Rapid Assessment of Health Needs and Resettlement Plans Among Hurricane Katrina Evacuees --- San Antonio, Texas, September 2005

Hurricane Katrina struck the coastal regions of Alabama, Florida, Louisiana, and Mississippi on August 29, 2005, resulting in one of the worst natural disasters in U.S. history (1,2). The city of New Orleans, Louisiana, was further damaged by severe flooding when major levees broke and released water from Lake Pontchartrain. Residents were evacuated to neighboring states and cities, including San Antonio, Texas. On September 3, 2005, approximately 12,700 evacuees arrived in San Antonio and were housed in four primary evacuation centers (ECs). Although many evacuees in San Antonio soon found other accommodations, as of September 16, 2005, approximately 3,700 evacuees remained in ECs awaiting resumption of public services in New Orleans. To assess evacuee needs for clinical care, public health services, and housing assistance, the San Antonio Metropolitan Health District (Metro Health) requested CDC assistance to conduct a needs assessment of heads of households in the ECs. This report summarizes the findings of that survey, which identified substantial numbers of evacuees with chronic health conditions, physical or mental disabilities, and needs for counseling and housing assistance. The findings underscore the need to augment local public health and public assistance resources to address ongoing health and housing needs of evacuee populations.

Assessment Methods

Survey data were collected for 4 days (September 15, 16, 17, and 19), during which the American Red Cross (ARC) distributed monetary aid to all heads of households in the four main San Antonio ECs (an empty warehouse and an office building at a former Air Force Base, an empty clothing distribution center, and an empty department store at a suburban shopping mall). Heads of households were identified and assigned special wristbands. ARC distributed aid at a different EC each day for 4 days. Interviews were conducted by trained public health practitioners and medical student volunteers and by CDC and Metro Health staff while heads of households were waiting to be processed. Interviewers clarified that participation in the survey did not affect eligibility to receive ARC aid. Identifying information was not collected. Respondents were asked about 1) basic demographic information and household size, 2) settlement plans, and 3) whether any household members had chronic medical conditions, physical or mental disabilities, or counseling needs. The heads of households were asked to report the number of persons in their household who had a condition that requires them to visit a health-care provider regularly or a physical or mental disability. Those reporting one or more members with a condition were counted as a household with a family member having the condition.

Assessment Results

Interviews were completed with 1,360 heads of households who resided in ECs. According to ARC estimates of the daily EC census, approximately 75% of all heads of households were recruited. The response rate was 95%. Response rates and recruitment rates were similar each day for each EC. The highest nonresponse rate for any individual question was 9.4%.

Respondents were 55% male, with a median age of 46 years (range: 18--89 years). Eighty-nine percent of respondents were black, 6% were white, 2% were Hispanic, and 3% were of other race/ethnicity. Median household size was two persons (range: one to 11); 46% of all households contained a single person. Ninety-one percent of those surveyed were from a New Orleans postal code. Approximately 51% (714) of heads of households reported holding jobs in unskilled professions (e.g., food service, manual labor, housekeeping, or retail sales), whereas 21% (290) reported working in skilled occupations (e.g., health care, education, or law enforcement). The remaining heads of households were unemployed (10%), retired (8%), or receiving Social Security or disability benefits (11%) before evacuation. Among 3,286 total evacuees in surveyed households, the median age was 32 years (range: <1--94 years). A total of 1,049 (32%) evacuees were aged <18 years, and 324 (10%) evacuees were aged >60 years.

Approximately 42% of respondents reported having a household member with a chronic medical condition, approximately 28% reported having a member with a physical or mental disability, and 20% reported having someone in need of counseling services to better cope with their recent experiences (Table). The majority of respondents (774 [57%]) did not know when they would be leaving their EC; 251 (19%) planned to leave in less than 1 week, and 54 (4%) planned to stay for at least 4 weeks. Approximately half of evacuee households planned to stay and settle in San Antonio, and fewer than one fourth planned to leave Texas. Of 719 households whose members planned to stay in San Antonio, 62% reported needing housing assistance, 29% planned to rent housing on their own, and 5% planned to move in with family or friends. The evacuee population expected to settle in San Antonio was compared with those planning to leave San Antonio by respondent race/ethnicity, employment status, and proportion of family members with chronic illness or disability; no statistically significant differences between these two groups were detected.

Reported by: N Rogers, MPH; F Guerra, MD, San Antonio Health Dept, San Antonio, Texas. Hurricane Katrina Response Team, US Dept of Health and Human Svcs and CDC. PS Suchdev, MD, AS Chapman, DVM, RN Plotinsky, MD, M Jhung, MD, E Miller, PhD, EIS officers, CDC.

Editorial Note:

According to the findings of this assessment, approximately 1,700 evacuees from New Orleans who remained in San Antonio ECs at the time of the interview planned to settle in San Antonio. This population included multiple households with persons with ongoing health needs and disabilities. In addition, one half of the heads of households planning to stay in San Antonio held unskilled jobs, and approximately one third were either unemployed, retired, or on disability assistance before evacuation. The rapid assessment results were provided to San Antonio health officials, who used the findings to facilitate health-care delivery to the sheltered evacuees.

The findings in this report underscore the need to augment local public health and public assistance resources to address the ongoing health and housing needs of evacuee populations. In addition to those resources used to provide immediate assistance for this displaced population, additional resources are needed to address long-term needs of those evacuees remaining in San Antonio. Evacuee families, in particular those with chronic conditions or mental health needs, will require links to the health-care system to address both chronic conditions and routine health needs. Such services might include provision of health-care access via Medicaid enrollment and expansion of reproductive health, mental health, dental health, immunization, and elder-care services. Other needs to be addressed include securing adequate assisted housing and meeting schooling needs of children.

The findings in this report are subject to at least three limitations. First, because the survey sample consisted primarily of evacuees at EC sites in San Antonio, the results might not be generalizable to evacuees in San Antonio not living in ECs or to evacuees in other centers in the United States. Second, probability sampling was not feasible because of the movement of the evacuee population in and out of the different ECs and the lack of consistent evacuee registration. However, nonprobability sampling methods are often used to conduct rapid needs assessment surveys after disasters (3), and interviewers for this survey attempted to interview all heads of households residing in ECs and were able to survey approximately three fourths of them. Some San Antonio evacuees living in smaller shelters serving the specific needs of older persons and new and expectant mothers (representing about 5% of the total sheltered population) also were not accounted for by this survey. Finally, information collected from this assessment represents the views of evacuee heads of households during the 4-day survey period; those views might change over time.

In the wake of its response to Katrina evacuees, San Antonio also responded to the needs of thousands of persons whose homes were destroyed or severely damaged by Hurricane Rita. The results of this survey have been useful to San Antonio officials as they continue to enhance the city's long-term social services and public health infrastructure to better assist both current and future evacuee populations. Metro Health continues to explore ways to expand existing public health programs to meet the needs of these new San Antonio residents. The findings in this report also might have implications for local resource planning in other communities providing services to populations displaced by disasters.

Acknowledgments

The findings of this report are based, in part, on contributions by C Rohr-Allegrini, PhD, J Berlanga, MPA, I Villegas, B Chavez, and V Falcon, San Antonio Metropolitan Health District; and G Cox, MSN, American Red Cross.

References

1. Travis J. Scientists' fears come true as hurricane floods New Orleans. Science 2005;309:1656--9.
2. CDC. Hurricane Katrina response and guidance for health-care providers, relief workers, and shelter operators. MMWR 2005;54:877.
3. Noji EK. Disasters: introduction and state of the art. Epidemiol Rev 2005;27:3--8.

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