California has known that disabled people need help in fires. After LA, can it better prepare?

Associated Press

19-02-2025

When strong winds shattered the windows on the top floor of Nancy Busacca's Pasadena home, Michelle Hollis knew it was time to go.
Hollis, Busacca's caretaker for the past year, packed the essentials. She tried to remain as calm as possible so as not to frighten Busacca, who, weakened by esophageal cancer, could not walk.
As flames neared the home, Hollis first worried about smoke inhalation because Busacca used supplemental oxygen. At the same time, Hollis tried to figure out how she would lift Busacca into her SUV. Luckily, a second caregiver who had wrapped up her overnight shift had stayed to help.
Hollis recalled turning to the second caregiver: 'I said, 'Hey, do you have faith?' And she was like, 'Yeah.' I said, 'Okay, we're gonna get through this.''
They did, but their experience in the wildfires that ravaged two Southern California communities last month served as another reminder of the threat that natural disasters pose for people with disabilities and limited mobility as well as their caregivers, who often take on the role of first responders in these situations.
These dangers have been apparent for decades, especially since Hurricane Katrina, the most deadly natural disaster in recent U.S. history, leveled the Gulf Coast in 2005. In California, the deadly fires that struck Sonoma and Butte counties in 2017 and 2018 resurfaced these issues. A state audit from 2019 showed that historically, emergency response by state and county agencies have struggled to properly assist people with disabilities and limited mobility.
Several of the people who were killed in the most recent Southern California wildfires were disabled and the majority were over 70, news reports identifying the victims show. The stories are tragic, but not surprising, aging and disability advocates say.
'Older adults and people with disabilities are often disproportionately impacted by wildfires due to factors like mobility limitations, chronic health conditions and social isolation, and that appears to be the case again in Los Angeles,' advocates wrote in a letter to Gov. Gavin Newsom and the Legislature.
In the letter, a coalition of 126 organizations that included the AARP, Justice in Aging and the Alzheimer's Association, asked the governor and lawmakers to prioritize disabled and older residents as the state distributes wildfire recovery funds. The request to the state is less about a specific dollar amount and more about creating a recovery process with this population in mind, said Hagar Dickman, director of long-term services and support advocacy at Justice in Aging.
Advocates and caregivers also want more resources and centralized planning to prepare for the next disaster. As climate change fuels more frequent and more devastating events, prompt action is key, they say.
County officials are still assessing the effect of the fires on people with disabilities and the elderly, said Laura Trejo, director of the Los Angeles County Aging and Disabilities department. Part of that work, she said, is checking in with nursing homes and assisted living facilities on their relocation and reentry efforts; it also involves calling and checking in on people who live at home and receive county services or participate in a county program, such as in-home help or transportation services.
The biggest challenge has been the scale of it all, Trejo said. 'In over 35 years of doing this work in Los Angeles County, I have never had that many facilities evacuated at the same time, that was unprecedented.'
The January fires prompted some 2,500 people to be evacuated from nursing homes alone, according to Trejo's department's latest counts, she said. Nursing home and assisted living residents were temporarily sent to emergency shelters, and later relocated to facilities where they could stay more long-term.
It is unknown exactly how many people with a disability or limited mobility who were living at home were displaced by the fires because there isn't one centralized way to track them.
The governor's office referred questions about resources and plans specific to this population to the California Office of Emergency Services. The office did not reply to questions from CalMatters. In a press release from last month the governor's office listed a number of efforts that state agencies are participating in, including wellness checks on people with developmental disabilities and facility inspections on nursing homes and assisted living centers to ensure a safe reentry.
Tailoring emergency response for unique needs
People with physical and cognitive disabilities have needs that aren't usually met with traditional emergency response. Many cannot drive. Some may not fully understand the risk they are in.
'The thing for people with disabilities is that the ability to, at the last minute, throw something together and get out of harm's way, you cannot rely on that,' said Silvia Yee, policy director at the Disability Rights Education and Defense Fund. 'That won't happen. So the planning has to be there.'
In a 2019 report, the state auditor said that California was not adequately prepared to protect and respond to vulnerable populations during a natural disaster. A look at three counties — Butte, Sonoma and Ventura — showed deficiencies in wildfire evacuation warnings. It also found that none of the counties had done assessments of their respective populations' needs or pre-arranged for evacuation assistance. 'Inadequate preparation likely hindered the counties' responses to the 2018 Camp Fire, the 2017 Sonoma Complex fires, and the 2017 Thomas Fire,' the report said.
The issues that people with disabilities face in emergency situations have been widely known for some time, but the urgency to improve plans seems to come and go, Yee said.
'Periodically, something happens,' Yee said. 'People are appalled. Advances are made, and then we just fall back. We don't advance in terms of implementation and enforcement.'
County officials and advocates have a number of improvements they'd like to see.
Dickman at Justice in Aging said one of her concerns during the January fires was the seeming lack of preparation in evacuation centers to accommodate disabled and older adults. When nursing home residents were taken to the Pasadena Convention Center, for example, news reports showed a shortage of cots and basic supplies, such as respirators and incontinence products.
'These are individuals who need a significant amount of support and durable medical equipment,' she said. 'Shelters or emergency centers need to be prepared to receive individuals from all kinds of areas with all kinds of needs.'
Trejo with the Los Angeles County's Aging and Disability department — a fairly new agency — said she'd like to expand emergency education efforts and take the 'vial of life' protocol to scale. A vial of life refers to a packet that includes all of a person's medical information. The state's Department of Aging has an emergency preparedness guide that includes a vial of life that people can print and fill out. Ideally every home would have one, Trejo said.
She'd also like to create a tool for people who want to self-identify as having unique needs. That way local agencies know where these people live even if they're not enrolled in a county program or service. Some disasters, such as earthquakes, hit without warning, but fires may allow for more thought-out evacuations.
'If we're pre-evacuating an area then we would know 'in this area we have 25 people that live alone who are mobility challenged and who we need to assist earlier,'' Trejo said.
Janie Whiteford, president of the California In-Home Supportive Services Consumer Alliance, is 80 years old and a quadriplegic. In the past she has relied on her local fire department in Los Gatos to help her or her husband.
'I think it is super important that your local fire department knows who you are,' Whiteford said. 'Our guys know me well because I've fallen out of my wheelchair a couple of times and I've called them when I can't get back up. I've said 'Put me on your list. If we have an earthquake and it's a bad one, I want you guys to call me or come and check on me.''
Whiteford imagines a system where first responders or a separate local agency can immediately call people with disabilities and check in. 'In a perfect world, you would have an organization that would have vehicles that could go out to help these people, or would know exactly who to contact,' she said. 'Some type of rapid response taxis.'
In large events, first responders may not be able to check in on individuals right away. For that reason it is also important for people and their caregivers to build their own response team of nearby family and friends or neighbors who know about people's limitations, said Yee at the Disability Rights Education and Defense Fund.
'You have to build the community around you to survive this kind of situation,' Yee said, 'Because it's not always going to be the police or the fire department riding to the rescue.'
Training caregivers for the next disaster
Hollis didn't have an evacuation plan in place as the Eaton fire approached, but more than 30 years of experience as a caregiver both in California and in her home state of North Carolina prepared her to think quickly and keep calm in the face of the Eaton fire.
Her original plan was to get Busacca in the car and drive to a hotel. But as she packed, she and the second caregiver flagged down a police officer who was ordering residents to evacuate. The officer called for Emergency Medical Services to pick up Busacca. After about a 30-minute wait, Busacca was taken to the hospital for evaluation, Hollis said.
Hollis feels grateful they were able to get out safely. Busacca died on Jan. 31 from cancer; she was able to come home for her final days.
While difficult to plan a smooth evacuation, Hollis believes emergency training for caregivers could be of significant value in thinking through different scenarios.
In many ways, caregivers are also first responders, but emergency training for them is often overlooked. Some training courses for caregivers exist, although the availability of these can vary by county and depend on funding.
The Center for Caregiver Advancement creates and provides training programs for caregivers, including those who work in nursing homes and those who provide care at home. One of its courses focuses on climate change and emergency planning.
The organization is currently offering its emergency planning course to workers of the In-Home Supportive Services program in San Bernardino County as part of a partnership with the labor union SEIU, which represents caregivers. Corinne Eldridge, the chief executive at Center for Caregiver Advancement, said her organization has so far provided the emergency planning course to about 4,000 In-Home Supportive Services workers across the state since 2021 – that's out of approximately 600,000 caregivers in this workforce.
Stories of the victims in the LA fires show that more preparedness is needed, said Nairi Issagholian, an instructor with the center. The emergency course she teaches gets providers to assess their skills, abilities and communication plans. It helps them go over scenarios they may come across in an emergency, such as losing electricity and with that access to an elevator or ventilators.
The course also teaches providers how to recognize the signs of trauma following an emergency. The idea is to help caregivers feel more prepared and self-assured before, during and after, Issagholian said.
'When the emergency happens, just that sense of a little control can make you feel like 'I'm prepared. I know what I'm doing,'' she said. 'It can give you that confidence.'