CDR Harvey Ball, ASPR-ABCLCDR Joe Holshoe, ACF

What is the FNSS?

Guidance created by FEMA in coordination with Department of Justice

Planning for the integration of functional needs support services (FNSS)into general population shelters

Based upon the application of the Americans with Disabilities ACT (ADA)– which is NOT waived during a disaster

Communities and States must plan for the integration of functional needs populations in their general population shelters Medical shelters only for those requiring

intensive medical care

What are Functional Needs Services Services that enable individuals to

maintain their independence in a general population shelter, i.e., Reasonable modification to policies,

practices, and procedures Durable medical equipment (DME) Consumable medical supplies (CMS) Personal assistance services (PAS) Other good and services as needed Others who may benefit: women in late

stages of pregnancy, elders, and those needing bariatric equipment

Functional Needs Examples Dietary Special diets

Communication Language & other communication services, .i.e., visual

Mental health services Quiet areas

Medications Access to meds to maintain health & mental functioning

Durable medical equipment Oxygen

Transportation Para-transit

Sleeping accommodations Accessible cots, child & bariatric cots

How is this accomplished? States and communities are expected

to establish MOU’s with local area pharmacies, clinics and hospitals, durable medical equipment suppliers, catering companies, and transport services to provide these services when called upon

Shelters are expected to plan for and provide the staffing required for these services via training and MOU’s

The FNSS Process

1. Individual arrives at shelter2. Initial screened for needs3. If needs identified, medical

screening for nature of care required (NOT diagnosis driven, but care required driven)

4. Provide appropriate functional supports within the capabilities of the shelter

Medical Care in the General Population ShelterMedical Providers Physicians, Registered Nurses, Licensed Vocational Nurse, EMT’s and Paramedics Psychiatrists and Dental providers Emergency veterinary service provider Access to dialysis treatments (this includes providing access to transportation to

and from the dialysis facility and a meal(s) if a resident is not at the shelter during meal time(s))

DME providers Oxygen providers

Medical Staffing Services On-site nursing services Emergency medical services Emergency dental services Pharmaceutical services

Resource Suppliers O2 Dialysis Constant power source Blood sugar monitoring

General Population Medical Staff Recommendations Onsite Medical Staff

• Provide OTCs• Implement methods to minimize contagion• Make referrals for emergency medical and dental treatment

Medical Station Staff with a minimum of 1 RN and 1 paramedic

at ratio of 1:100 shelter residents at all times On-Call Medical Staff

Maintain on call physician and psychiatrist 24/7

Shelter populations

Shelter populations most often a component of under-served populations Multiple needs, i.e., chronic medical,

behavioral health needs, limited resources, few social supports

Those that can afford to stay at a hotel, stay at a hotel! Pets to people shelter ratio

Historically, FMS provided care for chronic conditions rather than acute injury

FNSS: Potential Challenges Training & credentialing of appropriate staff Team work required for effective medical

evaluation and care Security of medicines and medical supplies Legal liabilities to those who provide Rx & medical

supplies Monitoring: patients can go down hill fast OHSA compliance for DME & medical waste Potential for admitting all persons for fear of legal

action Potential to eliminate small shelters who cannot

contract for FNSS support services Confusion over the nature & implications of FNSS Possible short notice ESF-8 request s

FNSS: State-Specific Challenges Must have plans and MOU’s for multiple

support services Requires trained medical screeners Requires trained & credentialed

nursing/care-giving staff Requires documentation and

management of various support services, i.e., Rx & DME

If no Presidential Declaration– significant financial burden

• FEMA is the overall lead for the federal emergency response • ASPR is the USG lead for Emergency Support Function ESF-8, Public Health and Medical• ACF is the HHS lead for ESF 6 (Mass Care, Sheltering & Human Services) in support of FEMA• OFRD—through the RDFs—is one of the main staffers of the Federal Medical Station

So What has been the Response to the FNSS?

Medical Providers Response:

“PEOPLE WILL DIE!”

Shelter’s Response:

WE DON’T HAVE THE PEOPLE

OR SUPPLIES!

FMS Mission StatementAn FMS is designed to accommodate 250 patients with conditions

requiring observation, assessment, or maintenance; chronic conditions which require daily living assistance, assistance with medication administration, and home nursing care that does not require inpatient hospitalization. An FMS is not an acute care hospital, inpatient hospital ward, or emergency department, but rather a primary care platform with temporary holding capacity.

The scope of care for this configuration includes medical, nursing, mental health, and therapy care for non- complicated and stable non-acute patients; to include medical workups and examinations required during recovery, nursing care for special needs patients (to include geriatric, limited bariatric, and limited pediatric and obstetric), administration of medical and nursing treatments, and administration of vaccines or other countermeasures.

Medical Care in the General Population ShelterMedical Providers Physicians, Registered Nurses, Licensed Vocational Nurse, EMT’s and Paramedics Psychiatrists and Dental providers Emergency veterinary service provider Access to dialysis treatments (this includes providing access to transportation to

and from the dialysis facility and a meal(s) if a resident is not at the shelter during meal time(s))

DME providers Oxygen providers

Medical Staffing Services On-site nursing services Emergency medical services Emergency dental services Pharmaceutical services

Resource Suppliers O2 Dialysis Constant power source Blood sugar monitoring

So what is the role of the FMS in the FNSS?

How Does PHS Fit?

How Does PHS Fit?

Historically PHS provided/assisted with: FMS Service Access Teams Shelter Assessment Teams Technical Assistance and Subject Matter

Experts MRC

PHS can help meet FNSS needs:

Large population of deployable nurses Deployable providers Deployable pharmacists SAT SME/TA Shelter Assessment Teams Liaison for national advocacy

organizations

FNSS: Potential for PHS

Focus on core mission of PHS PHS exposure to general population Reinforce the value that PHS provides Serve underserved, at-risk &

vulnerable populations

Partnering with the community Community advocates know their

communities needs and strengths Knowledge asset Functional need specific groups

All Disasters are local events Build from the ground up

Many advocacy groups have EPR programs that can serve as foundation for shelter planning

Community Partners

Shelters will have to leverage the skills of community organizations AIDS Projects Visiting Nurses Associations Hospices

Community Advocacy Groups State nursing boards ECAR-VHP coordinators CERT Teams

A new role? Less emergency response, more basic care skills