group • Interagency Coordinating Council • Community Preparedness Initiatives • Employment opportunities • Communications Access Working Group • Durable Medical Equipment & Consumable Medical Supplies • Universal cots • Contracts and Caches • Personal Assistance Services Contracts • Disability Integration Specialists in all regions and at HQ • Disability Integration Advisor Cadre Development • Constituent and Stakeholder Outreach • National Level Exercises • Training • Promising Practices conferences and tools • Publications • Whole Community Integration Planning Grants • Inclusive Emergency Grant Guidance

10. REGIONAL DISABILITY INTEGRATION SPECIALISTS Responsible for ensuring that the access and functional needs and requirements of individuals with disabilities are being properly included and addressed in all aspects of emergency preparedness and disaster response, recovery, and mitigation.

11. Promising Practices in Preparedness www.fema.gov/about/odic

12. Cots

13. Meeting Access and Functional Needs Individuals with access and functional needs, including those with and without disabilities can be accommodated with actions, services, equipment, accommodations and modifications including physical/architectural, programmatic, and communications modifications. Some individuals with access and functional needs have legal protections including, but not limited to, the right to freedom from discrimination based on race, color, national origin (including limited English proficiency), sex, familial status, age, disability and economic status.

14. The U.S. Department of Justice has provided guidance to State and local governments advising that people with disabilities should be housed in mass care shelters even if they are not accompanied by their personal assistance service providers. “Some people with disabilities use personal care assistance for activities of daily living, such as eating, dressing, routine health care, and personal hygiene needs. One question that frequently arises is whether people with disabilities who use attendant care can be appropriately housed in mass care shelters. In most instances, they can.” -DOJ

15. General Population Sheltering Functional Needs Support Services (FNSS) Guidance • Planning • Finding subject matter experts • Selecting potential shelter sites • Accessible toilets and bathing facilities • Personal assistance service needs • Medical Care • Durable Medical Equipment and Consumable Medical Supplies • Legal obligations • Service and assistance animals

16. Physical Access

17. Programmatic Access

18. Effective Communications Access

19. Guidance on Planning for Personal Assistance Services in General Population Shelters November 2010

20. Every community will have residents and visitors needing PAS in a disaster. Planning to meet these needs in advance strengthens the ability of the community to meet the needs of its members and maximize limited resources.

21. As with other shelter services, it is imperative that plans to provide PAS are in place prior to an emergency or disaster. • Because PAS are offered in virtually every community, emergency managers and shelter planners can begin planning for these services at the local level by involving people who routinely use and provide these services. In many instances, the individuals and/or agencies that are experienced PAS providers will be willing and able to continue providing those services in a shelter setting. However, should these services be unavailable, the State should plan to use volunteers and/or paid providers to ensure a sufficiency of care when PAS is needed.

22. Because each jurisdiction (State, local, and tribal) is different and the laws, rules, and regulations that apply to each State and community vary, there is no single national plan for providing PAS in general population shelters.

23. Estimating PAS requirements • 3.8% of the population over age 6 uses PAS on a regular basis. • This percentage needs to be adjusted to reflect local demographics and other factors (tourists, aging populations, etc) • During a disaster, individuals may have additional needs for PAS due to factors such as: • Loss, damage or lack of power for durable medical equipment/assistive technology • Separation from family or service animal • Even in fully accessible temporary shelters and housing, unfamiliar settings or environments may require a higher level of assistance to maintain health, safety and independence.

24. Refer to the PAS Guidance for: • Development of plans • Community Resources • Recruitment and enrollment strategies • Developing a training curriculum • Pre-identifying resources and equipment • Power • Oxygen • Dialysis

25. During emergencies, many personal assistance services providers– like other people – evacuate or shelter with their own families. • Assisting providers to plan for both their individual and family needs and participate in planning for the needs of the individuals they serve may increase the likelihood that they will be available to assist the individual during a disaster.

26. Proactive community actions that may reduce the need for Personal Assistance Services • Physical, programmatic and effective communication access in shelters • Assist individuals who use PAS/AT/ DME/service animals etc, their PAS providers and their circle of support to plan for emergencies • Encourage active involvement of people with disabilities, personal assistance service providers, disability services and advocacy organizations and assistive technology loaner programs in community preparedness efforts, as partners, subject matter experts and local resources. • Teach first responders not to separate people from their PAS/AT/ DME/service animal during evacuation. • Plan for accessible transportation to keep people with their PAS/AT/ DME/service animal during evacuation.

27. Overall, inclusive planning is expected to increase the community-wide margin of resilience and increase capacity to meet a wide range of disaster related needs utilizing existing resources and reducing dependence on acute medical resources for maintaining health, safety and independence and preventing discrimination.

28. NOTHING ABOUT US, WITHOUT US

29. FEMA PERSONAL ASSISTANCE SERVICES CONTRACTS Augment the ability of States, tribes, and Territories to help individuals with access and functional needs maintain their health, safety, and independence in congregate facilities after a Presidential declaration.

30. Types of services provided: The PAS contract provides two levels of support to help individuals with access and functional needs maintain their independence in congregate facilities: • Basic personal care, such as grooming, eating, bathing, toileting, dressing and undressing, walking, transferring, and maintaining health and safety. • Higher level of care, including changing dressings on wounds (such as pressure point sores), administering medications / injections (such as insulin), catheterization, and respiratory care (to include mechanical ventilation) when allowed by the State or Territory.

31. Eligibility: Eligible applicants are State, tribal, or Territorial governments that request FEMA to provide PAS in congregate facilities after a Presidential declaration.

32. Requirements: • A Presidential declaration of emergency or major disaster • A request is received from the State, tribal, and/or Territorial government when they have determined that shortfalls exist.

33. Cost There is a cost-share to the State, tribal, or Territorial government to implement PAS under this contract. The cost-share is typically 25% of the cost.

34. What about potential duplication of benefits? • Individuals who need PAS cannot wait for the contract to be activated; therefore, if other resources are available, those options will be implemented first. Not all individuals who need PAS have Medicare, Medicaid, or insurance. PAS are often provided by family, friends, and volunteers who may have become separated during a disaster or emergency. As there is a cost-share for this service, States, tribes, and Territories will exhaust other, less costly, options before requesting activation of the contract.

35. Individuals requiring PAS have the right to choose or reject a PAS provider and cannot be required to use a friend, family member or volunteer simply because this is the most cost-effective option. All decisions regarding PAS providers will be made with the consent of the individual requesting the service.

36. Who identifies who will receive PAS under the contract? How is this decision made? • The congregate facility manager (shelter), nursing staff, and, in some cases, the shelter critical assessment team, will identify and validate PAS requirements. The facility manager will forward requests to the County/Parish office of emergency management for action. If PAS staff cannot be provided at the local level, the office of emergency management will send the request to the State, which will either deploy resources or request FEMA to implement the PAS contract.

37. Can PAS staff provide assistance to more than one individual? • The answer to this question will depend on the extent of assistance required by an individual. In some cases, the ratio will need to be one-to-one. In other cases, PAS staff will be able to assist more than one individual.

38. Who supervises contracted PAS staff in congregate facilities? • Contracted PAS staff report to the congregate facility manager. In addition, the Contracting Officer and/or technical monitor(s) for the contract will deploy to the field to ensure that the services provided comply with the requirements of the contract.

39. Are PAS staff deployed under the contract required to meet training, certification, and other requirements? • The contractor is required to ensure that all PAS staff are properly licensed, trained, and certified per the local, State, Territorial, and Federal laws and regulations where the congregate facility is located. PAS staff deployed under this contract are required to have successfully passed a background investigation.

40. When would PAS staff demobilize? • As implementation of the PAS contract must be requested by the State, the State also determines when the resource is no longer needed. Throughout the period that congregate assistance is provided, State and local governments are encouraged to seek State/local resources to meet the needs of individuals with access and functional needs in congregate facilities. The State is requested to provide 48-hour notice when demobilizing the contract at each site.

41. INTEGRATION AND COORDINATION When communities integrate the access and functional needs of children and adults with and without disabilities in all phases of community-wide emergency management, they strengthen their ability to prepare for, protect against, respond to, recover from, and mitigate all hazards.

42. Helpful Links: • FEMA Office of Disability Integration and Coordination • www.fema.gov/about/odic • Guidance on Planning for Integration of Functional Needs Support Services in General • Population Shelters • http://www.fema.gov/pdf/about/odic/fnss_guidance.pdf • FEMA Personal Assistance Services Contract -Frequently Asked Questions • http://pascenter.org/news/news_home.php?id=536 • Getting Real- Promising Practices in Inclusive Emergency Management • gettingreal-ii.webcaston.tv/home/homepage.php • Planning for the Whole Community • http://terrorism.spcollege.edu/Broadcasts/LRBroadcast0611.aspx • First Responder Guide • http://terrorism.spcollege.edu/SPAWARAFN/index.html

43. Helpful Links: • CAL EMA Office for Access and Functional Needs • http://www.calema.ca.gov/ChiefofStaff/Pages/Access-and-Functional-Needs.aspx • Disaster Resources for People with Disabilities and Others with Access and • Functional Needs http://www.jik.com/disaster.html • PCA Tool Kit: • Chapter 7- Emergency Management Under Title II of the ADA • http://www.ada.gov/pcatoolkit/toolkitmain.htm#pcatoolkitch7 • ADA Checklist for Emergency Shelters • http://www.ada.gov/shleterck.htm • An ADA Guide for Local Governments: Making Community Emergency • Preparedness and Response Programs Accessible to People with • Disabilities • http://www.ada.gov/emergencyprep.htm

44. Waddy Gonzalez Mass Care Waddy.gonzalez@fema.dhs.gov 202.212.1077 Marcie Roth Office of Disability Integration and Coordination marcie.roth@fema.dhs.gov 202.212.1537 www.fema.gov/about/odic