The Recovery of Individuals with Disabilities Following Disaster Laura M. Stough, Ph.D. Elizabeth H. Ducy, M.Ed. Texas A&M University

Photos credit the Associated Press

A rescuer carries a young man who is unable to walk to safety.

Photos from:

Tanisha Blevin, 5, holds the hand of fellow Hurricane Katrina victim Nita LaGarde, 105, as they are evacuated from the Convention Center in New Orleans, La., Saturday, Sept. 3, (AP Photo/Eric Gay )

Hurricane Katrina Resulted in the loss or destruction of housing for over 1.5 million individuals Estimated that 23% of those people affected were individuals with disabilities (National Organization on Disability, 2006)

Discussion Point #1 Hurricane Katrina occurred in an area of the country that is vulnerable to hurricanes In the past 30 years, Louisiana has been hit by 11 hurricanes with three being rated as Category 3 storms (Blake et al, 2007) What are some disasters that could occur where you live?

Types of Disasters Floods Tornados Fires Earthquakes Hurricanes Ice Storms Tsunami Flu outbreak Terrorist attacks

Katrina Aid Today A National Case Management Consortium Implemented by UMCOR and Consortium Partners to Assist Katrina-Displaced Persons KatrinaAidToday.org

Goal UMCOR, in cooperation with FEMA, formed a Consortium as lead agency The consortium, Katrina Aid Today, includes 9 members to provide case management Cost: $66 million Time: 24 months

National Disability Rights Network The goal of Katrina Aid for Individuals with Disabilities is to provide high quality, cost- effective nation-wide case management services for displaced individuals with disabilities and their families.

Design of Evaluation I. Survey of 50 case managers providing services as part of Katrina Aid Today II. Face-to-face interviews with 15 case management supervisors and administrators III. Quantitative analysis of types and costs of case management services received by 63,759 families affected by Hurricane Katrina IV. Five focus groups in Texas, Louisiana, Mississippi, and Georgia with 31 people with disabilities

Analysis of Quantitative Data Extracted data on 63,759 families who had received case management services through Katrina Aid Today Database relied on input from case managers Descriptive statistics Between groups (NDRN clients versus KAT clients) analyses

Discussion Point #2 Displacement was the largest impact felt by clients Displacement includes housing issues and was the second largest concern What would you do if your house was damaged from a disaster? What would be your plan?

Housing Issues Shelter Family/ Friends Temporary Housing Repairs New housing Finances Relocating

Discussion Point #3 A large percentage of the clients were mandatory evacuees It is likely that you will have to evacuate in the event of a catastrophic emergency What would be your needs in an evacuation?

Evacuation needs Durable Medical Equipment Medical supplies Medicine Communication Personal Care Service animal Transportation Disaster Kit or Go Kit Varies from individual

Discussion Point #4 The cases were open an average of 6 to 7 months. Think back to your housing plan. Would your plan work for an extended amount of time?

Similar to clients of the other partners, NDRN clients were 1 : Predominantly female and predominantly African American; Nearly all displaced and had experienced damage to housing; NOT likely to have lived in subsidized housing pre-disaster; Likely to have their case open an average of 6 to 7 months; Not likely to have their case referred to Long Term Recovery Committee; Likely to have “primary needs met” or “recovery plan achieved” as the reason for case closure; Likely to indicate satisfaction with their case manager and with services received. 1 X 2 analysis found no significant difference found between groups given p<.05

In contrast to clients of the other partners, NDRN clients were: Older (F= , p<.001); More likely to need housing (X 2 =4.07, p<.05); Less likely to have experienced loss of income (X 2 = 33.70, p<.001) ; Less likely to need employment/job training (X 2 =4.77, p<.05).

Of particular note-- NDRN clients were less likely to express satisfaction in how other agencies assisting in their recovery had responded (X 2 = 9.90, p <.01). Throughout the KAT program as a whole, the average number of months a case was opened was significantly greater for those clients with aged/disabled service needs Clients with disabilities had cases opened an average of 8.86 months while others had their case opened 7.82 months ( F=270.21, p<.001, eta squared=.040 An additional 42% of cases had yet to be closed

Implications Needs of individuals with disabilities differ significantly in a number of key areas that have implications for both case management and resources needs during the long term recovery phase post-disaster Recovery can be assumed to take longer, require more expensive resources, and demand more intensive case management

Focus Groups of Individuals with Disabilities Five focus groups: Houston, Baton Rouge, New Orleans, Gulfport, and Atlanta Each group consisted of three to eight group members Five questions presented to each group with follow- up probes

Analysis of Qualitative Data Line-by-line analysis of qualitative data Open coding Axial coding Relationship among the categories determined

Focus Group Questions 1. What has helped you recover from Hurricane Katrina? 2. What help or services have helped you get the things you need? 3. What have been things that prevented you from recovering?

Focus Group Questions 1. What have been things that prevented you from recovering? 2. What has helped you recover from Hurricane Katrina? 3. What help or services have helped you get the things you need?

What have been things that prevented you from recovering? Lack of concrete resources Housing they tore my house down just about three weeks ago and she is going to use my insurance money to help get me a handicap accessible home not the trailer I am in…You know, I have a trailer, and I just appreciate God for giving me a trailer. I am uncomfortable in a way because the sofa is old. I am sleeping on top of a pillow because the back bedroom the bed is so high I cannot get into it. And they got one air conditioning unit in there and it does not cover the whole trailer. Certain parts of the day it gets hot, but I still praise God that I have somewhere to be. (Mississippi Focus Group)

What have been things that prevented you from recovering? Medical …my baby needs medicine right now, but CVS will not take his Medicaid card and he catch pneumonia. He has a respiratory disease, and he catch pneumonia like three times a year. And I got a prescription right now and they are like “we are not taking that” you know and it is just I am scared to transfer and then I am scared not to…(Georgia Focus Group).

What have been things that prevented you from recovering? Lack of Financial Support Well, like with me I am just staying in an old trailer that was there. I had no help to fix it, I am on low income, I am on disability. But I just don’t have money to fix it. But I have not had any help from nobody so I am just doing the best I can, what can I do about it? (Mississippi Focus Group)

Difficulty in Obtaining Services The “runaround” …it is the most frustrating thing is to call a number and they tell you they’re going to be able to help you but then when you call that number, “Right, but let me give you another number you can call” and then you call that number “Here’s another number you can call,” and you’re sittin’ there with a list of numbers and you call that whole page [but] you still have nothing (Georgia Focus Group ).

Difficulty in Obtaining Services Psychological status It is like we have lost our hope. No one answers our phone calls, no one calls us back, you know. We have been left out. By asking certain questions or asking for something that we need, desperately need, and it just “Call this number, well, call this number, call this number.” I had six in one day, different ones to call and nobody had any answers for me. So that has been a very long drawn out thing. Getting the answers as to who do we talk to. (Mississippi Focus Group)

Discussion Point #5 A lack of concrete resources and difficulty obtaining services was expressed as barriers to recovery What type of resources are available to you? What agencies can assist you post-disaster?

Resources for Recovery Project REDD produces the Texas State Guide to Supports and Services for Individuals with Disabilities and their Families Affected by Disaster Locate resources and agencies in your state or area

What has helped you recover from Hurricane Katrina? Um, I guess mainly the support from people here, from my church. Just from family and friends…So basically it has been relationships that have been the strongest piece, I think. Cause even with working with persons with some of the other agencies there have been relationships that have been developed from that communication and that contact with persons from other agencies. That is basically what it has been, relationships. (Georgia Focus Group)

What has helped you recover from Hurricane Katrina? Prayer and my people. My son and my sister. Out of thirteen of us I only have two left. So like, if I need something I call my sister. She needs something, if I got it I call her. My mother and my father always teached us…nothin’ like your own. (Baton Rouge Focus Group)

What has helped you recover from Hurricane Katrina? What became apparent after interviewing all of the groups was that, without exception, every participant in each of the focus groups was still recovering from the disaster- none saw themselves as having “recovered.” Recovery was seen as an ongoing process that the participants were overwhelmingly still experiencing.

Discussion #6 Think about your own network of support. What would be your supports in assisting you with your recovery? Who would assist you?

Supports in Disaster Recovery Family Friends Faith/Church Neighbors Community Social Agencies Government Agencies

Context of Displacement I think it’s more then money, it’s …knowing where you live, the ground that you walk on and when you wake up you know where you are and, you know, it’s just your whole life has changed. I don’t think you’ll ever really recover because you’ll never get back what had. Everybody’s lost friends and family is scattered all around the country… (Houston Focus Group)

Context of Displacement You know when that storm hit, uh, my home is the only two story in that area. I had, what, thirteen, fifteen neighbors over there. Thirteen, fifteen neighbors over there at my house. Didn’t know them, didn’t know their names. Didn’t know they stayed around the corner, but I know that I was the only shelter that they had and I took them all in...About three days later, Coast Guard came and and got everybody and I stayed…in that house over three weeks. (New Orleans Focus Group)

Context of Displacement I been around the world at least six to seven times. Red Ocean, Pacific Ocean, Gulf War, Atlantic…I been around the world to Egypt- and they always trained us for when the ship [might] sink. And since 1987 we never had one experience where…I had to worry about ships sinking in the middle of the ocean…but here I am in my own home, and I’m seeing water rise above me, trying to knock a vent out on the roof thinking I’m going to drown right there in my own home. (New Orleans Focus Group)

As a group, policy and evaluation studies imply that, following a disaster, people with disabilities are likely to need support that … Is more intensive in nature Involves multiple areas of support (transportation, mobility, self-care, financial, daily living, employment housing, etc) Is sustained over time Will enable them equitable access to disaster-related services

Photo by Kendall Kessel; April 2006