Disaster response can involve many federal, state, territorial, tribal, private sector, and voluntary organizations. The National Response Framework describes how the federal government, states and localities, and other public and private sector institutions should respond to disasters and emergencies. For example, state, local, tribal, and territorial governments are to play the lead roles in disaster response and recovery. Local emergency agencies—police, firefighters, and medical teams—are to be the first responders. In serving individuals who have disabilities and others who have access or functional needs, disaster responders at all levels are responsible for ensuring compliance with any applicable requirements for equal opportunity and non-discrimination. Federal agencies become involved in responding to a disaster when effective response and recovery are beyond the capabilities of the state and local governments. The Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) authorizes federal funding and support to assist states and localities in responding to a disaster. This federal support is available under the Stafford Act when the President declares a major disaster or emergency in response to a request by the governor or by the chief executive of a tribal government. Under the National Response Framework, DHS is the federal agency with primary responsibility for coordinating disaster response, and within DHS, FEMA has lead responsibility. In addition to DHS, at least 29 other federal agencies carry out disaster assistance programs and activities. The National Response Framework identifies 15 emergency support functions (ESFs)—such as communication, transportation, and energy— and designates a federal department or agency as the coordinating agency for each function. Under the National Response Framework, FEMA is designated as the coordinating agency for ESF-6, which includes mass care, emergency assistance, temporary housing, and human services. The National Response Framework also designates primary and support agencies for each ESF. Both FEMA and the Red Cross are the primary agencies for ESF-6. As co-primary agencies, FEMA and the Red Cross are responsible for working closely to coordinate mass care and related services across sectors, including identifying resource needs, organizations with mass care capacity to address those needs, and establishing strategies to address resource gaps (see fig. 1). According to ESF-6, Red Cross also provides technical assistance to FEMA and serves as its principal mass care subject matter expert. The Red Cross works with FEMA to provide such assistance to state and local partners, according to FEMA. In addition, the Red Cross and FEMA facilitate the mobilization of resources and coordination within the whole community for the provision of mass care services. The Red Cross role in ESF-6 has shifted over time. At the time of Hurricane Katrina, Red Cross was a primary agency, but in the 2008 update to ESF-6 it became a support agency. However, in a 2013 update, Red Cross was shifted back to the primary agency role and given new responsibilities such as working with FEMA to identify available mass care capacity, anticipate mass care requirements, and establish strategies to address gaps in coordination. These responsibilities, among others, remain in effect under the current ESF structure. FEMA and Red Cross coordinate mass care with the support of other federal agencies such as USDA, the Department of Health and Human Services, and the Department of Defense (DOD), as well as voluntary organizations and partners at the state and local levels. There are also over a dozen federal agencies named as having supporting roles in ESF- 6 (see app. I for a list of ESF-6 support agencies). For example, DOD and its Army Corps of Engineers provides construction and engineering support for temporary housing and sheltering, including inspecting shelter facilities to ensure accessibility and suitability. In addition, ESF-6 names over 50 members of the National Voluntary Organizations Active in Disaster (NVOAD) that provide a wide range of services in support of mass care and other ESF-6 activities, including the Salvation Army, Southern Baptist Convention Disaster Relief, and Feeding America. State and local governments are vital to mass care provision and assessing their own communities’ response capabilities. According to ESF-6, local government agencies coordinate with voluntary organizations and the private sector to coordinate activities that meet immediate needs of disaster survivors. When those needs exceed local resources, the state may provide additional support. When these resources are insufficient, federal assistance may be requested through the FEMA regional office. We found in 2018 that FEMA faced a number of challenges that slowed and complicated its response efforts to the 2017 hurricanes, especially Hurricane Maria in Puerto Rico. The sequential and overlapping timing of the three hurricanes strained staffing resources and created logistical challenges in deploying additional assistance (see fig. 2). In particular, FEMA had already deployed staff and resources to support the response efforts for Hurricane Harvey in Texas when the other major hurricanes made landfall shortly thereafter. Moreover, FEMA’s response efforts in Puerto Rico and the U.S. Virgin Islands were complicated by a number of factors, including their distance from the continental United States and limited local preparedness for a major hurricane. We have previously reported that there is increasing reliance on the federal government for disaster assistance as the number of natural disasters increases and that costs will likely continue to rise as the climate changes. FEMA identified key findings related to mass care in its After-Action Report for the 2017 hurricanes, noting differences in shelter populations across the states, as well as the duration of shelter stays (see fig. 3). FEMA also reported facing challenges transitioning survivors out of group shelters in a timely fashion. In order to qualify for federal emergency preparedness funding, states and eligible urban areas (grantees) are required to regularly submit information to FEMA on their ability to respond to a disaster. Specifically, grantees first identify their own capability targets—such as for sheltering disaster victims—through the Threat and Hazard Identification and Risk Assessment, and then assess their progress toward these targets annually in the Stakeholder Preparedness Review (capabilities assessments). In fiscal year 2018, FEMA awarded $402 million to states and territories through the State Homeland Security Program, and $580 million to urban areas through the Urban Area Security Initiative, both of which require grantee capability assessments. FEMA provides guidance and technical assistance to state and local partners in their self-assessment efforts. According to officials, FEMA does not conduct its own evaluations of state, local, and voluntary organizations’ capabilities. FEMA and Red Cross established joint operation centers where they co- located with key partners such as the Salvation Army and NVOAD for each of the 2017 hurricanes, which facilitated coordination of shelter, feeding, and supply distribution. In addition to co-locating at FEMA’s National Response Coordination Center in Washington, D.C., FEMA, the Red Cross, and key mass care partners also co-located in state and local emergency operations centers (see fig. 4). Our prior work has found co-location of staff enhances interagency collaboration. Co-location contributed to relationship-building that facilitated communication and coordination of mass care services, according to FEMA, Red Cross, and emergency management officials in all four states we visited. See figure 5 for examples of how various agencies and sectors prepared food and supplies for mass care operations. Co-location meant workers could communicate face-to-face, as key partners needed to collaborate and communicate resource requests to FEMA and other agencies. In the U.S. Virgin Islands, DOD provided airplanes that enabled workers to fly between the islands to attend face- to-face meetings, according to FEMA regional officials. According to officials in two states we visited, this type of face-to-face communication facilitated building relationships. Moreover, officials in one state told us that co-location enabled them to communicate survivor needs directly to FEMA, which could then provide assistance. This was especially critical when power and cell phone service were out, particularly in Puerto Rico and the U.S. Virgin Islands, which experienced prolonged power outages and disabled electronic communications. Officials from federal agencies and the Red Cross described some additional benefits of co-location: USDA Food and Nutrition Service (FNS) officials said co-located ESF- 11 (Agriculture and Natural Resources) staff in the National Response Coordination Center provided food inventories to staff at the ESF-6 desk. Red Cross officials said they were able to quickly obtain supply trucks after Hurricane Harvey in Texas because the Red Cross had representatives at FEMA’s National Response Coordination Center. As we previously reported, DOD provided high-water vehicles, amphibious vehicles, and boats to transport supplies for the Red Cross and support FEMA logistics efforts. Officials in one state noted that in-person communication was especially useful for coordinating mass care when FEMA’s on-line system for submitting resource requests could not be used (see text box). Web Emergency Operations Center Resource requests can be communicated through the Federal Emergency Management Agency’s (FEMA) Web Emergency Operations Center (WebEOC), an electronic system that processes and tracks resource requests from state or local governments. WebEOC supports emergency management processes and functions by providing a real-time operating picture for FEMA headquarters, regions, and federal, state, local, and tribal strategic partners. In 2015, the Department of Homeland Security’s Office of Inspector General (OIG) found that WebEOC was not sufficiently integrated with key agency systems and could cause delays in providing disaster assistance. In 2017, WebEOC was used in two of our four selected states, and a predecessor system to WebEOC was used by one of FEMA’s regional offices, according to officials in these areas. WebEOC was useful in tracking resource requests, but in-person communication was more helpful for coordinating mass care, according to FEMA regional officials. In cases where staff could not access WebEOC, requests to FEMA were presented on paper, according to state officials. In 2018, FEMA reported that it had provided every state with FEMA WebEOC accounts so state users could submit resource requests directly to FEMA. WebEOC also allows FEMA to share aggregated data, such as shelter counts and feeding information, according to FEMA officials. Federal officials and partners in Texas, Florida, Puerto Rico, and the U.S. Virgin Islands described many challenges they encountered in coordinating mass care. While the concurrence and intensity of the 2017 hurricanes presented many unforeseen challenges, several state and local governments and voluntary organizations told us about issues related to mass care coordination and planning. As a result, some supply distribution, sheltering, and feeding needs went unmet. Miscommunication: Miscommunication among disaster workers affected supply distribution. For example, FNS officials reported challenges with delivering baby formula for about 28,000 infants in Puerto Rico through FEMA. One shipment of baby formula was lost and discovered frozen and unusable in Puerto Rico because FEMA officials were not aware that the products had been delivered, according to FNS’ 2018 After-Action Report. The report also stated that some perishable infant formula and food remained at a port in Florida several weeks after delivery. FEMA officials told us they shipped nearly 400 containers of infant formula and food in the first 3 months after Hurricane Maria, but that competition for port clearances made it challenging to coordinate, prioritize, and track supplies. As a result, some who needed these supplies may not have received them. FEMA officials also noted that they believe survivor needs were met by a combination of disaster relief supplies and the restoration of capacity at grocery stores. According to FNS’2018 After- Action Report, their officials met with FEMA and completed training on FEMA’s logistics system in 2018 to be able to better track future shipments of these products. Insufficient shelter staff: In Texas and Florida, emergency managers we spoke with described having unprecedented numbers of residents needing shelters but not enough staff initially to operate them. To address this gap, they said they relied on members of the state National Guard or local government and community organizations to staff shelters, but in some instances, shelters continued to have insufficient numbers of workers. To improve shelter staffing for future disasters, emergency managers in Florida told us they are working on training additional county employees to serve as shelter staff. Serving individuals who have disabilities: Public shelters faced challenges in some cases serving individuals who have disabilities, as we previously reported. For example, we reported in 2019 that some individuals who have disabilities faced challenges accessing services from local shelters, including restrooms. In another example, the lack of a quiet space in public shelters for individuals with autism negatively impacted their mental health, according to officials from an advocacy group. Extensive damage to hurricane shelters: In Texas, Puerto Rico, and the U.S. Virgin Islands, Hurricanes Harvey, Maria, and Irma damaged many buildings planned for use as hurricane shelters, according to emergency management and local government officials in these areas. As a result, some remaining shelters were at maximum capacity. In some cases, survivors and staff had to relocate to alternate sites during the hurricanes. For example, an arena in Humacao, Puerto Rico, and a Department of Human Services building in the U.S. Virgin Islands served as shelters when intended shelter buildings were destroyed by Hurricanes Maria and Irma, respectively (see fig. 6). Damaged roads and communications infrastructure: Damaged and flooded roads and the affected terrain in all four states contributed to challenges in distributing supplies, especially in Puerto Rico and the U.S. Virgin Islands. In Puerto Rico, FEMA received complaints from municipalities that food was not reaching neighborhoods in need. Impassable roads and no ability to communicate challenged FEMA’s plans, which had designated certain partners to distribute meals. Several weeks after Hurricane Maria hit, FEMA redesigned its distribution strategy, which included identifying the most vulnerable municipalities and having liaisons from the Puerto Rico Emergency Management Agency and the municipalities help coordinate the distribution. This enabled food to reach neighborhoods in need. Insufficient supplies: According to Puerto Rico Department of Education officials, FEMA was initially reluctant to provide water to schools serving as shelters because the schools were supposed to have their own water supply from the Puerto Rico Department of Education’s warehouses. However, Puerto Rico Department of Education officials said they only had enough water for shelter residents for 30 days. The agency requested help to meet additional needs, but FEMA did not have enough water or food boxes to help supplement the schools’ supply. There were several thousand people sheltered in the schools, but according to these officials, the Puerto Rico Department of Education was responsible for providing food and water to survivors whether or not they were shelter residents. Once the Puerto Rico Department of Education officials met with FEMA and demonstrated their need for water, they were able to secure supplies from FEMA. Early relocation of survivors to hotels: In Texas, the early relocation of survivors from shelters to eligible hotels under FEMA’s Transitional Sheltering Assistance program challenged mass feeding operations, according to two Texas emergency management officials and representatives of two voluntary organizations. As a result, some survivors did not receive food assistance, as described below. FEMA’s Transitional Sheltering Assistance program and the Department of Agriculture’s Disaster Supplemental Nutrition Assistance Program (D- SNAP), while not considered to be a central part of mass care under the National Response Framework, provide assistance to survivors after disasters and provide services that may intersect with mass care activities. According to officials in Texas and Florida, some aspects of how these programs were implemented contributed to unmet needs. Transitional Sheltering Assistance program: After the initial response effort ends and mass shelters close, FEMA’s Transitional Sheltering Assistance program is intended to provide short-term sheltering assistance to survivors who are still unable to return home. States request FEMA approval for Transitional Sheltering Assistance when they determine there is a need for short-term assistance. According to officials in Texas, the Transitional Sheltering Assistance program was activated earlier than they expected before mass shelters closed, resulting in survivors leaving early to stay in program-eligible hotels. According to these officials, the early activation resulted in the inability to track where survivors were located and where survivors needed assistance. According to an official at a voluntary organization, survivors in program-eligible hotels were going without food and some were eating coffee grounds in their hotel rooms because they had no food and no money to purchase food. Officials from state agencies and voluntary organizations that could provide assistance told us they could not get information from the hotels about how many survivors were guests at specific hotels, due to the hotels’ reluctance to provide guests’ information. When voluntary organizations tried to set up feeding operations at hotels, some hotels did not want the organizations to set up feeding operations on hotel premises, according to organizational representatives. One state official also said some hotels did not allow food distribution because of concerns about food sitting in rooms or the hotels’ preference that their guests use their restaurant facilities. D-SNAP: D-SNAP provides temporary food assistance for households affected by a natural disaster. D-SNAP usually begins after grocery stores have re-opened and families are able to purchase and prepare food at home. USDA’s FNS offers guidance to states that choose to operate a D-SNAP program on where and how to operate D-SNAP registration sites, including guidance on serving individuals who have disabilities and the elderly. For example, FNS guidance states that D- SNAP registration sites should offer extra cooling measures in a special waiting area for individuals who have disabilities and the elderly, and move these individuals to the front of regular registration lines. FNS’ After-Action Report identified, and state and county officials in Texas and Florida said they observed, D-SNAP registration sites that did not appropriately serve elderly individuals or those who have disabilities, such that some elderly survivors fainted while waiting in the heat. In one state we visited, officials from a local voluntary organization said the state government did not work with community-based groups to identify local D-SNAP registration sites. As a result, D-SNAP registration sites did not align with where survivors needed assistance, and according to these officials approximately 50,000 applicants came to one site and were turned away after waiting for hours in the heat. To help address these challenges, some elderly individuals and individuals with disabilities in Florida were allowed to register for D-SNAP over the phone in December 2017 and in May 2018, according to a state official. While the National Response Framework indicates that many agencies participating in disaster response formalize their responsibilities in written agreements, we found that key mass care partners did not have such agreements or that they did not clearly outline responsibilities at the time of the 2017 hurricanes. Although Red Cross has written agreements with some state and local partners, counties we visited in Florida, Texas, and the U.S. Virgin Islands—states where Red Cross shelters disaster victims—did not have written agreements that clearly specified what mass care services would be provided by the Red Cross. In Florida, several counties we visited did not have formal agreements with the Red Cross during the 2017 hurricane season. In lieu of a formal agreement, one of the counties had an email from the Red Cross stating that the Red Cross could support one of 15 shelters, according to officials and documents we reviewed. In some cases, even when written agreements were established, there were still unclear roles and expectations. For example, another Florida county did have an agreement in place, but county officials said they found out after the 2017 hurricane season started and shortly before Hurricane Irma that the Red Cross could support only eight shelters—a substantial decrease from previous years. Further, when counties did have written agreements with the Red Cross, the agreements did not always clearly define responsibilities. The agreements also did not specify how and at what point sheltering and feeding needs and capabilities should be communicated by the Red Cross to counties, which exacerbated challenges in providing these services after the hurricanes. After the 2017 hurricane season, officials in three states we visited said they have been working toward clarifying responsibilities in written agreements. Red Cross officials also said they have been developing letters of intent with local government partners since 2017, which describe what services can be provided by the Red Cross in these localities. However, our review of some of these new finalized agreements found they lack consistency and detail in what each of the parties can deliver regarding sheltering, feeding, and supply distribution. For example, Red Cross’ agreement with one Florida county specifies it can operate two shelters for about 1,000 residents, while its agreement with another county states it will “support shelters as resources allow.” Red Cross officials said written agreements may be difficult to change as needs and capabilities change over the course of the response to a disaster. Outside of written agreements, Red Cross officials said they collaborate with government agencies in other ways, such as participating in mass care exercises to create a shared understanding of mass care roles and work on jointly-developed response plans. Red Cross officials also told us that they need to be clearer with local jurisdictions about what they can and cannot provide, and that they need to reach mutual understanding with local governments about shared planning assumptions, such as the peak shelter population and what the Red Cross could provide within specified timeframes. According to Red Cross officials, neither they nor local governments established clear expectations in the past. In August 2017, the Red Cross launched a nationwide readiness initiative focusing on mass care planning discussions with local governments. This initiative also includes clarifying planning assumptions with local governments on a recurring basis. FEMA provides some guidance to states and localities about how to effectively coordinate with mass care partners, as well as a training course that encourages establishing written agreements. FEMA’s training materials for the mass care planning and operations course describe the differences in types of agreements that states and localities might establish with mass care partners, and specifically suggest defining the roles and responsibilities of each party. In addition, FEMA has helped developed tools for stakeholders to use when specifically coordinating mass care operations, such as the Multi-Agency Feeding Support Plan Template. This tool guides states, voluntary organizations, and other partners to clearly establish roles and responsibilities related to specific aspects of feeding, including the delivery of supplies and networking with other organizations to identify unmet needs. FEMA officials noted that all of their mass care templates encourage this type of planning for roles and responsibilities. However, FEMA guidance and training materials do not suggest detailing the specific responsibilities of each entity for mass care services in the written agreements. For example, the guidance does not explicitly prompt states and localities to use their written agreements to specifically establish how much shelter and feeding assistance an agency, government, or organization can provide. Our prior work has found that clarifying responsibilities through written agreements is critical to effective interagency collaboration. When an agency, government, or organization does not specifically indicate how much shelter and feeding assistance it can provide in a disaster, its partners may have unfounded expectations. For example, in Texas, officials in one city said when one large mass shelter first opened, there were only a small number of Red Cross volunteers, which was insufficient to operate and manage a shelter with tens of thousands of survivors; this was short of city officials’ understanding that Red Cross would fully staff the location from the beginning. Without further guidance from FEMA on how to establish effective written agreements, unmet expectations between state and local partners and voluntary organizations may persist and place disaster survivors at risk. Our prior work has also found that federal agencies engaged in collaborative efforts need to create the means to evaluate their activities in order to identify areas for improvement. In addition, federal internal control standards state that management should establish an organizational structure, assign responsibility, and delegate authority to key roles in order to achieve objectives. Moreover, the organizational structure should be evaluated periodically in order to meet the objectives and adapt to new situations. FEMA is responsible for coordinating and supporting the federal response to major disasters and relies significantly on the Red Cross as its co-primary agency under ESF-6. While FEMA and the Red Cross conduct after-action reviews following certain major disasters, including for the 2017 hurricane season, these reviews are focused on response and recovery efforts and do not include a broader review of roles and responsibilities of the co-primary agencies. Based on its findings on the 2017 hurricane season, FEMA called for some revisions to the National Response Framework and ESF annexes related to coordination across sectors. Accordingly, FEMA is currently revising the framework, which is considered a living document to be regularly reviewed to reflect experience gained from its use. However, FEMA has not proposed revisions to ESF-6 as part of its current review of the National Response Framework and ESF annexes. Specifically, FEMA has not reviewed whether the current structure of ESF-6 leadership roles and responsibilities is best suited for coordinating mass care, or whether there are responsibilities that should be shifted. ESF-6 is unique among ESFs in that it has a voluntary organization serving as a co-primary agency. Further, the Red Cross’ role under ESF-6 has changed multiple times since Hurricane Katrina. According to FEMA officials, FEMA is not required to review ESF-6 leadership roles and responsibilities, and instead focuses on the overall improvement of mass care delivery, including mass care activities and services. However, FEMA’s ESF Leadership Group noted that it was not always clear which agency that is part of an ESF is best suited to carry out a task. Evaluating collaborative efforts can help key decision makers within the agencies obtain feedback for improving both policy and operational effectiveness. Moreover, the National Response Framework is considered a living document, and DHS plans regular reviews to evaluate consistency with existing and new policies, evolving conditions, and the experience gained from its use. As we have previously reported, in disasters in which the federal government is involved, the extent and effectiveness of the Red Cross’s activities could have a direct impact on the nature and scope of the federal government’s activities. Given the challenges experienced with mass care during the response to the 2017 hurricanes, FEMA is missing an opportunity to identify areas for improvement and strengthen interagency coordination by not reviewing ESF-6 leadership roles and responsibilities. Many FEMA, Red Cross, local government officials, and representatives from local voluntary organizations we interviewed emphasized the importance of pre-existing relationships among established partners in coordinating mass care during the 2017 hurricanes. Relationships between these established mass care partners were often formed during non-disaster periods through regular conference calls and mass care training exercises. For example, officials in all four state emergency management departments we visited described positive relationships developed with FEMA staff through regular joint training exercises. FEMA’s Voluntary Agency Liaisons (VALs) help facilitate relationships between FEMA and established mass care partners. For example, VALs serve as contacts for non-governmental organizations active in disasters on a routine basis and during disaster response. In one FEMA regional office, officials said VALs serve as mass care specialists and regularly participate in calls with mass care partners. While such pre-existing relationships among established mass care partners facilitated mass care coordination, officials from voluntary organizations that did not have pre-existing relationships—unaffiliated organizations—reported challenges connecting with established mass care organizations, such as FEMA and the Red Cross, to share knowledge that could have informed response efforts. During the 2017 hurricane response, officials from unaffiliated organizations such as local advocacy groups and faith-based organizations told us they experienced challenges sharing critical information regarding needs, resources, and capabilities with established mass care organizations. These coordination challenges affected their ability to provide mass care services to certain populations. For example: A group of community organizations in Florida representing low- income and migrant populations had information on the location of people needing assistance, but reported difficulties in locating FEMA and Red Cross officials with whom to share that information. Representatives of a community group that assists victims of domestic violence in the U.S. Virgin Islands said there was no centralized way to share critical information and no plan for how to best address the issues facing these survivors. For example, they said the Red Cross had mapped damaged areas but was not sharing that information with community groups that could have provided assistance. This group said these maps could have been used to help locate people who were at particular risk. Red Cross officials stated that they experienced challenges in sharing damage assessment information in the U.S. Virgin Islands due to technology issues, which prevented them from being able to share these data securely with other organizations. Representatives from several faith-based organizations in multiple states told us they had food, water, and supplies, as well as local knowledge of need. Two of these representatives said FEMA and the Red Cross did not share information with them as to where they had already distributed supplies. This information was important so as to not duplicate efforts and to ensure those who still needed supplies were not overlooked, according to these representatives. Some migrant populations in all four areas we visited were hesitant to seek or receive assistance from federal, state, and local government agencies due to their undocumented immigration status, according to emergency management officials and community group representatives. Officials from multiple local voluntary organizations said they knew where migrant populations were located and what types of assistance they needed; they were trusted by these populations, but had difficulty finding FEMA or Red Cross representatives for sharing this information. Established mass care partners, including FEMA and the Red Cross, may not share information with unaffiliated organizations due to concerns about privacy, according to officials. Local governments also may not receive such information, because FEMA shares it with the states and the states are responsible for determining when to share it with local governments, according to FEMA officials. Local governments and unaffiliated organizations told us, however, that they do not need personally identifiable information, and that aggregated information about overall resource needs in certain locations would be sufficient for their purposes. For example, county officials in two states told us it was difficult to get FEMA data that would have helped them target areas for assistance, including those that other agencies might not have been able to reach. Similarly, the leader of a group that coordinates local voluntary organizations said they only needed aggregate-level data to identify needs in different counties. In addition, the Red Cross told us that mass care partners could access certain information from their RC View portal, which provides situational awareness information that supports resource requests and needs assessments. However, the Red Cross did not share such information with all its partners during the 2017 hurricanes because the technology was not yet ready. As of May 2019, Red Cross officials told us they are working on providing access to their RC View portal for several key partners, and that they intend to expand access to RC View to additional organizations in the future. ESF-6 states that Red Cross, in conjunction with FEMA, will facilitate the mobilization of private sector partners for the provision of mass care services. FEMA’s most recent strategic plan emphasizes the importance of a whole community approach to disaster response because individuals and local communities are the true first responders in a disaster. FEMA guidance states that the integration of non-traditional responders (which may include unaffiliated organizations) providing mass care services may be necessary during severe disasters. Federal internal control standards also emphasize the importance of communicating externally to key stakeholders. By not engaging in information sharing with unaffiliated organizations, FEMA and the Red Cross may miss opportunities to more accurately and efficiently coordinate mass care. As a result, those in need may not receive critical assistance in a timely way. Red Cross’ Training for Staff Deployed to Disaster Areas Red Cross provides training for its staff and volunteers deployed to disaster areas. This training includes information on the area of deployment, the nature of the disaster, and any cultural sensitivities they need to be aware of, according to Red Cross officials. However, unfamiliarity with local traditions and norms challenged Red Cross personnel when they arrived at disaster sites in 2017, and some local governments and community groups said this affected mass care coordination. Red Cross officials said they initially did not have enough Spanish speakers in Puerto Rico during the response to Hurricane Maria, for example. To address this need, they used Spanish-speaking workers from the International Red Cross community in Mexico and South America to assist with mass care coordination, according to Red Cross officials. As a result of challenges encountered during the 2017 hurricane season, Red Cross officials said that they have made changes to their approach intended to increase their engagement with the Latino community. This effort includes having materials translated into Spanish. To counter concerns among some disaster survivors about providing immigration status information, Red Cross officials said they have taken steps to clarify that the Red Cross does not collect this information. Information on the mass care capabilities of state and local jurisdictions that FEMA collected in 2016 and 2017 was not specific enough to aid the agency in its response to the 2017 hurricanes, according to FEMA’s After- Action Report and agency officials. The reporting process at the time of the 2017 hurricanes did not require grantees to report specific estimates of their current capabilities for providing mass care, which resulted in an incomplete picture of capabilities. With regard to mass care capabilities, FEMA did not ask grantees to report the number of people they could shelter, or how long they could maintain sheltering operations. For example, one state affected by the 2017 hurricanes identified gaps in the state’s capability to provide cots, blankets, laundry facilities, kitchens, and shelter facilities, but did not quantify the shortfall in its assessment submitted in December 2016. In addition, it was optional for grantees to describe deficiencies in their mass care capabilities at the time of the 2017 hurricanes, according to FEMA officials. One grantee affected by the 2017 hurricanes had indicated in its assessment from December 2016 that there were gaps in several mass care capabilities, such as shelter equipment and training for family reunification. However, this grantee chose not to include an additional description of what those gaps were. As a result of these limitations, FEMA and its grantees did not have specific information on state, territorial, and urban mass care capabilities or gaps at the time of the 2017 hurricanes. Officials from several states told us they were not aware of capabilities assessments being used during the response to the 2017 hurricanes, but some said this information could have been useful. For example, an official in one state said the information could be used for resource targeting. In submissions from the year following the 2017 hurricanes, 35 state and territorial grantees did not provide gap descriptions for mass care, which were optional at the time. According to FEMA, the agency recognized the limitations of the capabilities assessment data it had been collecting and began revising its methodology prior to 2017. FEMA’s After-Action Report for the 2017 hurricanes stated that one reason the agency began revising its capabilities assessment methodology was to provide more actionable information to use during response. Revisions were implemented for the 2018 reporting period that could result in FEMA collecting more specific and descriptive data on mass care capabilities, such as the number of people for whom the grantee can provide shelter, food, water, and relocation assistance as part of mass care (see table 1). FEMA’s 2018 guidance encouraged grantees to use a standardized format developed by FEMA, which allows grantees to insert community- specific numbers into a template when they report capability targets and estimates. The new standardized format also generates a quantitative statement of a grantee’s capability gaps (see table 2). Other new changes in FEMA’s revised approach will also allow the agency to collect more specific information on mass care capabilities. For example, starting in 2018, grantees were required to: Report the extent to which capabilities have been lost, built, or sustained over the previous year. Describe intended approaches for addressing capability gaps and sustaining capabilities built, including investments in resources. Describe the extent to which funding sources contributed to building or sustaining capabilities and improving disaster outcomes. Rate their level of confidence (1-5 scale) in the accuracy of their capability assessment for each target. These data elements have the potential to inform both disaster planning and response operations. FEMA revised its methodology for collecting capabilities assessment data in 2018, but it does not collect key information that could better inform its mass care planning. FEMA does not specifically require grantees to solicit the input of key partners in assessing mass care capabilities, according to officials, even though mass care generally depends on the work of such organizations. For example, the Salvation Army and the Southern Baptist Convention Disaster Relief often play key roles in mass care feeding, and the Red Cross manages sheltering in many locations, but they are not always included in mass care capabilities assessments submitted by grantees. FEMA officials told us that the new methodology should naturally foster engagement between grantees and their stakeholders, which should provide a better understanding of local capabilities for sheltering and feeding. According to these officials, under the new framework, FEMA requires grantees to report the number and type of government agencies and nongovernment organizations that participated in estimating capabilities (see fig. 7). However, by not requiring that grantees solicit input from organizations that provide mass care, or that grantees name specific organizations in their submissions, FEMA may rely on capabilities assessments developed without consultation with voluntary organizations providing key mass care services. We found that two of the six grantees included in our review did not report participating with the Red Cross, faith-based organizations, or other VOAD groups, in their 2018 assessments. An official from one of these jurisdictions confirmed that they had never reached out to voluntary organizations to take part in the assessment process, due to staff turnover and lack of time, despite relying on these organizations for providing mass care. An official from another jurisdiction said it is detrimental not to have voluntary partners’ input when preparing capabilities assessments because these partners are critical to providing mass care and play vital roles in disaster response. According to FEMA’s guidance, all organizations—not just government agencies—should be involved in preparedness efforts, and grantees should involve stakeholders throughout the process. FEMA’s guidance encourages a whole-community approach in which grantees include community stakeholders and subject-matter experts in estimating capabilities. Further, federal internal control standards emphasize the importance of designing systems for obtaining information that help an agency achieve its objectives. Without including key mass care providers when estimating capabilities and naming them in their capabilities assessments, grantees and FEMA may not collect reliable mass care capability estimates, or know who to contact in response to a disaster. States and localities may not be able to efficiently allocate their own resources to areas of unmet need and may be more reliant on outside resources during disaster response, which could have implications for the allocation of federal resources. FEMA reviews grantees’ capabilities assessments using standard checklists, but does not have a systematic process for providing feedback to grantees on their submissions in order to improve the usefulness of the information in them. FEMA officials use the checklists to assess the completeness and reasonableness of the submissions. Specifically, FEMA regional officials use the checklists to look for outliers, inconsistencies, invalid information, and inputs that to do not align with FEMA guidance or information that does not pass a “common sense” check. For example, one 2018 checklist we reviewed included comments from FEMA that the grantee’s capabilities assessment was only partially “complete and reasonable” because it showed no gaps for most capabilities, which might suggest that the targets it set are too low. FEMA officials told us that if the checklist identifies shortcomings in a grantee’s assessment, the regional office will send the assessment back to the grantee and communicate what needs to be changed. However, regional offices vary in their approaches to following up with grantees to obtain more information when potential issues are identified, and FEMA has not provided them with written guidance to standardize this feedback process. FEMA officials from two regional offices told us that the headquarters and regional preparedness divisions discussed follow-up protocols by phone, but they did not provide documentation that identified conditions or considerations for when to follow up with grantees or provide feedback. As a result, grantees may not receive consistent feedback from FEMA on their assessment of mass care capabilities and the information provided may remain incomplete. Rather than systematically providing feedback on the content of capabilities assessments, FEMA officials told us that they focus on identifying areas in which they can provide support to grantees. Their view is that communities know more about their own capabilities than the federal government does, and that it would not be appropriate to suggest major changes to the submitted assessments. Officials from one FEMA region said they view these submissions as self-assessments that are used for maintaining relationships with states and to help states better understand their capabilities and gaps. Officials also said that the FEMA regional office or the national preparedness office, or both, examine grantees’ disaster scenarios described in the assessments, the grantees’ self-assessed scores, and areas of grantee strengths and weaknesses to determine how FEMA can better support them. FEMA officials said they also phone grantees after each submission cycle to discuss challenges, including how to improve FEMA’s technical assistance and support, and how to make the process more useful for grantees. State officials we spoke to said that especially since the 2017 hurricanes, they have received more upfront guidance from FEMA than previously. Generally, FEMA’s support to grantees includes published guidance, annotated examples, technical assistance webinars, and a help desk for phone and email assistance. In 2018, FEMA also began piloting readiness visits where FEMA regional officials met with state and local grantees to discuss capability gaps identified in their assessments, according to officials. However, officials from three of the six grantees included in our review said that they did not receive key feedback from FEMA about their mass care capabilities assessments that would have been useful. An official in one state said it did not receive helpful feedback from FEMA prior to the 2017 hurricane season and, in particular, the official would have liked FEMA to confirm whether the state had completed its assessment correctly and completely, or if other information was needed. Officials from another state said that they did not receive any substantive feedback on their 2017 assessment. Officials from one urban area grantee said they did not receive technical feedback on areas of least readiness, and noted it would be helpful if FEMA could provide insight on the information provided in cases where the grantee had assigned a low confidence level in its capability assessment. Officials from four of the six grantees we spoke with said they would like additional clarity about the process from FEMA. For example, one state official said that understanding how FEMA uses capabilities information would have helped the grantee know how to improve its responses; get other agencies to participate more in the process; and solicit better, more tailored information from partners. This official noted that FEMA addressed this issue in 2019 by sharing more information about how it uses capabilities information. An official from another state said the state preparedness office would like input about how to obtain information from other agencies and how to assess capabilities at the local level. FEMA has an opportunity to use its review of capability assessments to improve its ability to assist with future disasters. After reviewing the 2018 submissions that used the new methodology, FEMA officials told us they are planning to develop criteria for evaluating future submissions and establish a regular process for providing feedback. By not systematically following up with grantees thus far, FEMA limits the extent to which it can build and supplement the emergency preparedness capabilities of these grantees. According to FEMA, it routinely analyzes capabilities assessment information for this purpose. FEMA has a strategic goal that involves supporting emergency managers in building the capacity to self- evaluate, monitoring the completion of improvement actions, and sharing insights. Providing feedback to grantees, including on the effective use of capability assessments as well as potential pitfalls, may help grantees develop their capability assessments and inform plans for how FEMA and the grantee will respond to disasters. Without clear protocols for providing feedback, grantees and FEMA may not possess complete, accurate, and reliable information on communities’ mass care capabilities, which will limit the effectiveness of the capability assessment process in contributing to the goal of national preparedness. The 2017 hurricane season presented unprecedented challenges for mass care service providers, and for survivors in Florida, Puerto Rico, Texas, and the U.S. Virgin Islands. While many partners coordinated extensively on the mass care response to 2017 hurricanes, unmet needs in sheltering, feeding, and supply distribution should spur FEMA and the Red Cross to consider the sufficiency of current agreements, especially with state and local governments. In particular, the 2017 hurricanes highlighted the importance of state and local governments understanding the services that mass care providers can deliver, particularly when disasters are severe or overlapping. Without FEMA providing more targeted guidance to help states and localities develop specific written agreements with voluntary organizations providing mass care services, expectations for what these organizations can provide may be unclear, putting disaster victims at risk. Moreover, without proactively considering the roles and responsibilities that the federal disaster framework establishes for agencies and organizations coordinating mass care, DHS lacks assurance that responsibilities are assigned to the entities best suited to carry them out. In addition, mass care coordination efforts during the 2017 hurricane season illustrated the importance of appropriately sharing information about capabilities and resources as part of advance preparation. During a disaster, local community groups are often the most informed about where needs exist, but also may not be connected with established mass care partners. Further leveraging community groups could prove vital for meeting mass care needs in a large-scale disaster, especially for the most vulnerable populations. FEMA does not explicitly require grantees to involve key mass care providers in their capabilities assessments. This may make it difficult for grantees to be well informed as to what they are actually capable of delivering locally. Further, FEMA has not documented a consistent, systematic approach to following up with partner governments on their reporting of mass care capabilities, while some grantees have said that additional feedback would be useful for preparedness and response efforts. As a result, some grantees may be ill-prepared to meet the mass care needs of the public during future disasters. We are making a total of six recommendations, including the following recommendation to the Secretary of Homeland Security: To strengthen the mass care response to future disasters, the Secretary of Homeland Security should direct FEMA to periodically review the current structure of ESF-6 leadership roles and responsibilities for coordinating mass care. (Recommendation 1) In addition, we are making the following four recommendations to the FEMA Administrator: To better clarify what mass care services voluntary organizations can provide, especially for severe or overlapping hurricanes, FEMA should strengthen its guidance to state and local governments to emphasize the importance of clearly defining roles and responsibilities related to mass care when state and local governments develop written agreements with partner organizations. This could include creating a guidance document or memo that calls attention to the issue and brings together existing resources, such as the Multi-Agency Feeding Plan Template and training materials, in a comprehensive and accessible manner. (Recommendation 2) To ensure assistance reaches all survivors, FEMA should develop mechanisms for the agency and its partners to leverage local community groups, such as conducting regular outreach to communicate and share aggregate information with these groups. (Recommendation 3) To ensure more accurate mass care capability assessments, FEMA should require grantees to solicit capabilities information from key mass care service-delivery providers in making capability estimates and identify these providers in their submissions. (Recommendation 4) To build the emergency preparedness capabilities of grantees, FEMA should develop systematic, documented protocols to determine the conditions under which it will follow up and provide feedback to grantees about mass care capability assessments. (Recommendation 5) We are also making the following recommendation to the American Red Cross: To ensure assistance reaches all survivors, Red Cross should develop mechanisms for it and its partners to leverage local community groups, such as conducting regular outreach to communicate and regularly share aggregate information with these groups. (Recommendation 6) We provided a draft of this report to DHS and the American Red Cross (Red Cross) for review and comment. DHS and American Red Cross provided written comments, which are reproduced in appendices II and III, and described below. In addition to its formal letter, DHS provided technical comments, which we incorporated as appropriate. We also provided relevant excerpts of the draft report to third parties, such as state and local government agencies and voluntary organizations we interviewed. These third parties provided technical comments, which we incorporated as appropriate. In its formal letter, DHS concurred with four of our recommendations and did not concur with one recommendation. Specifically, DHS and FEMA did not concur with our recommendation that FEMA should require grantees to include key mass care service-delivery providers in making capability estimates and identify these providers in their submissions. The letter noted the importance of involving stakeholders and subject matter experts at multiple levels of government and across sectors in order to develop complete and accurate assessments. However, DHS and FEMA said that requiring communities to include the key mass care providers in capabilities assessments is not the most effective approach for achieving this outcome. Because grantees cannot control which partners participate, DHS and FEMA said implementing this recommendation would increase the burden on grantees and could put certain communities at a disadvantage. In addition, DHS and FEMA said that because capabilities assessments are not limited to mass care, such a requirement may have unintended consequences for other partners. Instead, the letter stated that FEMA plans to continue working with the mass care community to identify the best solution, including encouraging collaboration at all levels of government. We modified our recommendation to address their concern. Specifically, we clarified that FEMA should require grantees to solicit information from key mass care partners and to identify these partners in their submission. This change acknowledges that grantees cannot compel partners to participate, but they can, at a minimum, invite such partners to participate in the process. We continue to believe that grantees should be required to make an effort to include mass care providers in developing their mass care capability assessments, as this is vital for developing high quality assessments. FEMA has emphasized the importance of having an active relationship and ongoing communication with key partners before disasters strike. In its Strategic Plan, FEMA states that pre-disaster coordination and communication among partners is critical to improve response and recovery outcomes. Thus, we do not believe it would be an undue burden to reach out to such partners as part of the capability assessment process. With regard to the remaining recommendations, DHS and FEMA described steps they have taken or plan to take to address the issues raised. While DHS concurred with recommendation 1 to direct FEMA to periodically review the ESF-6 leadership roles and responsibilities, the department considers this issue to be resolved because FEMA routinely conducts after-action reports and recently established a working group focused on performance metrics and corrective actions. We agree that these actions are important parts of effectively overseeing and evaluating ESF activities and results. While these efforts may address the responsibilities of ESF agencies, they may overlook the overall leadership roles of ESF agencies. In order to fully implement the recommendation, DHS and FEMA would also need to establish a process for reviewing the structure of ESF leadership roles on a regular basis. In concurring with recommendation 3, DHS and FEMA detailed several approaches they use to connect with local resources, including collaborating with VOAD groups at national, state, and local levels, and indicated that they consider this recommendation already implemented. Given the information gathered from several unaffiliated organizations in areas affected by the 2017 disasters, it is clear there is more work to be done in terms of sharing critical information about mass care needs and resources. Therefore, we continue to encourage FEMA to develop additional mechanisms to enhance outreach to organizations that may not be aware of existing approaches such as collaboration with the VOAD groups. Red Cross agreed with our recommendation to leverage local community groups through outreach and information-sharing. Red Cross noted several ongoing activities to engage such community groups and said the organization intends to continue expanding outreach, data-sharing, and engagement initiatives. We are sending copies of this report to the appropriate congressional committees, the Secretary of Homeland Security, American Red Cross, and other interested parties. In addition, the report is available at no charge on the GAO website at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512- 7215 or larink@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. GAO staff who made key contributions to this report are listed in appendix IV. Department of Homeland Security - Federal Emergency Management Department of Homeland Security - Federal Emergency Management Support Agencies with Roles Directly Related to Mass Care (Feeding, Sheltering, Supply Distribution, and Family Reunification): Corporation for National and Community Service Department of Defense/ U.S. Army Corps of Engineers Department of Health and Human Services Department of Homeland Security Department of Veterans Affairs National Center for Missing & Exploited Children National Voluntary Organizations Active in Disaster (National VOAD) In addition to the contact named above, Scott Spicer (Assistant Director), Amy Moran Lowe (Analyst-in-Charge), Grace Cho, and Michael Walton made key contributions to this report. Also contributing to this report were Joel Aldape, Aditi Archer, Susan Aschoff, James E. Bennett, Deirdre Gleeson Brown, Alicia Cackley, Sarah Cornetto, Elizabeth Curda, Chris Currie, Kelly DeMots, Erin Guinn-Villareal, Camille Henley, Denton Herring, Sara Schibanoff Kelly, James Lawson, Matthew T. Lowney, Sheila R. McCoy, Jean McSween, Amanda R. Parker, Sara Pelton, Brenda Rabinowitz, Michelle Sager, Brian Schwartz, Almeta Spencer, Manuel Valverde, Jr., and Su Jin Yon.

Summary: Three catastrophic hurricanes affected more than 28 million people living in Texas, Florida, Puerto Rico, and the U.S. Virgin Islands in 2017. Hurricanes Harvey, Irma, and Maria—which all made landfall within four weeks—caused a combined $265 billion in damage, and led to unprecedented demands for food and shelter, according to FEMA. FEMA and the Red Cross are the primary agencies responsible for coordinating mass care under the federal disaster response framework. GAO was asked to review their efforts. This report examines (1) FEMA's and the Red Cross' coordination of mass care in response to the 2017 hurricanes, and (2) FEMA's support and use of assessments of mass care capabilities for the 2017 hurricanes. GAO reviewed relevant federal laws, federal frameworks, and written agreements between federal, state, or local governments and various voluntary organizations providing mass care services. GAO also interviewed state, territorial, local, and voluntary organization officials in Florida, Puerto Rico, Texas, and the U.S. Virgin Islands; as well as officials from Red Cross, FEMA, other relevant federal agencies, and voluntary organizations. Following the three major U.S. hurricanes in 2017, disaster relief efforts of the Federal Emergency Management Agency (FEMA) and the American Red Cross (Red Cross) benefitted from locating key partners in the same place. In-person coordination was critical to maintaining communication in Puerto Rico and the U.S. Virgin Islands given the prolonged power outages and damage to public structures (see photo). However, some needs related to mass care—such as shelter, food, and supply distribution—were unmet. For example, local officials in Texas said flooded roads prevented trucks from delivering supplies. Providers encountered challenges in part because state and local agreements with voluntary organizations did not always clearly detail what mass care services could be provided. Additionally, FEMA guidance and training materials do not explicitly encourage states and localities to include in their written agreements the specific assistance each agency or organization can provide. This limits the benefits of mass care coordination and may put disaster victims at risk. State, territorial, and local grantees of federal disaster preparedness grants are required to regularly submit information on their capabilities to FEMA, and FEMA has provided related guidance and technical assistance. However, the information some grantees provided to FEMA was not specific enough to aid its response in 2017. Moreover, FEMA does not require grantees to specify the organizations providing mass care services in their capabilities assessments. Also, FEMA does not have systematic protocols for providing feedback to grantees to improve their assessments. These limitations hinder FEMA's efforts to strengthen emergency preparedness. GAO is making six recommendations, including that FEMA emphasize the importance of defining roles and responsibilities in its guidance to states and localities, require them to solicit information from key mass care providers in assessing capabilities, and develop protocols for providing feedback to grantees on capability assessments. FEMA agreed with all but one of GAO's recommendations; GAO maintains its recommendations are valid.