the Experts: Creative Solutions for Local Providers
by Local Providers
was management by the seat of the pants and lots of luck (that element
when opportunity meets up with preparation)—
Elsa Ramirez Brisson, Nutrition Manager, Monterey County AAA, Salinas,
natural disasters occur through floods, tornadoes, earthquakes, and
hurricanes, and some may be serious enough that they are Presidentially
declared. This declaration brings to bear the resources of the federal
government in order to restore the public facilities of a community
and to assist individuals in restoring their lives. During such declared
disasters, the Administration on Aging will disburse special funds to
those State Units on Aging affected. Many more disasters occur on a
smaller scale that are not of such scope and, therefore, are ineligible
for a federal response. This often leaves older persons dependent upon
their own individual resources and capabilities, which are often inadequate.
natural disasters on a small or large scale, incidents may occur at
congregate nutrition sites and senior centers, at a participant’s home,
at an agency’s office, on an agency operated van, etc. If a participant
or staff member encounters a problem, staff must be ready to respond
by calling for emergency assistance and/or providing on the spot remedial
treatment whether it is first aid or the use of the Heimlich maneuver.
Programs must have participant information on hand to contact family,
caregivers, or their physician if there is a medical emergency. Program
staff needs to know what to do when they find a home delivered meal
participant lying on the floor unable to move. Equipment breakdowns
also require alternate plans whether it means transferring food from
a non-working refrigerator to one that works or providing an alternate
menu that requires no cooking. Evacuation procedures must be in place
and practiced regularly in the event of a fire or other emergency that
requires evacuation. Programs need to have a plan in place to notify
participants of emergency situations such as floods, tornados, ice storms,
on-going activities provided by the Aging Network serves as preparation
for an appropriate emergency or disaster response. Currently, many States
require Area Agencies on Aging (AAAs) to develop disaster preparedness
plans that deal with the process of disaster response. A key element
to the disaster response strategy is disaster advocacy and outreach.
Typically, agencies will expand or develop new services in order to
meet identified needs. One of the services that may be established is
"Disaster Advocate and Outreach Services". Over the years,
this service has been identified as the most critical service that can
be provided by the Aging Network for older disaster victims.
Units on Aging, AAAs, and Indian Tribal Organizations play critical
roles in disaster response. State Units on Aging (SUAs) must facilitate
the flow of information, provide technical assistance and maintain momentum
in service delivery and development of funding to support the needs
at the local level and older adults in the community effected. For example,
the SUA must assure that the AAA know when shelters are going to be
open and their locations so that AAA staff can be present to facilitate
assistance for older adults. The SUA must coordinate the flow of information
so that appropriate state organizations, including the State Emergency
Management Agency and the Administration on Aging know the status of
older victims and assistance needs. (From
the Administration on Aging’s Emergency Preparedness Manual for the
Aging Network, 1995)
the local level, AAA and provider staff may be responsible to coordinate
emergency procedures with their respective Emergency Management Office
(EMO) and be included in their local EMO plan. This may mean keeping
staff and participants informed of the nature of the disaster and response.
Congregate dining centers and other facilities operated by an AAA or
provider may become a temporary shelter and/or food preparation site
serving people of all ages. Plans for such assistance should be in place
that includes the facility’s capacity to become a shelter, the type
of food items to be available (e.g., soups, sandwiches, and beverages),
and the responsibilities of staff and volunteers. It is important to
be familiar ahead of time with the agencies that provide financial or
material assistance and their reimbursement and documentation requirements.
These agencies include the SUA, the State agency that administers USDA
commodities, the Red Cross, and others. Such required documentation
may include a log of food and disposable items used, a record of the
number of meals provided and to whom, a telephone log, and a list of
workers and volunteers and their time involved in an emergency.
dealing with emergency situations must be sensitive to the needs and
capabilities of older adults in the planning and provision of emergency
services. It is a good practice for the State Unit on Aging, AAA, and
local providers to work with their emergency response agencies in developing
guidelines to best serve older adults. The Administration on Aging’s
Emergency Preparedness Manual for the Aging Network includes
a summary of special concerns of older adults and this is included later
in the text.
learn more about how nutrition service providers have prepared for emergencies,
a “Quick Survey” on the subject was distributed to the Aging Network
via the Center’s Listserve and distribution lists in December 2001.
This survey was developed with assistance from Marla Bush in the Disaster
Relief section and Jean Lloyd of the Administration on Aging. A total
of 19 responses were received and a number of individuals offered to
share their expertise and written documents. The survey below, is presented
as a checklist of items that should be addressed by SUAs, AAAs, and/or
local providers. The responses, indicated by percent, provides a snapshot
of where programs have and have not developed procedures for a particular
emergency situation. Use this checklist to determine your programs’
level of emergency preparedness.
Written procedures are in place: (n=19)
contact staff (eg, telephone and cell numbers, phone tree) (100%)
weather-related emergencies. (100%)
determine program closings. (90%)
notify participants of program closings (eg, radio, telephone). (90%)
facility and equipment breakdowns. (75%)
individuals are hurt or become ill. (63%)
emergency service agencies to assist in meal delivery, rescue, or
other matters. (53%)
key personnel are absent (eg, cooks). (50%)
threat of harm (eg, bomb threats). (16%)
Staff is trained: (n=18)
dealing with participants who experience a sudden illness or are involved
in an accident. (83%)
fire/building evacuation emergency procedures. (78%)
treat participants who are choking (eg, Heimlich Maneuver). (72%)
In an emergency, available are: (n=16)
food/catering services (eg, restaurants, schools, hospitals, etc.).
such as water, portable radios, batteries, flood lights and flashlights,
first aid kits. (50%)
to power refrigerators/freezers and/or alternative cooler space. (38%)
nutrition program’s foodservices plan to provide food to the
community (eg, emergency shelters, senior housing). (38%)
To assist older adults in an emergency situation: (n=19)
files include emergency contact or caregiver designee information.
are provided printed information about the types of foods and other
necessities to have on hand for emergencies. (84%)
are identified ahead of time if they will need special assistance.
meal packages are provided to selected congregate participants for
future use. (58%)
meal packages are provided to selected homebound participants for
future use. (58%)
requiring shelf-stable meal packages for emergencies receive them
regardless of their funding source. (58%)
checks on a regular basis to ensure that participants that received
shelf-stable food packages have them available (that the meal packages
were not used). (32%)
to access health care in emergencies. (26%)
number of responses to the survey was limited. Only 10 of the 25 procedures
on the checklist were in place by 75% or more of the respondents. This
snapshot of general program preparedness indicates that there are still
many areas that require attention by programs. A number of individuals
have shared their policies, procedures, and other documents as requested
in the survey and these are listed below. Other federal agencies and
organizations that provide for emergency services are also listed.
State Division of Aging Bonnie Athas, Program Specialist.
and guidelines are available. Each Center is responsible for tailoring
emergency plans in response to chemical spills, power outage/other utility
problems, storms, civil disturbances, earthquakes, fire, flood, nuclear
problems, and bomb threats.
County Area Agency on Aging (Olathe, KS) Linda Netterville,
Nutrition Program Manager. Policies
and procedures for center and kitchen staff are available to respond
to emergencies. These procedures include staff communications, participant
notification, criteria for closing centers and home delivered meal services,
and the provision of emergency meals.
County Area Agency on Aging (Cortland, NY) Joyce Maney, former
Nutrition Project Director is also a trainer for emergency response.
procedures for the agency are available to respond to emergencies
or disasters/critical incidents in coordination with other emergency
management agencies within the county and state. These procedures include
several important categories: (1) preparing for emergencies, (2) response
to alerts and general response to emergencies and shelter needs, and
of Duluth Parks & Recreation Department
(Duluth, MN) Kathleen Larsen, Senior Program Director. Small posters indicating the radio stations and other
media that announce the status of Meals on Wheels and Senior Center
closings are available.
County Chapter, American Red Cross A
group of older adults who experienced a two-week power outage when a
massive ice storm hit the Greater Rochester, New York, area worked with
their local chapter of the Red Cross (who is also a caterer for the
Visiting Nurse Service Meals on Wheels program) in preparing information
to assist in preparing for emergencies. http://www.redcross.org/disaster/safety/seniors.html
County Area Agency on Aging Elsa Ramirez Brisson, MPH, RD, Nutrition
County was the site of more than 6 nationally declared disasters from
1989-2000. Each time the areas hit the worst were in our agricultural
area and many migrant farm families were displaced. Ms. Brisson continues
to be active in the response and training of Department of Social Services
managers that work with the Red Cross to manage shelters and other needed
services. She lives within walking distance of the largest shelter
location and is bilingual/bicultural.
Monterey County Nutrition Program is prepared to assist the community
in a crisis. They know where some of the frailest older adults reside
and have a network that can reach them. All central kitchens are on
the A list for power and most have generator back-up.
in Case Kits” is an on-going program for home delivered meals participants.
Shelf stable meals are replenished each June or after use. The food
packs are purchased from Sun Meadows Foods. The program also assisted
the Red Cross with redesigning the "File of Life" or what
used to be called the “Vile of Life.” It includes a leaflet in a pouch
that sticks to the refrigerator with a magnet. The leaflet holds a
person’s medication and health information. EMS personnel are trained
to look on the refrigerator when arriving to assist someone especially
a senior. http://www.aaamc.org
and descriptions of many projects funded by the Red Cross and provided
by the aging network are available at www.prepare.org.
of Senior Centers and Services of New York City, Inc.,
Igal Jellinek, Executive Director, presented suggestions on emergency
preparedness with particular reference to the September 11, 2001
terrorist attack at the National Association of Nutrition and Aging
Services Programs Conference (Salt Lake City, June, 2002).
staff backs up all its essential computer files on a regular basis
and keep a copy in two different places.
that restaurants in the area are willing/able to provide emergency
a list of volunteers who are willing to help in an emergency.
with local law-enforcement and community-planning agencies to create
a secure photo ID system for professional health care and senor service
workers that will enable them access to your facility in an emergency.
with local officials to develop contingency plans for moving people
(including those in wheelchairs), emergency supplies, and medication.
Have seated canes and evacuation chairs available for
those less mobile.
- Develop a network of emergency pharmaceutical services
that includes the means to both fill medications and get them to those
who need them.
- Upgrade communication systems (including trunks of
phone lines and emergency response systems) and develop “redundancy”
communication plans, including instructions on the use of emergency
communications products and tools and back-up services. Staff should
have cell phone numbers, two-way radios, etc., to communicate.
- Contact clients and staff immediately and as continuously
as possible: ensure that people do not feel isolated or abandoned
and have the means to communicate with the outside.
- Teach staff to remain flexible in terms of implementing
emergency-preparedness plans, making sure to adopt to the nature and
site of the disaster/emergency.
- Understand that staff may feel a need to offer help
and to be helped; offer group discussion sessions, and if possible,
allow staff release time for volunteering.
- Provide crisis counseling for older adults, caregivers,
and staff. Older adults can be a resource as they lived through many
wars which makes them more familiar with disasters and better to cope
with the situation. Be aware and work with mental health services
who may not be accustomed to working with older adults.
- Be aware and provide for the needs of individuals who
are visually impaired and/or deaf or who have other special needs.
Maintain a list of who needs help in coops, apartment buildings, shelters,
- Ensure that individuals have adequate water and food
- Ensure that individuals have adequate shelter, toilet
- Be prepared and make it an opportunity to connect with
other agencies. Plan fund raising events for emergency supplies and
that an individual’s pet(s) is taken care as some individuals may
refuse to leave without their pet.
Foodservice Corp Jackie Abbott,
President, and Roger Whitfield, Vice President, presented suggestions
on emergency meal services at the National Association of Nutrition
and Aging Services Programs Conference (Salt Lake City, June, 2002).
at least 3 days worth of food on hand.
purveyors may provide freezer/cooler trucks for emergencies. Ask them
for support and product discounts.
may use dual power sources such as gas and electric. Determine value
of having back-up generators or know where to lease one in an emergency.
Sterno on hand, coolers and blue ice, disposable pans and utensils.
“Heater meals” heats itself and includes an entrée and vegetable ($3.25-3.75).
Used primarily by truckers and campers.
number of companies prepare and package shelf stable meals.
that your food supplier is prepared.
emergency plans in service contracts / RFP.
on Aging Website has a dedicated
section “Disaster Assistance Resources for Practitioners and the Aging
Network,” that provides numerous resources and links to agencies involved
in this effort. http://www.aoa.dhhs.gov/disaster/network/default.htm
Emergency Management Agency FEMA advises on building codes and flood
plain management, teaches people how to get through a disaster, helps
equip local and state emergency preparedness, coordinates the federal
response to a disaster, makes disaster assistance available to states,
communities, businesses and individuals, trains emergency managers,
supports the nation's fire service, and administers the national flood
and crime insurance programs. http://www.fema.gov/
Red Cross Provides numerous resources
and advise on topics such as terrorism--preparing for the unexpected,
power outages, family disaster planning, and special needs and concerns
with additional information for older adults and people with special
medical concerns that could hinder mobility during a disaster. http://www.redcross.org/services/disaster/beprepared/
Department of Agriculture, Extension Disaster Education Network
The EDEN links members from across the U.S. and various disciplines
-- so they can use and share resources to reduce the impact of disasters.
EDEN has resources covering food safety to field safety, physical and
psychological needs, governmental process and community development.
of Health and Human Services: Office of Emergency Preparedness
has the Departmental responsibility for managing and coordinating Federal
health, medical, and health related social services and recovery to
major emergencies and Federally declared disasters including: natural
disasters, technological disasters, major transportation accidents,
and terrorism. http://www.oep-ndms.dhhs.gov/
of Transportation - Office of Emergency Transportation The OET performs coordinated
crisis management functions for multimodal transportation emergencies,
including: natural disasters, technological incidents / accidents, labor
strikes, security situations, such as domestic criminal acts or international
terrorist acts, and national defense mobilization. http://www.rspa.dot.gov/oet/oet/
Business Administration Provides information on disaster recovery
loans and grants and financial assistance for older disaster applicants.
for Disease Control Provides public
health emergency preparedness and response information. http://www.bt.cdc.gov/
Accommodation Network (JAN) Published Emergency Evacuation Procedures
for Employees with Disabilities intended to provide an overview
of emergency procedures for employees with disabilities. The Americans
with Disabilities Act of 1990 (ADA) requires that employers, public
services, and public accommodations and services operated by private
entities modify their policies and procedures to include people with
disabilities. Though individuals with disabilities may have specific
needs and concerns, all employees will benefit from knowing workplace
safety features and emergency procedures. Because some individuals with
disabilities require a personal attendant or job coach, it is important
that these individuals are also consulted. In addition, many workplaces
contract with cleaning crews, security guards, and other services that
may have employees with disabilities on staff. http://www.jan.wvu.edu/media/emergency.html
Searchable Online Accommodation Resource (SOAR) is available at
and is designed to let users explore various accommodation options.
of Special Concerns (From
the Administration on Aging’s Emergency Preparedness Manual for the
Aging Network, 1995)
DEPRIVATION - Older persons' sense of smell, touch, vision and hearing
may be less acute than that of the general population. A hearing loss
may cause an older person not to hear what is said in a noisy environment
or a diminished sense of smell may mean that he or she is more apt to
eat spoiled food.
RESPONSE SYNDROME - Older persons may not react to a situation as fast
as younger persons. In disasters, this means that Disaster Application
Centers may need to be kept open longer if older persons have not appeared.
It also means they may not apply for benefits within specified time
DIFFERENCES - Depending on when individuals were born, they share differing
values and expectations. This becomes important in service delivery
since what is acceptable to an 80 year old person may not be acceptable
to a person 65 years of age.
ILLNESS AND MEDICATION USE - Higher percentages of older persons have
arthritis. This may prevent an older person from standing in line. Medications
may cause confusion in an older person or a greater susceptibility to
problems such as dehydration. These and other similar problems may increase
the difficulties in obtaining assistance.
DISORDERS - Environmental factors or chronic diseases may affect the
ability of older persons to remember information or to act appropriately.
TRAUMA - Frail older persons who are dislocated without use of proper
procedures may suffer illness and even death.
LOSS EFFECT - Many older persons have lost spouse, income, home, and/or
physical capabilities. For some persons, these losses compound each
other. Disasters sometimes provide a final blow making recovery particularly
persons. This may also be reflected in an inappropriate attachment to
specific items of property.
VULNERABILITY - Older persons are often much more susceptible to the
effects of heat or cold. This becomes more critical in disasters when
furnaces and air conditioners may be unavailable or unserviceable.
VICTIMIZATION - Con artists target older persons, particularly after
a disaster. Other targeting by criminals may also develop. These issues
need to be addressed in shelters and in housing arrangements.
WITH BUREAUCRACY - Older persons often have not had any experience working
through a bureaucratic system. This is especially true for older women
who had a spouse who dealt with these areas.
- Many older persons have lower educational levels than the general
population. This may present difficulties in completion of applications
or understanding directions.
AND CULTURAL BARRIERS - Older persons may be limited in their command
of the English language or may find their ability to understand instructions
diminished by the stressful situation. The resulting failure in communication
be further confused by the presence of authoritarian figures, such as
police officers, who may increase the apprehension and confusion in
the mind of the older person. A number of seniors speak languages other
than English, and there is a critical need
to be sensitive to language and cultural differences. This could mean
older persons in this category will need special assistance in applying
for disaster benefits.
IMPAIRMENT OR LIMITATION - Older persons may not have the ability to
use automobiles or have access to private or public transportation.
This may limit the opportunity to go to the Disaster Application Center,
obtain goods or water, or relocate when necessary. Older persons may
have physical impairments which limit mobility.
STIGMA - Many older persons will not use services that have the connotation
of being "welfare." Older persons often have to be convinced
that disaster services are available as a government service that their
taxes have purchased. Older persons
need to know that their receipt of assistance will not keep another,
more impacted, person from receiving help.
HEALTH STIGMA - Similar to welfare stigma, older persons often feel
ashamed that they may experience mental health problems. These attitudes
must be addressed individually if older persons are to receive mental
OF INDEPENDENCE - Older persons may fear that they will lose their independence
if they ask for assistance. The fear of being placed in a nursing home
may be a barrier to accessing services.
Abbott, President, and Roger Whitfield, Vice President,
JA Foodservice Corp., 377 Riford, Benton Harbor, MI 49022 (616)
926-2800 or JLAbot@jrpack.com
- Bonnie Athas, RD, Program Specialist, Division of Aging and Adult
Services, 120 North 200 West, Suite #125, Salt Lake City, UT, 84103;
(801) 538-3925 or firstname.lastname@example.org
Ramirez Brisson, MPH, RD, Nutrition Manager, Monterey County AAA,
1000 S. Main, Suite #211-A Salinas CA (831) 755-8495 or email@example.com
Jellinek, Executive Director, Council of Senior Centers and Services
of New York City, Inc., 49 West 45th Street, 7th
Floor, New York, NY 10036; (212) 398-6565, ext. 225 or firstname.lastname@example.org
- Kathleen Larsen, Senior Program Director, City of Duluth Parks
& Recreation Dept. 12 E. 4th Street, Duluth, MN, 55805;
(218) 723-3724 or email@example.com
- Joyce Maney, former Project Director, Cortland County AAA, 60 Central
Ave., Cortland, NY 13045 (607) 753-5060
- Linda Netterville, MA, RD, Nutrition Program Manager, Johnson County
Nutrition Program, 11875 S. Sunset, Suite #200, Olathe, KS, 66061;
(913) 447-8119 or firstname.lastname@example.org
Preparedness Manual for the Aging Network. March, 1995 - Produced
under the Direction of the US Administration on Aging, Fernando M. Torres-Gil,
Assistant Secretary for Aging, the Kansas Department on Aging, Joanne
Hurst, Secretary, Alicia Valadez Ors, Director. Accessed 4/30/02 at.
by Lester Rosenzweig, MS, RD, and staff of the National Policy and Resource
Center on Nutrition and Aging, Florida International University, Miami,
project is supported, in part, by a grant from the Administration on
Department of Health and Human Services (DHHS). Grantees undertaking
projects under government
sponsorship are encouraged to express freely their findings and conclusions.
Points of view or opinions do not, therefore, reflect official DHHS