Disaster Assistance: Improvements in Providing Federal Disaster Case Management Services Could Help Agencies Better Assist Victims
Published: 2009-12-02T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: As a result of the damage caused by Hurricanes Katrina and Rita in 2005, the federal government funded several disaster case management programs. These programs help victims access services for disaster-related needs. This testimony addresses the following questions: 1) How did the federal government support disaster case management programs after Hurricanes Katrina and Rita, and how did federal agencies coordinate their efforts?; 2) What challenges did disaster case management agencies experience in delivering services under federally funded programs?; and 3) How will previous or existing federally funded programs be used to inform the development of a federal case management program for future disasters? This testimony is based on a July 2009 report (GAO-09-561). To complete this report GAO reviewed federal laws, regulations, and guidance, obtained data from two programs, conducted site visits to Louisiana and Mississippi, and interviewed case management providers and federal and state officials. For this testimony, GAO updated certain information.
section_title: What GAO Found
paragraphs: The federal government provided more than $231 million to support disaster case management programs for victims of Hurricanes Katrina and Rita; however, breaks in federal funding hindered service delivery, and federal agencies and case management agencies faced coordination challenges. A lack of accurate and timely information sharing and incompatible data systems may have left some victims most in need without access to disaster case management services. Case management agencies experienced challenges in delivering federally funded disaster case management services due to staff turnover and large caseloads, limited community resources, federal funding rules, and a lack of coordinated outreach. For example, case management agencies saw the ability to provide direct financial assistance for items such as home repair, clothing, or furniture as key to helping victims, yet case management agencies that provided services under FEMA-funded programs could not provide direct financial assistance. Long-term recovery committees were a resource for case management agencies to obtain direct assistance, but utilizing these committees was sometimes unsuccessful. Ongoing evaluations of disaster case management pilot programs will inform the development of a federal disaster case management program, but to date, little is known about program outcomes. FEMA plans to analyze third-party evaluations submitted by the agencies administering the pilot programs to determine lessons learned and best practices for the future. According to an agency official, FEMA hopes to formalize the new program in June 2010.

section_title: Letter
paragraphs: I appreciate the opportunity to participate in today’s discussion on  disaster case management and to provide highlights of our July 2009  report entitled Disaster Assistance: Greater Coordination and an  Evaluation of Programs’ Outcomes Could Improve Disaster Case  Management. Hurricanes Katrina and Rita caused approximately $90  billion in property damage, destroyed over 300,000 homes, and displaced  more than 1 million people from some of the poorest communities in the  country when they struck the Gulf Coast in August and September 2005.  To assist victims with their recovery, the federal government stepped in  and, for the first time, provided more than $231 million to states and  nonprofit organizations to support several disaster case management  programs. Disaster case management involves helping victims access  services for a range of needs, including employment, housing, and health  care. In our report, we estimated that up to 116,000 families affected by  Hurricanes Katrina and Rita received federally funded disaster case  management services.
My statement today, based on our July 2009 report, addresses the  following questions: 1) How did the federal government support disaster  case management programs after Hurricanes Katrina and Rita, and how  did federal agencies coordinate their efforts? 2) What challenges did case  management agencies experience in delivering disaster case management  services under federally funded programs? and 3) How will previous or  existing federally funded programs be used to inform the development of a  federal case management program for future disasters?
To prepare the report, we reviewed the roles and responsibilities of the  federal government for disaster recovery services, as well as federal laws,  regulations, and guidance for the federally funded disaster case  management programs established to assist victims of Hurricanes Katrina  and Rita. We interviewed federal officials from the Federal Emergency  Management Agency (FEMA), the Department of Housing and Urban  Development (HUD), and the Department of Health and Human Services  (HHS). We conducted site visits to Louisiana and Mississippi and  interviewed organizations involved in disaster case management in those  states. We also obtained data on clients in two disaster case management  programs and used only those data elements we found to be sufficiently  reliable for the purposes of our work. We conducted the performance  audit from May 2008 to July 2009 and updated information in November  2009, in accordance with generally accepted government auditing  standards. Those standards require that we plan and perform the audit to  obtain sufficient, appropriate evidence to provide a reasonable basis for  our findings and conclusions based on our audit objectives. We believe  that the evidence obtained provides a reasonable basis for our findings  and conclusions. A detailed explanation of our methodology is included in  our July 2009 report.
In summary, we found that FEMA, HHS, and HUD supported disaster case  management programs following Hurricanes Katrina and Rita. However,  breaks in federal funding and coordination challenges adversely affected  the delivery of disaster case management services to some hurricane  victims. Coordination challenges included a lack of accurate and timely  information sharing and incompatible data systems. In addition, case  management agencies experienced challenges in delivering services due to  large caseloads, limited community resources, federal funding rules, and a  lack of coordinated outreach. For future disasters, FEMA is developing a  federal case management program based on evaluations of several disaster  case management pilot programs. However, we found that FEMA had not  established a time line for developing this program, and some of the  evaluations had limitations, such as a lack of information on program  outcomes. In our report, we recommended that FEMA establish a realistic  and achievable time line for designing and implementing a single, federal,  disaster case management program for future disasters, conduct an  outcome evaluation to determine the results of the disaster case  management pilot programs, and ensure that the federal disaster case  management program it develops includes practices to enhance and  sustain coordination among federal and nonfederal stakeholders. FEMA  agreed with our recommendations and is taking steps to address them;  FEMA hopes to finalize the federal disaster case management program in  June 2010.
subsections: section_title: Background
subsections: section_title: Federal Role for Funding and Coordinating Disaster Case Management Services
paragraphs: The Robert T. Stafford Disaster Relief and Emergency Assistance Act  (Stafford Act), as amended, is the primary authority under which the  federal government provides major disaster and emergency assistance,  and FEMA is responsible for administering its provisions. At the time of  Hurricanes Katrina and Rita, the Stafford Act contained no explicit  authority to fund disaster case management services. However, the  passage of the Post-Katrina Emergency Management Reform Act of 2006  (Post-Katrina Act), which amended the Stafford Act, granted the  President the authority to provide financial assistance for case  management services to victims of major disasters.
In addition to its responsibilities under the Stafford Act, FEMA has  responsibility for administering and ensuring implementation of the  National Response Framework, which became effective in March 2008 and  replaced the former National Response Plan. The Framework maintains  FEMA’s responsibility for coordinating human services and specifically  includes disaster case management as a category of human services.  Moreover, the Framework requires federal agencies involved in mass care,  housing, and human services to coordinate federal response efforts with  the efforts of state, local, private, nongovernmental, and faith-based  organizations.
In September 2009, the President announced the formation of a Long-Term  Disaster Recovery Working Group, co-chaired by the secretaries of the  Department of Homeland Security (DHS) and HUD, to examine lessons  learned during previous catastrophic disaster recovery efforts, and areas  for improved collaboration between federal agencies and between the  federal government and state and local governments and stakeholders. As  part of this initiative, FEMA and HUD are co-chairing the National Disaster  Recovery Framework Working Group, which will define the federal, state,  local, tribal, private non-profit, private sector, and individual citizen’s roles  in disaster recovery; design and establish an effective coordinating  structure for disaster recovery programs; identify gaps, as well as,  duplications, in recovery programs and funding; and establish  performance standards for the federal support of state and local recovery.
section_title: The Federal Government Supported Disaster Case Management Programs, but Breaks in Federal Funding and Coordination Challenges Hindered Assistance
paragraphs: Multiple federal agencies provided resources for disaster case  management programs to help thousands of households cope with the  devastation caused by Hurricanes Katrina and Rita, but breaks in federal  funding and coordination challenges adversely affected the delivery of  these services to some hurricane victims.
subsections: section_title: FEMA, HUD, and HHS Supported a Variety of Disaster Case Management Programs for Hurricane Victims, but Breaks in Federal Funding Adversely Affected Services to Some
paragraphs: More than $231 million of FEMA and HHS funds have been used to  support disaster case management programs to assist victims of  Hurricanes Katrina and Rita. These programs include:    Katrina Aid Today (KAT)––FEMA awarded a $66 million grant to the  United Methodist Committee on Relief, which then used the grant to  establish KAT, a national consortium consisting of nine social service and  voluntary organizations, to provide case management services to  Hurricane Katrina victims.
The Cora Brown Bridge Program––Following the termination of KAT,  Louisiana and Mississippi received Cora Brown Funds from FEMA to  continue providing services to individuals and families affected by  Hurricanes Katrina and Rita.
The Disaster Case Management Pilot Program (DCM-P)––Following the  termination of the Cora Brown Bridge Program, FEMA used funds from its  Disaster Relief Fund to establish a state-managed DCM-P program to  serve Hurricane Katrina and Rita victims in Louisiana and Mississippi, with  the primary goal of helping them achieve sustainable permanent housing.
The Louisiana Family Recovery Corps (LFRC) case management  program—HHS distributed emergency Temporary Assistance for Needy  Families and Social Services Block Grant funds to Louisiana, which  contracted with LFRC, to provide disaster case management services to  victims of Hurricanes Katrina and Rita.
The case management portion of the Disaster Housing Assistance Program  (DHAP)––Using funding provided by FEMA, HUD designed and  implemented this program to provide rental assistance to eligible victims  of Hurricanes Katrina and Rita. To participate in the program, clients also  had to receive case management services.
The case management portion of the DHAP Transitional Closeout  Program—Some DHAP clients continued to receive housing assistance  following the completion of DHAP. In Louisiana, housing assistance was  accompanied by disaster case management services. The state has used  funding provided by HUD and through HHS’ Social Services Block Grant  program.
These programs began at different times and sometimes overlapped as  federal agencies identified ongoing need for services (see fig. 1).
Breaks in federal funding for disaster case management programs initiated  after Hurricanes Katrina and Rita adversely affected case management  agencies and may have left victims most in need of assistance without  access to case management services. For example, as the first federally  funded disaster case management program, Katrina Aid Today (KAT),  drew to a close in March 2008, some case management agencies began to  shut down their operations. Some cases were closed not because clients’  needs had been met, but because the program was ending, and it is  unknown whether these clients obtained assistance elsewhere or whether  their cases were eventually reopened under the Cora Brown Bridge  Program.
Clients with open cases under the Bridge program were supposed to  seamlessly transition from the Bridge program into FEMA’s new state  managed DCM-P program. However, in Mississippi, the state-managed  pilot program did not begin until approximately two months after its  scheduled start date, and many of the smaller case management  organizations had to lay off case managers with the hope of hiring them  back once they received federal funding. In addition, in Louisiana, the  state-managed pilot became operational in September 2009, approximately  15 months after it was scheduled to begin. The program will serve an  estimated 3,300 households that remained in FEMA temporary housing as  of April 2009.
section_title: Challenges to Coordination among Federal Agencies and Case Management Agencies Contributed to Implementation Difficulties
paragraphs: Initial coordination activities among federal agencies and case  management agencies were minimal following the hurricanes, which may  have resulted in some victims not receiving case management services and  others receiving services from multiple agencies. In previous work, GAO  has identified key practices to enhance and sustain coordination among  federal agencies, and has since recommended these same key practices  to strengthen partnerships between government and nonprofit  organizations. Key practices for coordination include establishing  mutually reinforcing or joint strategies and compatible policies,  procedures, and other means of operating across agency boundaries.
Difficulties in coordinating disaster case management services resulted in  a lack of accurate and timely information sharing between federal  agencies and case management agencies. Case management agencies  providing federally funded disaster case management services said they  faced challenges in obtaining timely and accurate information from FEMA;  however, FEMA officials said requests for information often did not meet  their requirements. For example, FEMA approached HHS about serving  some victims of Hurricanes Katrina and Rita under its pilot disaster case  management program following Hurricanes Gustav and Ike. When the case  management agency implementing the HHS pilot requested client  information from FEMA, FEMA only provided aggregate data, which the  case management agency found unusable. According to FEMA officials, its  routine use policy precluded it from sharing client-level information for  this purpose. However, FEMA officials said they have fulfilled many  requests for information and worked with states on how to request  information. For example, FEMA provided information to the Louisiana  Department of Social Services so as to prevent duplication of efforts or  benefits in determining eligibility for disaster assistance. In a previous  report, we identified as a lesson learned the value of standing agreements  for data sharing among FEMA and state not-for-profit agencies as a means  to expedite recovery services. Such agreements can clarify what data can  be shared and the procedures for sharing it while protecting the data from  improper disclosure.
Federally funded case management programs used different databases,  making it difficult to track clients across case management agencies, and  potentially allowing hurricane victims who applied to more than one  program to receive duplicate services. For example, clients who received  case management services through KAT may have also received services  through the LFRC disaster case management program, but because the  KAT and LFRC databases were not compatible, some case management  agencies for these two programs may not have been able to screen for  duplication of services.
section_title: Case Management Agencies Experienced a Range of Service- Delivery Challenges, and As a Result, Some Hurricane Victims May Not Have Been Helped
paragraphs: Case management agencies experienced a variety of challenges in  delivering federally funded disaster case management services. Some  agencies had high staff turnover, and some case managers had large  caseloads, making it difficult to meet client needs. Clients frequently  needed housing and employment, according to case managers and  program data, but these resources were limited following the hurricanes.  Further, case management agencies saw the ability to provide direct  financial assistance for items such as home repair, clothing, or furniture as  key to helping victims, yet only one federally funded program allowed case  management agencies to use federal funds for direct financial assistance.
subsections: section_title: Staff Turnover and Large Caseloads Were Barriers to Meeting Clients’ Needs
paragraphs: Some case management agencies experienced high staff turnover and  large caseloads, which made it difficult to meet clients’ needs. For  example, one agency reported 100 percent turnover in case managers  during the KAT program, which an agency official attributed to case  managers’ expectations of a short-term assignment or to the work being  too emotionally draining. In terms of caseload size, KAT and LFRC case  managers had larger caseloads than program guidance recommended. For  example, KAT case managers had caseloads ranging between 40 and 300  clients even though the guidance recommended an average of 20 to 30  cases. Several factors may have contributed to high caseloads, including  the magnitude of the disaster and a shortage of case managers.
section_title: Clients Needs Included Housing, Employment and Transportation; However, These Community Resources Were Limited
paragraphs: Case managers and program data indicated that one of the main needs of  clients was housing (see fig. 2). clothing nd frnitre)
According to program data, approximately 67 percent of KAT clients were  displaced from their primary residence as a result of Hurricane Katrina. As  GAO recently reported, one commonly cited challenge faced by displaced  households was finding affordable rental housing, since rents increased  significantly following the storms in certain Gulf Coast metropolitan  areas. For example, HUD’s fair market rent for a two-bedroom unit in the  New Orleans-Metairie-Kenner metropolitan area increased from $676 to  $1,030, or about 52 percent, between fiscal years 2005 and 2009. We also  reported that disaster victims faced other obstacles in returning to  permanent housing, such as insufficient financing to fund home repairs  and significantly higher insurance premiums.
Case managers said client needs also included employment and  transportation, but these resources were limited. According to the Bureau  of Labor Statistics, between August 2005 and August 2006, almost 128,000  jobs were lost in eight areas of Louisiana and Mississippi that were heavily  affected by Hurricane Katrina. In addition, the unemployment rate in the  New Orleans-Metairie-Kenner metropolitan area more than tripled  between August 2005 and September 2005, and the unemployment rate  remained above pre-Katrina levels until March 2006. We previously  reported that transportation services can provide a vital link to other  services and to employment for displaced persons; yet multiple sources  stated that case management clients, particularly those living in FEMA  group sites, lacked transportation following Hurricanes Katrina and Rita.  Case management officials said lack of access to transportation made it  difficult to connect clients living in remote group sites to services such as  employment, education, and child care. Federal agencies developed the LA  Moves program to provide free, statewide transit service for residents in  Louisiana group sites; however, LA Moves service was limited to FEMA  defined “essential services,” specifically, banks, grocery stores, and  pharmacies and did not include transportation to welfare-to-work sites,  employment, and human and medical services.
section_title: Case Managers Faced Challenges in Meeting Client Needs Due to Federal Funding Rules on Direct Assistance and Difficulties in Accessing Needed Resources Through the Long-Term Recovery Committee Process
paragraphs: Case management agencies saw the ability to provide direct financial  assistance for items such as home repairs, clothing, or furniture as key to  helping clients with their basic needs; yet such assistance was not always  available. An official from a case management umbrella organization said  that without direct service funds, short-term needs ultimately can become  long-term issues, and individuals may then become dependent on  government assistance rather than becoming self-sufficient. Case  management agencies that were part of KAT or that provided services  under FEMA-funded programs, including the state-managed DCM-P  program in Mississippi and the Disaster Housing Assistance Program, were  not permitted to provide direct financial assistance. According to a FEMA  official, direct financial assistance was not part of these programs because  FEMA already provided funding for this purpose through the Individual  and Households Program. The maximum amount that an individual or  household may receive through the program is $25,000, adjusted annually  to reflect changes in the Consumer Price Index; however, a FEMA official  noted that the maximum amount may not be enough to meet all disaster- related needs.
While long-term recovery committees were a resource for case managers  to obtain direct assistance to address clients’ unmet needs, in some cases,  the efforts to utilize these committees were unsuccessful. Some  committees were unable to help clients since the member organizations  were depleted of goods or donations to pass on to clients. In addition, case  managers also cited challenges in the process of working with these  committees. They said the process for obtaining assistance could be  onerous, time consuming, and confusing.
section_title: Case Managers Said Program Eligibility Requirements Were a Barrier to Providing Disaster Case Management Services
paragraphs: Eligibility requirements for receiving disaster case management services  varied depending on the funding source, which may have left some in need  without services. For example, KAT services were available to victims of  Hurricane Katrina but not Hurricane Rita. In addition, LFRC officials said  they initially received TANF funds only, which limited their agencies to  serving families with children. Lastly, programs such as the Mississippi  DCM-P program were restricted to serving those receiving FEMA housing  assistance. As a result of certain eligibility requirements, some programs  may not have been able to assist individuals and families in need of case  management services.
section_title: Case Managers Stated that a Lack of Coordinated Outreach May Have Left Some without Access to Needed Services
paragraphs: Many case management agencies conducted little, if any, coordinated  outreach and, as a result, those most in need of case management, such as  those residing in FEMA group trailer sites, may not have received services.  According to LFRC officials, there was no coordinated approach for  providing case management services among federally funded programs,  and as a result, residents in these group sites may not have received  needed case management services. According to a KAT official, KAT case  management agencies were not required to conduct outreach to residents  in FEMA group sites. In addition, we have previously reported that federal  efforts to assist victims of Hurricanes Katrina and Rita with employment,  services for families with children, and transportation generally did not  target group site residents.
section_title: FEMA Plans to Use Ongoing Evaluations of Pilot Programs to Inform the Development of a Federal Disaster Case Management Program for Future Disasters; However, Early Evaluations Had Limitations
paragraphs: Several agencies’ evaluations of the various disaster case management  pilot programs are ongoing, but to date, little is known about program  outcomes. FEMA and HHS completed evaluations of the initial  implementation of two pilot programs, but neither of those evaluations  included information on program outcomes, or results, such as the extent  to which clients’ disaster related needs were met and what factors  contributed to client outcomes. In our July 2009 report, we recommended  that FEMA conduct an outcome evaluation of the disaster case  management pilot programs. FEMA does not plan to conduct its own  outcome evaluation, but will determine lessons learned and best practices  from third party evaluations of ongoing pilot programs submitted by each  of the agencies administering a pilot program. According to a FEMA  official, each of the third party evaluations will examine program  outcomes.
Using information from the ongoing evaluations, FEMA will develop a  model for a federal disaster case management program for future  disasters. In our report, we also recommended that FEMA establish a time  line for developing this program and ensure that the program includes  practices to enhance and sustain coordination among federal and  nonfederal stakeholders. FEMA agreed with our recommendations, and,  according to a FEMA official, the agency is hoping to formalize the  program in June 2010. Going forward, FEMA intends to implement disaster  case management services in two phases. In the first phase, HHS will  administer disaster case management services for up to 180 days using  FEMA funding. The second phase will be a state-managed disaster case  management program funded by a direct grant from FEMA to the affected  state. According to an agency official, FEMA is working closely with HHS  on all program development requirements and plans to obtain feedback  from relevant stakeholders prior to formalizing the program.
In conclusion, the federally funded disaster case management programs  implemented following Hurricanes Katrina and Rita faced unprecedented  challenges, yet they played a key role in assisting victims in their recovery.  A critical component of future recovery efforts is FEMA’s timely  development of a single, federal disaster case management program. The  success of those efforts will depend, in part, on whether agencies can  improve coordination to help ensure that those most in need receive  services, and to prevent duplication of services. The experiences of past  and ongoing disaster case management pilots likely provide valuable  lessons learned regarding client outcomes and contributing factors, and it  is important to understand those lessons and apply them to future disaster  recovery efforts.
Madam Chairman, this completes my prepared remarks. I would be happy  to respond to any questions you or other members of the subcommittee  may have at this time.
section_title: GAO Contacts and Staff Acknowledgments
paragraphs: For further information about this statement, please contact Kay E. Brown  at (202) 512-7215 or brownke@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this statement. Key contributors to this statement were Kathryn A.  Larin, Assistant Director; Susan Aschoff, Jessica Botsford, Melinda  Bowman, Nisha R. Hazra, Ryan Siegel and Walter Vance.
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