APRIL ‑‑ Navigating the FEMA Emergency Relocation Reimbursement Process
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Captioner Trish Messinger

 
This text is being provided in a rough draft format.  Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings. 

 
>>:  Mary, we ready? 
>>:  Go ahead and start your spiel, people are getting settled in.
>>:  Hello everyone and welcome.  I'm Elissa director of operations and conference coordinator for APRIL and the facilitator for today's webinar.  Thank you for joining us for this workshop.  Navigating the FEMA emergency relocation reimbursement process.
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And we're going to start today with a short video.
The following video shows aryl view from drone footage of a lake front cityscape of Chicago.  With high‑rise apartment buildings and several nursing home facilities that house our
...
>>:  I'm 48 years old.  I was there from 40 years, like I said I had problems from day one.  It was really bad.  I got physically abused there.
>>:  You know early in the morning, after 5:00 o'clock, all the masks start falling off, and when I see that I just go into my room and don't talk to people without masks period.
>>:  August of 2019 when I moved into ... I'm in a building with many people who don't wash their hands after the bathroom.  So, no, I do not feel safe from the get‑go.
>>:  The roommate I had ... had COVID‑19.  I'm demanding a test they came into my room, took my roommate out, sent him the hospital, then moved another roommate in ... 3 beds many this room.  And again they had moved in a guy into the very bed that the COVID guy was in at 130 in the morning.
>>:  I think the majority of those rooms are not meant to be 3 beds.  That middle bed has no space (chuckling) like it's literally like you can put your feet out on each said and then you have some space underneath the TV.
>>:  When COVID fist hit they were saying about not making any unnecessary trips to the hospital, no face mask, no social distancing, they didn't let people know how many cases was there.  It was really dangerous.  They had no separation from people that were sick.
>>:  I intend to Mary and have a children and a life, and I don't belong dieing in this what I would term a hell hole.  Okay.
>>:  Considering the facility that bread is, I want to be as at least involved with them as humanly possible.
>>:  About 3.1 million Medicare beneficiaries resided in nursing homes in 2020.  Forty‑two percent of them, 1.3 beneficiaries had or likelihood COVID‑19.  U.S. department of health and human services.
 ...
>>:  And now I'm honored to introduce our next speaker Ebony Payne.
EBONY:  Good afternoon everyone, my pronounce she/her.  Imagine being paralyzed from the neck down.  Living in a nursing home depending on someone else for your daily needs and to keep you safe.  My name is Ebony Payne, I'm an African American ... in Chicago and this is my reality.
I've been a quadraplegic for 18 years now, being paralyzed in January of 200 #.  I was a victim of a violent crime and involved in a car accident at the same time.
Since then I've been in and out of nursing facilities, however I didn't begin to self advocate right away.  Having both experience and witness unfair treatment prompted me to begin advocating.
After contracting a near fatal blood infection I began to self advocate.  A nurse ... who are an advocate and ago between for the residents when she saw the facility wasn't taking me seriously.  They became a vital tool for me.  When id advocate for other residents or assist them to advocate for themselves.
The October before it was announces as a pandemic, my facility which houses over 200 residents experienced an outbreak with flu like symptoms, I personally experienced severe cough for weeks that progressively got worse including chills, body ache and an abnormal temperature.  It was so bad that I was admitted to the hospital with what they can only describe as an upper respiratory infection.
I remained hospitalized for approximately 2 weeks having to receive over 2 different antibiotics and two different breathing treatments every 4 hours.  A few weeks after that my ... and diagnosed with the same thing.  Once it was established there was in fact a virus spreading, steps were taken to lessen the spread and congregate situations.  You have to wonder out effective those steps are.  We face things like forced isolation, lack of proper PPE and staff who weren't observing the hand date to social distance and isolate.
Initially the severity of the pandemic hadn't met any of us yet, but after a few weeks I was really worried.  I wondered how sanitary the facility was.  Their initial statement when a CNA ... was quote this is a mask free facility.  This scared me because I'm compromised.  It's much more easier for me to contract viruses.
Then mental health came into play when dealing with prolonged isolation.  I was accustomed to visits from family every other day.  I was also accustomed to going out with family.  This doesn't count the surprise visits and outings with friends.  Ned less to say my mental health was affected so much so that I had to start telehealth therapy sessions.
My facility was until and unless the news.  The CNAs were protesting and speaking out about not being informed about virus and the COVID related deaths in the facility and not having proper PPE.  My facility was also in the news as being in the top 3 facilities with the highest number of outbreaks and here I was stuck amongst over 200 other people with no way out and no way to truly isolate or social distance.
We experienced 6 COVID related deaths, 3 staff and 3 residents.  One of the staff members was in my room giving care the Friday before she was found deceased.  One of the residents family didn't even know he was in the hospital.  To this day my facility does not update us on out probation of patients they admit with COVID.
We also have staff who weren't taking precautions and flying to what was labeled as hot states such as Georgia, Florida, California, Nevada.
While my facility has been vaccinated, there's no recourse for people like myself who can't vaccinate due to medical issue.  My concern is how to people like me protect ourselves being in a congregate care facility I have to interact with people from being in close quarters with my roommate, kitchen staff, activity aides ... as well as other residents.
Now suspect that the opposite of isolation and social distancing?  Why not make a way for people to truly isolate, a way they can interact with one person, giving them care, a way to be safe during the emergencies and life threatening situations such as these.
And nan ideal world, those residents like myself who want t to leave congregate facilities would be much easier.  This way if you do become infected you know exactly who calls you to be exposed.
I would love to be able to leave the facility and be in a place where I can colony environment.  Currently I'm working with the covert Williams program (phonetic) to transition out of the nursing home, but COVID has caused in the back up in the ability to keep and processer to get and keep the process going in a timely manner.
Due to COVID and the facilities being closed to visitors it's become near impossible for them to properly ... my interviews have to be conducted via Zoom or Google Duo.  And a 3 to 4 month process has turned into 2 years.  Trying to navigate the relocation process is a as the income itself and for those residents that who are unaware of the resources at their disposal, transition out there just stuck.  Something should be done.  Thank you.  And now I'm turning it over to Misty.
MISTY:  Thank you, Ebony.  It's certainly hard to follow a story and a difficult process like Ebony's, but I'm hopefully able to share a success story of where Roads to Freedom has been able to emergency relocation services through ... so with that, like Ebony said, my name is Misty Dion ... I go with I use she/her pronouns.  And I'm a middle‑aged woman, long dark hair.  Curly, wearing glasses, sitting in my office.
And with that, we'll start sharing the screen.  As soon as we have our slides up.  All right next slide.
So transition services.  Like I said, I am CEO for Roads to Freedom Center for Independent Living, and as many of you are aware in July of 20 ... the ... was signed into law and transferring the ... also included was the fifth core service of transition, which included preemployment transition and institutional transition.
Money follows the person as authorized in a deficit reduction act of 2005 and reauthorized a few times thereafter.  Also helps support states efforts for rebalancing their long‑term services and supports so that individuals have a choice where they live and receive services.
So this is of course despite disaster or blue sky days.
With that I want to show a quick video.
>>:  People just want to go out (chuckling).  Like I don't blame them because we've been in lock down.
>>:  80 percent of region's deaths are in nursing homes, CBS.
>>:  We were contaminating and the nursing passed it tall way down.
>>:   ... New York post.
>>:  On this last wing I was on, there was 3 portable phones for 40 people.  You can imagine how that didn't work well.
>>:  Nursing homes ask states for immune NPR.
>>:  I have gone into other people's rooms to tuck to them because I need socialization and had no idea I was exposed to this until just today moments or so before I made this call.
>>:  A woman on oxygen.
>>:  Hi guys my name is Desiré L, and I'm just so excited to share my story today of my transition from the nursing facility the center of independence living transitioned me in September for ... after being there long‑term into my new apartment.
>>:  Hope.
>>:  I found out that there was a program I would be able to get amenities.
>>:  She made the necessary arrangements to get furniture and food and to pay the first month's rent and deposit.
>>:  Community.
>>:  Our life has changed dramatically since we left the nursing home in February.  I think that Carol has made significant advances being at home.  We got her on the right track.  Got her started on the right road for recovery and she's progressed very well.
>>:  Independence.
>>:  You're on your own doing and things on your own, noticing you can do it again or that you always good, should have never doubted yourself.
>>:  Yeah I'm in my apartment and I'm just so glad to be in here.  Doing a time like this it's the perfect time.
>>:  We know that thinking about moving can feel daunting, especially in these uncertain times, but if you believe that you or a loved one should live as independently as possible in the safest setting available, please contact your local center for independent living.  Their nursing home transition programs will do their very best to find a community based home ... for a safe, secure and dignified life.
>>:  It just felt so right.  And I felt like freedom coming back.
>>:  Roads to freedom center for ... living of north central Pennsylvania ... 
MISTY:  So the video we just showed or you just saw was a video that our center for independent living decided to produce and sort of help educate our communities on transition.  I know the analogy I said prior to showing the video was the that transition services are offered on blue sky days, and so we're talking here about a pandemic and disaster emergency relocation, and so for us at Roads to Freedom Center for Independent Living early on in the pandemic, we sort of set back and started looking at some of the transition services that we were providing and the individuals that we had in congregate settings and trying to work with other ... services to the individuals we are providing transition services to that are right now locked into congregate settings like Ebony described.
So on this slide here I have a flowchart that can be found on the website of services offered through independent living centers and you'll see circled and with the red arrow is moving from institutions and also resources here on the I LR LU ... which can provide more information on transition and sort of ins and outs of it.
Next slide.
On this slide is a image of the A C L website here again and the link here for the peer transition programs and more resources about the initiating emergency relocating transition.  This is the presentation we did back in March.
Go to the next slide please.
In those resources adapting nursing home transition programs and really relocation is transition on steroids.  Our team sort of met back in early of 2020 and discussed how we can adopt our nursing home transition to incorporate emergency relocations using hotels, dormitories, moats and with services and supports in place so that individualized assistance was available, attendant care services, DME, transportation, all of the things we would typically be using in a transition but sort of expedited with a use of a hotel room as well.
During the federally declared disasters FEMA, as we're doing this, we understand that April of 2020 FEMA initiates a category fee funding approval for homeless, first responders and healthcare workers.  Shortly after we worked with other allies advocates to discuss what does FEMA Category B funds look like, what do they cover, and sort of understand FEMA a little bit better.  And later in this presentation Marcie going to share information about that.  But this is the timeline ... related to one emergency relocation we provided in ... county.  
And during the process, and there's a sort of more extensive listing of all the correspondence and the timeline that we had, but this is sort of a condensed version to show you that as soon as we learn about FEMA category B funds for noncongregate sheltering, we start thinking how can we use these funding sources to help relocate people in noncongregate settings.
... to give residents of institutions the option of moving to a safe environment.
So with the FEMA Category B funds we understand there's reimbursement for life saving emergency protective measures and as we follow up in June, by this time advocates are convening with federal, state, and local officials to understand what category B looks like, how do request reimbursement through it and you'll see here on the slide instruction are now being tabulated 14 ... (reading verbatim) ...  And during this discussion in late June, FEMA is eager and willing to explore the possibility of reimbursing a center for independent living on relocation services.
Our state department of health is interested in looking to tweak policy ... PE MA says funding only goes to facilities and we'll talk about that, what the reference is during a federally declared disaster ... unfortunately CILs are not consider ...
... sort of delay the process a little bit further as we're trying to figure out with FEMA what sort of category B fund if relocation is eligible and how to draw down those funds, we're advised to go back to our county.  FEMA's position in November of 2020 added at a disability summit is sort of reinforcing that FEMA wanted flexibility on how communities respond and sort of suggests we go back to our local county emergency management agency.
Also in November of 2020 go nor wolf says Category B funds are only specified for those 3 categories you mentioned earlier, homelessness, first important and healthcare workers.
The state FEMA ... and sheltering does not fit into the current allowable noncongregate sheltering action as we fined by FEMA in October of 2020.
Later they asked if ILCs operate a facility and asked as a FEMA question.  So I mean we can see there's still this sort of miscommunication A lack of knowledge on transitioning services provided by centers for independent living and how that relates to emergency relocation and whether or not we're a private nonprofit with a facility or what we later learn is that community based organization.
So also on this slide by ... county ... agency provides information to advocates who sort of contradict it is earlier advice of FEMA and PE MA and says county officials have no reimbursement authority and so you would have to go back to your state FEMA and PE MA so they go in a circle for a little bit.
Next slide please.
Thankfully in early December of 2020 with the help of the advocates from the partnership for inclusive disaster strategies and the world institute on disabilities there's finally an update a FEMA addendum that goes over Category B funds as we've been working and asking FEMA for more clarification, I think we'll see in this addendum near a link in and all of this included in the resources on your webinar where you enter the session.
Pages 7 and 8 call on counties to establish relationships with community based organizations.  And they specifically name CILs community based organizations and then advice on attending care services and transportation are actually covered under those category B funds.
Next.  So inconsistent spoils continue to hinder sort of the work as we had to spend all this time advocating and understanding the process.  In January ‑‑ or late January 2021 secretary of Pennsylvania department human services Tracy Miller says as an NHT provider, C I LNC P has (reading verbatim)  ... pandemic.  Unfortunately during this time, we've had 6 people die from COVID before the transitions could be completed and here's where I'm urging our state to advocate for emergency relocations and help us get more clarification on how we can actually request reimbursement.  This entire time as I explained we're ... not knowing if we can request reimbursement through FEMA.
Our state practices managed care so secretary Miller had been interested or at least in the process of discussing whether managed care organizations would also participate in and to what extent we request reimbursement through.
During this time infections 617447 infections in long‑term care facilities and 122180 deaths in long‑term care facilities due to COVID.
So next slide please.
And just as a little we've been providing transition services for decades and I started in 2005 and had never experienced deaths on our participants waiting to get out of the facility like we had of course during this time.
So as the numbers continue to increase, we continue to request for further clarification.
On march 4 or 2021 we hear from the administration of ... they heard about this emergency relocation work and is interested in funds ‑‑ innovative approach they would like to have further discussions on.
Next slide.
So here's a slide that sort of outside lines communication between February 2021 to the end of August of 2021 with tall infections and deaths included.  So in February 2 we submit a draft memorandum of understanding to our county, emergency management agency, actually that was on January 13.  And this was our understanding of what needed to take place in order for us to request the reimbursement for the expenses provided to the individuals we had relocated.
On February 2 the county emergency management respond says it's been sent to solicit or the for review.  Infections are at ....  At the time the death rate is now ‑‑ that's not right.  Maybe that's a typo.  We'll fix that.
March 19, 2021 we checked in on the status of our MOU and find that the county ... sends was link for what we would use if we were a private nonprofit which we established long ago that we weren't so further continuation estimate may 4, 021 and the county spoke with PE MA, in order to move forward needs us to revise our invoices so they are addressed to the county rather than to FEMA.
We do that and then August 9 we get an update from FEMA that C I L is not currently eligible because we didn't complete a form that the county needed to complete.
On August 31 we finally get the cop formation that our county submitted the paperwork needed for the next step and the process and we are officially an applicant.
So from what started in April of 2020 we no now at August 31 of 2021 and finally have an application.  In
Next slide please.
August 19 we're going back a little bit, but just to point out that between the August 9 and August 31 timeframe this correspondence took place with the director of after the office of equal rights and partnership for inclusive disaster aster strategies where it was further discussion and it was realized that our county and FEMA, there must have been some miscommunications between the two, we had not heard from the county as to whether better approved or not.
And so in following up we understood that there was further discussions between ... county and the FEMA so FEMA's rendition was ... to address our application with them.  They said FEMA says the request is somehow ... is not an option and that it's not needed, they can go to the county.  But one thing I left out earlier as many CILs cover many counties, we are 36 counties for transition, if you can imagine this process for each county, that's unrealistic.
This was for one relocation in one county.
Next slide please.
So on the screen is two pictures of the U.S. with infectious of COVID‑19 in nursing facilities from July 5 to September of 2021.  And then right‑hand side is the infections ‑‑ or sorry the deaths in the nursing facilities for the same timeframe.  And this slide is showing a gradual from light pink to dark pink as the U.S. fills up with COVID infections and COVID deaths during that time.  We wanted to show that during the process of trying to find out how to go about paying for relocation services, you know, we talk about the transition service being recently added service that didn't come tied with funding availability or extra funding.
Having to sort of up front the cost for emergency relocation if we could short than process and certainly be a private nonprofit that through down from FEMA, it would make it much more realistic than going to each county and developing an M O D going through the process of advocating for and receiving reimbursement services through FEMA through the county.
So that's the long story or the condensed story from our experience with emergency relocation.  There's more information and resources to give you sort of examples of the MOU we used and the resources that I NAD my slides.  And with that I will turn it over to Marcie Roth from the world institute or disabilities to share more about FEMA Category B .
MARCIE:  Thank you very much, Misty and Ebony and Elissa and everyone who has been working together.  My name is Marcie Roth, I'm the executive director of the world substitute on disability, I'm an older white woman with ... red glass, a black top, and I'm sitting in a room with a fireplace behind me and some red roses.
I'm going to give a very brief couple of slides about FEMA's public assistance Category B emergency protective measures process.  And I want to say that FEMA's reimbursement is now proven to be a solution for Independent Living Centers.  We still don't have a solution for providing those funding resources up front, but thanks to the work that Misty and her center for independent living did, without it we now know that FEMA can reimburse centers for category B eligible work.
And I'll talk a little more about that in a moment.
Next slide please.
So just to kind of get us sort of all on the same page, there is a federal disaster declaration process and it begins with either a disaster or a threat of disaster.  State resources are considered to be overwhelmed.  The governor of that state requests federal assistance.  And the President issues a declaration.
Next slide please.
When that presidential declaration is declare, it could be one of two kinds of declarations.  It could be either a major disaster declaration or an emergency declaration.  And in either case, public assistance can be provided if the State requests it.  To be clear, public assistance is not like we think of in human service, public assistance is infrastructure support in emergencies.
Next slide please.
So when we're talking about emergency declarations and public assistance, we're talking about emergency protective measures, we're not talking about individual assistance or hazard meditation, and.  We've talking specifically about public assistance and most Marley Category B emergency protective measures.
And FEMA provides these resource, reimbursement resources, to state local territorial and tribal governments and certain nonprofit organizations.
Next slide please.
And they have 166‑page guide that describes how all of this works so you can have the link here and it will be on the website.  Next slide please.
And those emergency protective measures are to eliminate or lessen the immediate threats to lives, public health, or safety and there's a long list of things that are included.  Transporting and prepositioning equipment.  Supplies and commodities.  Medical care and transport, evacuation or sheltering, use or lease of generators, dissemination of information.  And keeping in mind that every federal dollar spent by the Federal Government or given to the state or given to a grantee must comply with The Rehabilitation Act, physical access, program access, effective communication access.
So I have argued for a very long time that independent living centers should be able to be reimbursed for transportation that might be provided during a disaster if you're assisting people to evacuate.  It might include the opportunity to provide information in alternate formats before during and after the disaster.  It might include providing assistance in a shelter or in a disaster recovery center or many other types of emergency protective measures.
Next slide please.
And as Misty was talking about, there are a number of facilities that are considered to be nonprofits, that are eligible.  Disturbingly FEMA identifies 3 types of places that actually are considered nonprofit organizations eligible for FEMA assistance.  And those 3 are daycare for individuals with disabilities, or Access and Functional Needs, and then they specifically identify Alzheimer's disease, autism, and muscular dystrophy.
The second category are residential services for individuals with disabilities.  And the third category are sheltered workshops (reading verbatim)  ...
So I'm sure you will join me in my disgust over the very narrow thinking that went into the development of these policies.
Next slide please.
So there is quite a bit of information about noncongregate sheltering that became a particular focus during COVID.
And FEMA approved 100 percent cost reimbursement to the states to relocate people experiencing homelessness from homeless sheltering force noncongregate settings like hotels and motels.  And this period is from January of 2020 through November 30 of 2021 and it probably actually exceeds that because they have not just extended the public health emergency.
Next slide please.
And this of course includes infectious diseases and FEMA works with the centers for disease control in providing assistance and that assistance includes rescue, evacuation, movement of persons, movement of supplies, care, shelterings, and other essential needs of the affected human populations.
So needless to say the work that Independent Living Centers do and other disability lead organizations are work that should be reimbursed.
Next slide please.
And again there's a long list ‑‑ I'm sorry ‑‑ FEMA also provides assistance not only for sheltering, but in transitioning people when there's no longer an immediate threat to life or public health and safety.
Next slide please.
And there are a long list of those essential community services.  I'm going to move quickly here.  Next slide please.
And there are very important policies that have enabled the housing of people in noncongregate settings.  Next slide please.
And FEMA has made that funding available if it weren't for Misty and her center, Independent Living Centers would not have become eligible.  Well they were eligible ‑‑ we would never have cracked that code.
And while this is the end of my slides, I'm not going to ask that we move to the next slide.  Which is a video and this video is of the Washington monument.  And a recent art display, art installation with the 700, which is now 72 7,000 people move lost their lives to COVID.
We know that of those 72 7,000 people who have died near the U.S. from COVID the vast majority of them are people with disabilities.  Next slide please.
And so as we look at those flags, which are covering the area in front of the Washington monument, and next slide please.
And a close up of some of those flags thanks to our friend Marjorie riff kin, a flag for each state has been planted and those flags outline the number of deaths in institutions of our people due to COVID.
Thank you very much.  And I am now going to turn it to Germán Parodi to take us through the next slides.
GERMÁN:  My name ... I'm the co‑executive director of the partnership for inclusive disaster trait just.  I'm follow misty saying ... man using a wheelchair.  I'm wearing a black scarf and a purple long sleeve shirt.
As you've heard today, there are many issue, but there's a path forward.  But we need to do and to make this steam lined is having FEMA acknowledge centers for independent living and other community based organizations as eligible private nonprofits under the FEMA public ... guidelines.
And have they need to engage with the disability community leader as at the federal, state, and county local level.
HHS and A C L could also fully fund all the activities covered under the fifth core services as you well know and create a new 6 core service around emergency management.
And have Congress shaly there's ... inclusion for disasters act, HR 4938, S2658, which would create technical assistance and ... disabilities across the country.
And the disaster relief Medicaid act ... that's HR 4937, S266.  And to learn more visit it at reaadi.com.
Lastly please join our in two days in the APRIL conference on Thursday, October 21 where we will take this conversation further in our inclusive disaster resilience during the pandemic panel at our APRIL conference.  Thank you for having us.
>>:  Thank you so much to all of our presenters.  We're going to jump right to the Q & A.  We have just a few minutes left and we should be able to debt doctor we've got two questions, first coming to us from an anonymous attendee, this question is for Misty, why is your C I La nonprofit ‑‑ wait.  (chuckling) why is your C I L not a private nonprofit.
MISTY:  This is Misty so just to be clear as a center for independent living we are a 501 C 3 nonprofit organization.  However as recognized by FEMA, private nonprofits are like Marcie explained daycares and institutions rather than nonprofits as we classify.  Does that answer the question?
>>:  I think it does.
>>:  Okay, moving on to the next question from Aurri Houston ... operationalizing inclusion (reading verbatim) and leading global disability rights program for FEMA?
MARCIE:  Thank you jury much more that question.  This is Marcie Roth and feel free to reach out to me.  Our contact information was on the previous slide and I know it will be on the website I will be happy to connect you with the folks that are doing work that you might be interested in getting involved in.  And that would include the partnership for inclusive disaster strategies and A P R I L, of course you're already involved with APRIL, there are a number of us working together on both on a daily basis and through a shared initiative to relocate people out of institutional settings and disaster and to shut the front door and tear down the laws.
>>:  Thanks, Marcie.  This is Elissa and we are coming up on about 5 minutes left.  I don't see anymore questions in the Q & A box.  However I do want to remind everything that there will be resources on the APRIL conference website for everything you have heard here, seen here, the slide shows T videos, everything will be available to you.
And I also want to remind you to please fill out your evaluations, you should be prompted as soon as the session end, please to that.  That helps us improve if we need to, it gives great feedback for the presenter, and it's a very important part of making our conference a success every year.
So I appreciate all of you joining us today.  And if you have any further questions in the next couple minutes, please go ahead and pop them in the Q & A.  We've got about 3 minutes left or we can give you 3 minutes back of your day.  (chuckling).
>>:  I think Aurii wanted to say something.  Do you have your hand up to speak or did you want to connect with Marcie later?  Okay.
Well, thank you all again.  And like Elissa said we dropped the evaluation in the chat as well.  And we hope to see you at this evening's events of a social hangout.  It's definitely not a lounge or a hotel waiting room, but it's the best we can do (laughter).  Thank you and we'll see you all tonight or tomorrow morning.