Case management is an aspect of disaster response that UMCOR specializes in. It will play a major role in our long-term response to the events of September 11.
Life is often complicated and when a disaster strikes, its victims are left trying to juggle not only their disaster recovery but also all of the life events that continue to happen. Births, deaths, marriages, divorces, new jobs, unemployment, and financial struggles all pile up on top of a family's disaster recovery efforts. These events further deplete their physical, emotional, spiritual and financial abilities to respond. It can also be very difficult for people who take pride in their independence to ask for help, even in the aftermath of a disaster. Case management takes all these factors into account. It sits at the heart of long term disaster recovery efforts and looks at the big picture.
Case management offers healing and hope, and turns that hope into reality. Below are examples of how case management assisted in two families' recovery from recent disasters (names have been changed).
Esther was a single woman in her 50s, busy rearing her 12 year old grandson when hurricane rains flooded her home. Her home in the Houston, Texas area was located outside of the flood plain and had been in the family since she was a child. It had been the stabilizing asset that helped her stay above the poverty line and maintain her independence. After the two feet of flood waters left, Esther and her grandson saw that independence slip away along with their belongings piled up on the curb. Esther was guided to a United Methodist Church disaster recovery team where the case manager helped Esther develop a recovery plan that used Esther's FEMA funds and volunteers to repair her home. Later, it would become apparent that Esther needed more help than she initially requested.
Fifteen months after the flood, volunteers started repairing Esther's home and she worked with them side by side. At one point Esther became so light headed she couldn't stand up. After repeated inquiries from the volunteers, Esther finally admitted she had not had a hot meal since the flood because her range no longer worked! It had been too painful for Esther to ask for a range and other items because she didn't want to be "greedy," thinking other people needed help more than she did. By noon the next day, her case manager had a new range delivered to Esther's home. Esther responded with tears of joy, and when her grandson came home from school, he too wept. The image of a 12-year-old boy weeping over a range is powerful. It reveals how important it is for disaster recovery workers to look behind the spoken needs to discover the deeper and often unspoken needs.
Because Esther had gone through the case management process, all contributing organizations were able to quickly respond to this newly identified need. They were also able to identify a long list of additional needs and provide further assistance. There was no worry about duplicating services because through their partnerships, these organizations had built a solid foundation of trust that allowed them to work together on behalf of the disaster survivors.
The Floods of 1993 did not just come and go. The waters stayed up for months and many areas were flooded repeatedly for two or three years. Case management in this disaster was a long term commitment that greatly benefited many victims. Here is the story of one family in Missouri.
Lucy was a single mom with two sons, 8 and 10. They owned their own home in Rhineland, a town on the banks of the Missouri River. Across the river is Hermann, the center of Missouri's wine country and a tourist attraction. Lucy was part owner in a gift shop in Hermann. The family was making ends meet before the Missouri river overflowed its banks.
In the summer of 1993, the water was 36" deep in their house for eight weeks. When the water finally receded the house was beyond repair. The whole community was beyond repair. The federal government instituted a buy-out program which would allow the community to move from the river bank to the top of the bluff.
The family was given temporary shelter in a very small one-bedroom FEMA trailer. This temporary situation lasted for 22 months. During this time, Lucy had to sell her part of the gift shop to her partner. She was working a minimum wage job. Her emotional resources had completely dried up. She went into a deep depression, unable to make the necessary effort to seek out the resources available to get her family back on their feet. The red tape resulting from a disaster of this magnitude was overwhelming.
Fortunately, Lucy was assigned a case manager named Renee. Renee sat with Lucy several times a week to evaluate the family's financial situation and then go through program by program to identify the resources that were available. Renee helped Lucy fill out forms, get a fair buy-out price, and made sure Lucy was in the lottery system which was how the lots for the new town were assigned. She was even able to convince Lucy to seek counseling for her depression.
After twenty-two months Lucy and the boys moved into their new home. It wasn't even finished yet, but they didn't want to spend a second Christmas in the trailer. Lucy began to work alongside the volunteers who were helping complete her house. She started painting the walls and unpacking boxes. And Lucy started coming out of her depression.
Lucy and her boys now live in a 2 story, three bedroom house on the bluff in Rhineland. Lucy knows that they would have never been able to get there if it hadn't been for Renee and nearly two years of assistance. Case management brought Lucy to recovery-- both physical and emotional.
The case management situation in New York City is complex. The fact that this was an act of terrorism makes it a crime, therefore the Department of Justice is the lead agency, rather than the Federal Emergency Management Agency (FEMA). The massive outpouring of financial resources is another complicating factor–many of these resources are targeted for particular groups. Other factors include: the high number of deaths and surviving family members needing assistance, people from many nationalities were affected, many who need assistance are undocumented immigrants, and there is a secondary economic disaster with massive unemployment creating thousands of additional victims.
Below are examples of how case management has assisted people in the New York City area following September 11:
Ms. B., mother of a five-year-old and a two-year-old was living in a rent-stabilized apartment one block from the World Trade Center. She was going through a difficult divorce from an abusive husband, who is a trader on Wall Street. On September 11, she was walking her five year old to school and carrying the baby, when the planes struck the Twin Towers. She and her children were carried forward, covered in debris, by the running crowd toward the water and were herded onto the Staten Island Ferry. She stayed on Staten Island for a few nights, then was put up by friends, and then in a midtown hotel by a charity. Later that fall, she moved back to her apartment and was struck by asthma caused by the air pollution. A doctor told her that she could not move back to her apartment until the Summer of 2002.
Ms. B has had extreme financial difficulty. Her husband was ordered by the court in September to pay child support, but he stopped doing so. She had another Family Court date in mid-April to have him re-ordered to support the children. She is in a counseling program to address the emotional effects of September 11, including Post-Traumatic Stress Disorder. She has fears about being in crowds, which is a daily part of life in New York City. She is also participating in a group for abused spouses. Her five year old is going to counseling as well.
Ms. B has been in touch with FEMA "20 times" about the Mortgage-Rent Assistance (MRA) benefit, and she is ready give up on FEMA. She has given them all of the documents they require two or three times and they are still denying her MRA benefits - one reason they give is that the EPA insists the air at Ground Zero is healthy. Ms. B cannot return to her old neighborhood because she is fearful of becoming incapacitated by the asthma and unable to care for her children.
Ms. B had to give up the rent-stabilized apartment because she cannot pay two rents. She fears going forward with her application for MRA from FEMA because her lawyer says that her husband might use the benefit as an excuse to get the court to refuse child support. Her application can be pursued until September. Through case management, Ms. B's current rent was paid by UMCOR; and UMCOR will provide advocacy support for her MRA application after her next court date.
Ms. T was a cashier at the Century 21 department store across the street from the World Trade Center. She has not worked since the attack. She is in the process with FEMA for MRA, but her landlord is moving on eviction procedures. To prevent eviction, UMCOR paid the current rent.
Mr. M was a doorman at the Millennium Hotel across the street from the World Trade Center. He lives in the Bronx with his wife, who is pregnant, and four dependents. He has not worked since September 11. His application for MRA benefit has been held up because his landlord has refused to sign a required paper. Verizon (the phone company) has threatened to disconnect his phone. Through case management, UMCOR has paid the current rent and phone bill and advocated with FEMA for assistance in getting MRA processed.
Betty worked at a realty firm below Canal Street. When the building she worked in was destroyed on September 11, she was transferred to another office of the same firm in midtown. She was laid off on October 12 when the company downsized. FEMA refused her MRA benefits because she had been working in the midtown location, even though she was at Ground Zero on September 11.
UMCOR has paid Betty's rent and utility bills, and is providing advocacy with FEMA.
Photo Credit: copyright © Diana Barnett, September 2001, Used by permission. The picture(s) on this page was taken in Manhattan within a week after the collapse of the World Trade Center. Click on the photo to see a larger version.
