SILVER: Emergency Relocations – How CIL’s Can Tap Into FEMA Reimbursement

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Emergency Relocations: How CIL's Can Tap Into FEMA Reimbursement

In 2020, the first year of the pandemic, there was a devastating drop in transitions for residents of nursing facilities to independent living settings. In Illinois, for instance, the state achieved under 50% of their mandated annual transitions. Across the country, many centers for independent living (CILs) were forced to postpone all transition activities because of restricted access to people in facilities, fear of infection, limited accessible and affordable housing and adequate home-care resources. One CIL, however, embarked on an innovative strategy to relocate nursing facility residents at the height of the pandemic. Roads to Freedom Center for Independent Living (RTFCIL) in Williamsport, Pennsylvania, reframed the transition process – which often takes years – as an emergency response by offering temporary housing where residents could take refuge from congregate facilities which are COVID hotspots while accessing more robust permanent transition services.

“We couldn’t just sit back and watch our people die off in these highly infectious and dangerous environments,” says Misty Dion, RTFCIL’s CEO. “State and federal agencies saw the devastation taking place in nursing facilities but were choosing shelter-in-place strategies, which we’ve long known are, at best, only partially effective and, at worst, catastrophic and deadly.”

RTFCIL, along with supporting organizations, identified safe, feasible relocation strategies that could house consumers in hotels for two to six weeks while coordinators accelerated processes for permanent community-based services. It soon became apparent that the highest hurdle was not logistical - hotels had stepped up to provide accommodations and workers welcomed the opportunity to provide care in lower risk settings – but was access to funding.

At the time, FEMA, which provides relief funding to disaster-impacted states and their federally disaster declared county and local governments and certain non-profit organizations, allowed states to provide non-congregate sheltering for people experiencing homelessness. However, they did not recognize people in institutions as homeless and centers for independent living as qualified non-profits. Regional Emergency Management Agencies in Pennsylvania were left to interpret FEMA guidelines and rebuffed RTFCIL’s repeated requests for support. After about 18 months of negotiations, and the preventable deaths of over 100,000 people with disabilities, FEMA published the: Delivering Personal Assistance Services in Congregate and Non-Congregate Sheltering Addendum, to their guidelines that clarifies the process for requesting FEMA reimbursements to CILs. Thanks to this articulation, RTFCIL established the nation’s first federally supported CIL-managed emergency relocation of a disabled person from a nursing facility to non-congregate shelter, a hotel room, and then on to permanent housing in the community utilizing FEMA Public Assistance Category B emergency protective measures.  

“Our county emergency management agency cut us a reimbursement check for the relocation costs for one of our clients. This was a 57-year-old man who’d been trapped in a nursing facility for over a year. We provided him two weeks of temporary housing and supports until we found him permanent resources. He’s now thriving in the community in a safe, independent environment.”

Marcie Roth, CEO of the World Institute on Disability and a former FEMA Disability Director, sees this accomplishment as a major advance to providing equitable emergency response resources to people with disabilities.

“We celebrate FEMA’s support for CILs, which have unique qualifications to prevent institutionalization and save lives of institutionalized individuals during disasters. This singular accomplishment for one person, while seemingly small, is truly a monumental victory for thousands of people in congregate settings who previously had no recourse but to wait and pray that they survived in the highest risk environment available to them.”

Now that a precedent has been established, RTFCIL plans to request reimbursement for additional emergency relocations they’ve provided through memoranda of understandings (MOUs) with their local emergency management agencies. RTFCIL is creating a how-to packet to share with other CILs nationally, and there are experts available to assist CILs ready to save the lives of disabled people through emergency relocation from dangerous congregate settings and into permanent community living solutions. For more information, contact: Misty Dion at

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