Cot-to-cot: An evidence-based model for identifying client needs in disaster shelters

Background: In 2010 FEMA released guidance for meeting access and functional needs of clients in congregate care disaster shelters. Screening clients as they arrive in disaster shelters using a medical triage style system has shown that clients' functional support needs are often missed. This study sought to improve the screening instrument currently in use, and to tie identified access and functional needs to a staffing support/need prediction. Method: In 2011 in four disaster shelters,access and functional needs-focused client screening instruments were trialed. Assessment was done ‘by family' with 107 adults interviewed representing 233 individuals. Clients were interviewed three or more days post arrival to the shelter. Local census data of persons with disabilities was used to compare the percent of persons “predictable” as having functional support needs in shelters with the actual percent found in the shelters as result of the population assessment. Results: In no shelters was it possible to tie identified needs to published criteria for predicting staffing. In three of four shelters, data showed twice as many persons in the shelter needed functional support than was predicted by county census. Client needs were met through continuous presence of nurses who made rounds to supplement client-directed requests of assistance. Conclusion: Shelter clients are not always able to identify the range of their support needs on arrival. The ideal strategy for identifying and addressing access and functional needs is for shelter health care system to implement a Cot-to-Cot assessment strategy initially and repeat at least 72-96 hours later.