In Climate-Driven Disasters, Older People and the Disabled Are Most at Risk. Now In-Home Caregivers Are Being Trained in How to Help Them

Brian Smith was getting ready for work one Thursday in 2018 when he was jolted by loud raps on the window and poked his head out the door to see his neighbors running from house to house yelling, “Fire!”

Smith, an In-Home Supportive Services (IHSS) caregiver, wasn’t terribly alarmed. Residents in Magalia, California, got their fair share of fire alerts, usually with easy evacuations and speedy returns. But as Smith got in his car and rounded the corner near his house, he caught sight of Feather Canyon glowing an angry orange and knew this fire would be different. 

In the chaos of what would become California’s deadliest and most destructive wildfire, Smith’s thoughts darted to Donna, an 83-year-old client of his who was a recluse, and hadn’t left her trailer in over nine years. She’d be afraid, possibly even unaware of the fire, and unable to evacuate on her own. 

Realizing that every second mattered, Smith called his daughter Christina, who was also an IHSS caregiver at the time, to help him get Donna out. She grabbed Donna’s medication, comfortable clothes and a few photographs. Then Smith and his daughter drove her to safety, passing homes engulfed in flames and joining a throng of people trying to stay a step ahead of the Camp Fire as it ravaged across the canyon.  

Many caregivers in Butte County took similarly heroic measures that day. People who are older and disabled often lack the mobility to evacuate, putting them at greater risk of death or injury in a natural disaster. Of the at least 85 people who lost their lives in the Nov. 8, 2018, Camp Fire, as it came to be known, all but a dozen were over the age of 60. 

Most caregivers aren’t trained to be on the frontlines of fires, heat waves, floods or other disasters. But that may be changing. In Los Angeles and San Bernardino counties, caregivers are now getting the tools and training needed to respond to emergencies. For six weeks this spring, about 250 in-home support staff and about 250 workers from skilled nursing facilities participated by Zoom in the Caregiver Resiliency Teams Project, a pilot program teaching everything from emergency preparedness and response to how to manage post-crisis trauma and other impacts of climate disasters.  

“The idea is that our members aren’t just impacted by this, but they’re also actually de facto first responders,” said Marguerite Young, who works with the climate and environmental program of the Service Employees International Union’s (SEIU). “And yet, they aren’t really part of the emergency response network.”

Looking at pictures of people sleeping in parking lots after the Camp Fire left Cheryl Clearwater, who provides in-home support services, wondering how she would manage in such a situation. Hearing from people in the pilot program who do the same work validated those concerns. 

“We don’t all have the same ability to wing it if there’s not some pretty extensive support in place,” Clearwater said, adding that disasters “affect absolutely everyone, but some people more than others.”

No Population More Vulnerable

A 2019 California State Auditor’s report on the emergency response to wildfires in Butte, Sonoma and Ventura counties found that the state “is not adequately prepared to protect its most vulnerable residents from natural disasters.” The governor’s Office of Emergency Services has not provided guidance on best practices or offered local officials information from lessons learned in other disasters, the report noted. That leaves communities without the resources to develop plans to protect vulnerable populations in future disasters, it added. 

“There is no functioning [emergency response] program for individuals with access and functional needs, which would be all of the IHSS consumer population, which in California is over half a million,” said Corinne Eldridge, president and chief executive officer of the Center for Caregiver Advancement. 

Offering $200 stipends to those completing the Los Angeles and San Bernardino pilot program, the advancement center created the curriculum, pulling in nurses and advocates from climate organizations such as the Asian Pacific Environmental Network and Communities for a Better Environment, as well in-home and nursing home caregivers to provide context for real life experiences. 

“It wasn’t built based on anything else because we, too, couldn’t find anything else,” Eldridge said. In searching for models, she said, the center found more “theoretical concepts, as opposed to a program that has tangible, real-life skills that people can learn and utilize in their lives.”

In-home support staff make it possible for many older people to remain in their homes, which is where most people prefer to be as they age. These workers will be in even more demand in the coming decades, when the senior population is expected to balloon to more than 83 million—accounting for more than 1 in 5 Americans by 2050. 

And no population is more vulnerable to climate-driven and other types of disasters, like earthquakes, than seniors, who are more likely than younger people to have limited mobility, chronic illnesses, disabilities and less tolerance for excessive heat and other extreme conditions. Three of the deadliest hurricanes in this century have borne this out. Of the 1,170 people who died when Hurricane Katrina struck New Orleans in 2005, almost half were over 75. Of 52 people killed in New York City during Hurricane Sandy in 2012, about half were over 65. And when Hurricane Harvey made landfall in Texas and Louisiana in 2017, more than half of the 89 people killed were over 50. 

On the West Coast, heat has more often been the culprit. Last summer,1,400 people died during an unprecedented heat wave in the Pacific Northwest, and in community after community, the toll was greatest on seniors. Two-thirds of those who died in Washington were over age 65. In British Columbia, 9 out of 10 deaths were of people over 60.

As climate change spurs more fires, floods, hurricanes and heat waves, state and federal agencies will be forced to rely more on local authorities for help. The Federal Emergency Management Agency recognized concurrent emergencies as a significant concern in its 2021 National Preparedness Report. Communities hit by disasters often have needs that continue long after a natural disaster, and that governmental agencies might not be able to meet. 

In 2019, such issues led Zach Lou, then a graduate student at the Goldman School of Public Policy at the University of California, Berkeley, to bring organizations together to create a better model for disaster preparation and in-home care in the aftermath. In-home support services are integral to community resilience, the groups noted in a 50-page report that called for training programs and ways to increase retention for in-home caretakers, a workforce with a history of high turnover.

Using the report, the caregiver advancement center started the pilot program with funding from the California Workforce Development Board’s High Roads Training Partnership initiative, which identifies workforces that can be strengthened to respond to the impacts of climate change across various industries. 

The service employees union, which represents more than 400,000 California caregivers, hopes not only to train its workers to fill some of the gaps in emergency services but also to be compensated for that training. The union is advocating for wages that reflect the growing skill set of this essential and notoriously underpaid workforce. The hourly wage for home-care workers in Los Angeles County and in the state is around $16, which is about $6 under the living wage for a California resident with no children. 

“One of the basic tenets of our work is that it’s not just training for training’s sake, there’s value in it,” Eldridge said. “Workers should be rewarded financially for bringing those skills to the broader health care system and into their consumer’s home.” 

Getting the Ball Rolling

The County Welfare Directors Association of California and Children Now, a nonprofit association representing the human service directors from across California, are requesting $190 million from the state for emergency response, including $20 million for in-home support services workers. While state agencies have requested similar resources in previous years, the need at the county level has gone unfunded. The funding would bolster emergency services and disaster preparedness at the local level. 

SEIU and the United Domestic Workers union also want state funding for such things as a $2 an hour wage increase for in-home support staff during natural disasters, as well as providing caregivers with the resources necessary to help clients evacuate and to keep workers safe. The pilot program to train caregivers is a step in that direction. 

“My hope is that this starts the ball rolling and gets picked up for use in other places, so that it’s part of what hopefully becomes a national model for this kind of training,” Young said, adding,  “Also, the hope is that we do more than just train. That it helps us begin a conversation about how we are really building an infrastructure to support our response to climate change and to the impacts we sadly are not going to be able to avoid as things get worse.” 

Smith, a caregiver for the last 15 years, said the Camp Fire taught him a lot, but that he’d be interested in learning more about how to respond to disasters and their aftermath.  

While he and his daughter rescued Donna, Smith believes the fire hastened her death a few months later.

“She’s one of the fire casualties that didn’t burn in the fire but died because of the fire,” Smith said. “People don’t think about that side of it.”

Katie Rodriguez is a writer with the Investigative Reporting Program at the University of California, Berkeley, Graduate School of Journalism. The IRP reported on this story through a grant from The SCAN Foundation.