|
National Council on Disability on Hurricane Katrina Affected Areas
September 7, 2005
In the aftermath of Hurricane Katrina, people with disabilities
have unique needs that must be surveyed and responded to immediately. In
order to evacuate the large number of survivors from the New Orleans
area, as well as from other areas of Louisiana, Mississippi and
Alabama, people with disabilities were often forced to abandon
their wheelchairs, walkers and other medical equipment. People who are blind, who may no longer have a service
animal or cane to help them navigate, will require assistance in
navigating a new environmental landscape. People who are
deaf or hard of hearing will need visual access to emergency information. People
in need of personal assistance services may now no longer have
access to such services both as the result of separation from attendants
during the evacuation process or due to not knowing how to obtain
and fund the cost of qualified individuals in the locations where
they now find themselves and, consequently, nursing home care in
an institutional setting is often seen as the only remaining viable
alternative to living in shelters. People with mental health
needs, whose access to treatment and medications may have been
disrupted, are in critical need of treatment and/or medication.
In addition, mental illness symptoms are often exacerbated in times
of crisis, and many individuals, even those not directly affected
by the hurricane, may need assistance in identifying and accessing
available resources.
The Federal Government’s Response
The Federal Emergency Management Agency (FEMA) has set up a registration
process for people with disabilities and chronic health care needs,
and every hurricane survivor with a disability must register to
be able to receive the full range of federal disaster relief assistance. See https://disasterhelp.gov/portal/jhtml/index.jhtml or
call 800-621-FEMA or 800-462-9029 or TDD/TTY 800-462-7585.
The Food and Nutrition Service, run by the US Department of Agriculture,
has taken several actions to expedite and facilitate the Food Stamp
enrollment and receipt for evacuees of Hurricane Katrina in their
destination states, as identified on the webpage found at www.fns.usda.gov/fns/. This site’s “Newsroom” section
provides the latest efforts to date.
The US Department of Health and Human Services
(HHS) has set up a waiver between all the states housing hurricane
survivors who were already receiving Medicaid to have their Medicaid
accepted in their current location. HHS has also set up an expedited
process for Medicaid eligibility for those who may not be eligible
due to their hurricane related situation. The Centers for
Medicare and Medicaid Services are also offering the following
relief immediately:
- Health care providers that furnish medical services in good
faith, but who cannot comply with normal program requirements
because of Hurricane Katrina, will be paid for services provided
and will be exempt from sanctions for noncompliance, unless it
is discovered that fraud or abuse occurred.
- Crisis services provided to Medicare and Medicaid patients
who have been transferred to facilities not certified to participate
in the programs will be paid.
- Programs will reimburse facilities for providing dialysis to
patients with kidney failure in alternative settings.
- Medicare contractors may pay the costs of ambulance transfers
of patients being evacuated from one health care facility to
another.
- Normal prior authorization and out-of-network requirements
will also be waived for enrollees of Medicare, Medicaid or SCHIP
managed care plans.
- Normal licensing requirements for doctors, nurses and other
health care professionals who cross state lines to provide emergency
care in stricken areas will be waived as long as the provider
is licensed in their home state.
- Certain HIPAA privacy requirements will
be waived so that health care providers can talk to family
members about a patient’s
condition even if that patient is unable to grant that permission
to the provider.
- Hospitals and other facilities can be flexible in billing for
beds that have been dedicated to other uses, for example, if
a psychiatric unit bed is used for an acute care patient admitted
during the crisis.
- Hospital emergency rooms will not be held liable under the
Emergency Medical Treatment and Labor Act (EMTALA) for transferring
patients to other facilities for assessment, if the original
facility is in the area where a public health emergency has been
declared.
More information about CMS emergency
relief activities, including a detailed explanation of billing
and payment policy revisions, and phone numbers for the state
medical assistance offices can be found at www.cms.hhs.gov. Frequently
asked questions and their answers on the site will be updated
daily by 2pm. In
addition, members of the Interagency Coordinating Council (ICC)
on Emergency Preparedness and Individuals with Disabilities, a
federal interagency group led by the Department of Homeland Security,
participated in a conference call with consumer organizations to
identify the most immediate needs of hurricane victims with disabilities,
and have fielded comments and inquiries about surfacing problems.
More Needs to Be Done Immediately
However, more needs to be done
to effectuate a coordinated Federal Disability Recovery Plan
for Hurricane Katrina. In
declaring a public health emergency, HHS Secretary Michael Leavitt
identified as priorities for the survivors of Hurricane Katrina
to include health care, housing assistance, childcare and education.
While NCD recognizes that urgent needs and the necessary responses
are continuing to emerge in the days after the disaster, it would
like to offer the following recommendations in support of the Bush
Administration’s assistance to those affected by the disaster:
- NCD recommends that President Bush designate
a high-level official within Department of Homeland Security/FEMA
to resolve issues around disability access or related issues.
- NCD recommends that FEMA coordinate with
HHS’ Substance
Abuse and Mental Health Services Administration (SAMHSA), which
is equipped to train mental health workers and other human services
providers who assist survivors following a disaster. http://www.mentalhealth.samhsa.gov/publications/allpubs/ADM90-537/Default.asp The
SAMHSA Disaster Technical Assistance Center was established
to provide assistance to jurisdictions planning for or facing
an emergency event. SAMSHA should also continue to work
with mental health providers and consumers to develop and implement
a plan for providing or continuing services.
- Many organizations and individuals have
stepped up to provide donated equipment. For example, several Centers for Independent
Living (CILs) are in the process of obtaining a substantial
amount of durable medical equipment (DME). FEMA and the
agencies working with people with disabilities need to know about
these DME resources that have been obtained and about
other disability-specific resources and services that will
most definitely benefit incoming people with disabilities. NCD
urges FEMA to assist with immediate shipment of donated equipment.
- NCD urges the Federal Communications Commission to work with
agencies to designate Telecommunications Relay Services (TRS)
personnel, Public Safety Answering Point (PSAP) personnel, and
captioners as essential personnel to ensure that they can travel
to and from their designated facilities to provide continuity
of services for persons with hearing and speech disabilities.
Without trained personnel to provide these intermediate services,
individuals with hearing or speech disabilities will be denied
their rights to accessible communications and will not have access
to public alert and warning information during and after an emergency.
- NCD recommends that FEMA coordinate with
HHS to ensure that comprehensive medical approaches are used
to address the health care and medical needs of individuals
with disabilities across the lifespan of the Hurricane Katrina
disaster.
- NCD urges the Department of Transportation to coordinate with
state and local governments to provide expedited eligibility
to vocational rehabilitation services, paratransit services and
specialized telecommunication assistance programs.
- A multi-agency, cross-disability proposal for disability specific
funds should be developed to support on-going activities in the
Gulf region.
- Shelters and facilities must be accessible
to people with disabilities and to people who have expertise
in providing services to people with disabilities. NCD
recommends that the Justice Department issue a statement on
the legal requirements for accessible shelters and facilities.
NCD recommends that DHS issue a statement and operational guidance
encouraging accessibility.
- NCD recommends that the Department of Education
(DoEd) coordinate with state and local school districts to
ensure that students with disabilities are included in DoEd’s plans to work
with states and local communities to welcome students with disabilities
and get them enrolled into schools as quickly as possible. NCD
urges the use of “emergency” assessment procedures
by qualified school professionals to provide a record of general
functioning for temporary provision of special education and
related services. Plans for regular evaluation need to be established
within a reasonable timeframe after enrollment by state and local
school districts to avoid over identification of children from
diverse racial and cultural backgrounds as children with disabilities.
Counseling and other mental health services need to be made available
to all evacuated children and families through schools and collaboration
with health departments.
- FEMA/CMS/HHS should immediately determine
the location and status of residents of long-term care facilities,
including nursing home and group home populations, and assess
and respond to their immediate needs to ensure that they are
receiving the necessary range of services and supports. NCD
also recommends that CMS consider the impact of the implementation
of Medicare Part D.
- HHS and HUD have each established toll free
hotlines. HUD
has established a single toll-free number (1-888-297-8685) to
help disaster victims with all housing concerns. Assistance is
available from 7 a.m. to 8 p.m., CST, seven days a week. HHS
has established a crisis hotline for people in crisis in the
aftermath of Hurricane Katrina. By dialing 1-800-273-TALK (1-800-273-8255),
callers will be connected to a network of local crisis centers
across the country that are committed to crisis counseling. Callers
to the hotline will receive counseling from trained staff at
the closest certified crisis center in the network. However,
it is strongly recommended that these hotlines be made accessible
to deaf and hard of hearing consumers immediately by also establishing
a TTY/TDD telephone number. NCD also recommends that HUD consider
housing vouchers and other low income housing be set aside for
people with disabilities, and provide help in locating accessible
housing.
- The Secretary of Veterans Affairs to request
VA hospitals across the country to assist in providing outdated
or unneeded wheelchairs and other useful durable medical equipment,
currently in VA storerooms, to the relief effort. The
VA should also coordinate with the network of veteran's homes
and other veterans' organizations, like VFW and American Legion
chapters, whose members could provide donations to, or assist
with, equipment drives.
Subsequent Follow-Up Action NCD’s April 15, 2005 report Saving Lives:
Including People with Disabilities in Emergency Planning,
(http://www.ncd.gov/newsroom/publications/2005/saving_lives.htm)
provides an overview of steps the Federal Government should take
to build a solid and resilient infrastructure that will enable
the government to include the diverse populations of people with
disabilities in emergency preparedness, disaster relief, and
homeland security programs. This infrastructure would incorporate
access to technology, physical plants, programs, and communications.
It also would include procurement and emergency programs and
services.
- Department of Homeland Security should establish a Hurricane
Katrina Disability Access Advisory Group, made up of qualified
people with disabilities and others with disability-specific
disaster experience, who meet regularly with senior officials
to: share real time information from the Gulf Coast region, as
well as to discuss events and challenges and progress.
- Federal Government information web sites like DisabilityInfo.gov
should have ongoing portals designated specifically for Hurricane
Katrina disaster relief efforts, and these portals should be
accessible, accurate, timely, and updated regularly. To the greatest
extent possible, these sites should incorporate state and local
information that is relevant.
- The DHS Directorate of Emergency Preparedness and Response
should integrate information on people with disabilities into
Katrina-specific preparedness materials. It also should inform
readers and information users on how to get access to more customized
and regionally relevant materials.
- The DHS Office of Civil Rights and Civil Liberties should regularly
issue guidance for state and local emergency planning departments
to reinforce their legal obligation to comply with ADA and Section
504 and 508 of the Rehabilitation Act in planning for, operating,
and managing programs and services such as Citizen Corps, shelters,
and other Katrina disaster assistance and relief services.
- The FCC should develop stronger enforcement mechanisms to ensure
that video programming distributors, including broadcasters,
cable operators, and satellite television services, comply with
their obligation to make Katrina emergency information accessible
to people with hearing and vision disabilities, that it acts
immediately on violations, and that it is proactive on Section
255 hearing aid compatibility.
The Federal Interagency Coordinating
Council on Emergency Preparedness and Individuals with Disabilities
was established to ensure that the Federal government appropriately
supports safety and security for individuals with disabilities
in disaster situations. Chaired by the Secretary of Homeland
Security, the purpose of the Council is to facilitate cooperation
among Federal, State, local, and tribal governments and private
organizations and individuals in the implementation of emergency
preparedness plans as they relate to individuals with disabilities.
The following recommendations from the Council’s first
annual report to President Bush (http://www.dhs.gov/interweb/assetlibrary/CRCL_IWDEP_AnnualReport_2005.txt)
are salient as applied to our response to the Hurricane Katrina
disaster and should be immediately acted upon:
- Coordinate evidence-based Federal research
into the effectiveness of audio, visual and/or tactile protocols
and technologies related to emergency preparedness, alerting,
warning and response for individuals with disabilities. In
order to ensure that all persons are alerted to and warned
about disasters or emergencies, accessible technologies are
indispensable. The ICC is uniquely positioned to accelerate
research that guides the development and integration of appropriate
technologies into the Nation’s emergency
warning systems and practices. These technologies identified
from research will guide contract procurement and technical assistance,
and translate findings into guidelines. Findings will also result
in information on promising new practices for alerting and warning
individuals with disabilities.
- Ensure comprehensive medical approaches
that address the health care and medical needs of individuals with disabilities
across the lifespan of an emergency event. In order to ensure
that health care providers and emergency responders have the
appropriate skills to provide life-sustaining care to individuals
with disabilities for both pre-existing and incident-caused health
needs, they must receive training. Effective competency-based
instructional materials and training will increase positive outcomes
for individuals with disabilities in times of emergency and over
the duration of the recovery process. The ICC will work to ensure
development of this type of instructional material and training.
- Direct homeland security funding to promote
the full integration of people with disabilities in all aspects
of emergency preparedness, response and recovery. There must
be adequate funding to ensure that emergency planning includes
people with disabilities. In the present environment, it is
difficult for planners to find funds to meet their communities’ needs
for items ranging from evacuation devices to personal preparedness
education materials. In January 2005, the Secretary of Homeland
Security sent a letter to all Governors encouraging them to
consider using a portion of their homeland security grants
for such purposes. This effort should be replicated at the
State, local and tribal levels to encourage the use of homeland
security resources to achieve the goals of the Executive Order.
To expedite the process, the ICC will develop a database of
current funding streams devoted to emergency preparedness and
people with disabilities.
Leaders and experts within the disability community,
members of relief organizations, media professionals, and local,
state, and federal officials must establish a cooperative relationship
to address the catastrophic effects of tens of thousands of Gulf
Coast residents with disabilities. The challenges ahead will be
overcome only by clear communication and ongoing dialogue among
these and other groups. That dialogue must, at a minimum, identify
key needs of people with disabilities, develop effective and timely
strategies for addressing those issues, and build relationships
and delineate responsibilities among disaster mitigation organizations,
the media, and disability organizations.
- Disaster Preparation, Education, and Training. Relief
and rescue operations must have the appropriate medical equipment,
supplies, and training to address the immediate needs of people
with disabilities. Affected individuals will require bladder
bags, insulin pumps, walkers, or wheelchairs. Relief personnel
must be equipped and trained in the use of such equipment. In
addition, relief personnel should provide training, particularly
for personnel and volunteers in the field, on how to support
the independence and dignity of persons with disabilities in
the aftermath of Hurricane Katrina.
- Universal Design and Implementation Strategies. In the
aftermath of Hurricane Katrina, a universal design approach to
meeting the needs of people with disabilities will benefit many
people without disabilities, such as the very young or the aged.
A look at existing agreements among relief organizations and
local, state, federal, and international governments will offer
guidance in developing timely and effective strategies for universal
design and implementation plans. The federal government could
encourage or even mandate universal design and set standards.
- Partnerships with the Media. The media -- in partnership
with disability and governmental organizations -- should incorporate
ongoing advisories into emergency broadcasts in formats accessible
to people with disabilities, recognizing that information may
need to be conveyed through multiple mechanisms so that the information
is available in both audible and visual formats. Such advisories
should alert the public to ongoing threats (e.g., public health)
resulting from Hurricane Katrina, and for identifying responsible
and timely solutions. The creation and repetition of accessible
media messages is critical for empowering people with disabilities
to protect themselves from the chronic effects of Katrina.
- Partnerships with the Disability Community. Disability
organizations must join with Katrina relief and rescue organizations
and the media to educate and inform their constituents of disaster
contingency and self-help plans.
The Community’s Response
The disability community has mobilized to provide
its expertise in assisting with the response to the disaster.
Among many things, the community has organized several conference
calls, directly assisted survivors on the ground, engaged in
fundraising efforts, advised governmental entities, developed
workgroups for follow up actions, and established informational
websites. While the strength and unity of the disability community’s response has played
a critical role in disaster recovery, the full force of their assistance
has been hampered by the lack of relief organizations’ coordination
with community leaders in the provision of clear and systemic communications,
independent funding and resource support and not fully including
disability experts in the development and implementation of assistance
and recovery plans. Below are a few examples of the actions and
information dissemination of the disability community:
- http://www.katrinadisability.info/ has
been set up to provide information to people with disabilities
and their families who have been affected by Hurricane Katrina. New
information and resources will be added as it becomes available,
so people should visit often for information and updates.
- California’s Independent Living Centers, which are community-based
non-profit organizations serving people with disabilities of
all ages, have offered to serve as the collection points for
new or used items to be delivered to the survivors who are disabled. “We
know that many people who receive new replacement equipment,
or recover from an injury or illness, keep the older items in
case they’re ever needed, “according to Michael Collins
of the State Independent Living Council in Sacramento, “The
items gathering dust in garages and storage units around the
state could make a real difference to a survivor who cannot move
without assistance at a shelter.” Since many people
who are elderly, and children, need replacement items too, it
is hoped that the agencies serving such age groups will join
in the California collection drive. For anyone who would
prefer to donate money that will assist local disability organizations
in the Southeast, the California Foundation for Independent Living
Centers is also accepting such donations at www.cfilc.org.
Because the deliveries of donated goods need to be coordinated
with a local organization capable of temporary storage and
effective delivery to the people who really need the equipment
and supplies, it is being requested that advance contact
be made with a recipient agency near the shelter sites. California’s
Independent Living Centers have made those contacts, and will coordinate
shipment of the needed items. To find the location of the nearest Independent
Living Center or community collection drive, call the State Independent Living
Council at (866) 866-7452 or view the address www.calsilc.org.
Contact: Michael C. Collins, Executive Director
(866) 866-7452 (Toll-free)
(916) 505-4273 (Cellphone)
- United Cerebral Palsy Association (UCP)
has set up an emergency hotline for UCP of New Orleans. Concerned
consumers and their families, employees and volunteers can
call 800-872-5827 to receive information, as well as leave
messages about their personal status. www.ucpgno.org
Additionally, United Cerebral Palsy has set-up a Hurricane Katrina Disaster
Relief Fund to provide services to people with disabilities affected by hurricane
Katrina and assist UCP affiliates throughout the region in restoring their
operations as quickly as possible. Members of the public, who are able to
help, are encouraged to make an online donation at www.ucp.org.
- The National Alliance on Mental Illness
(NAMI) is providing a resource guide and a Katrina Hurricane
Relief Fund to assist consumers and families affected by the
hurricane. Included
in this resource: How NAMI is responding to the tragedy as it
relates to people with serious mental illness, NAMI’s Hurricane
Katrina Message Board, NAMI’s email alerts, Resources and
Links to support and information specific for people living with
mental illness and their families.
http://www.nami.org/TextTemplate.cfm?Section=Hurricane_Katrina&Template=/ContentManagement/ContentDisplay.cfm&ContentID=26242&lstid=566
1-800-950-nami (6264)
- The Spina Bifida Association (SBA) has a
Hurricane Emergency Life-Support Program including working
with industry to secure essential equipment, working with its
chapters to distribute supplies when the infrastructure in
the region has been restored, and develop an Emergency Preparedness
program for future emergency situations. Also links to
SBA Chapter and Clinic Lists.
http://www.sbaa.org/site/PageServer?pagename=campaign_SBA_HELP
1-800-621-3141
- TASH (serving persons with severe disabilities) has put together
the following information for TASH members and colleagues regarding
efforts to assist disability related organizations and individuals
with disabilities and their families in the Gulf States and the
states receiving refugees from the storm and floods. We will
be updating this page with additional information as we receive
it.
http://www.tash.org/katrinainfo.htm
410-828-8274
- The National Spinal Cord Injury Association
(NSCIA) has distributed “Ways
to Support Disability Related Relief Efforts for Hurricane Katrina.” They
include links for information, organizations, and assistance
http://www.spinalcord.org/news.php?dep=1&page=0&list=601
1-800-962-9629.
|