Case Report Challenges and Opportunities of Nursing Care in Special-Needs Shelters Belinda Joy Deal, RN, MSN, CEN, Rebecca A. Fountain, RN, MSN, Carol Ann Russell-Broaddus, RN, MSN, and Melinda Stanley-Hermanns, RN, MSN, BC Hurricanes Katrina and Rita forced many individuals along the coast of Texas and Louisiana to seek shelter inland. Among the evacuees were residents with special needs and residents of nursing homes and group homes caring for mentally retarded and physically disabled persons. Many nurses volunteered to provide health care for those in need. This article discusses challenges and opportunities that were encountered by nurses volunteering in special-needs shelters. Issues related to human and physical resources, patient care, and confidentiality are discussed including lessons learned. As nurses who cared for evacuees in the shelter, it is hoped some of the lessons learned can be utilized in future disasters. T he hurricanes that slammed into the Texas, Louisiana, and the Mississippi Gulf Coast in 2005 resulted in the displacement of nearly a million people. 1 Among the evacuees were residents with special needs, residents of nursing homes, and group home residents with mental retardation and physical disability. With very little warning, shelters had to be created in an East Texas community in antic- ipation of the arrival of an unknown number of evac- uees. This article describes some of the experiences of nurses volunteering in shelters for patients with special needs. In late August 2005, approximately 4 shelters were opened for persons being evacuated from New Or- leans owing to the damage from Hurricane Katrina. Before the shelters closed from Hurricane Katrina, a second hurricane, Rita, hit the Southeast Texas coast area, necessitating more evacuations to safer commu- nities hundreds of miles inland. Despite being satu- rated with Katrina evacuees, the East Texas area soon began to receive Hurricane Rita evacuees as well. Some Louisiana evacuees who had sought shel- ter in the South Texas Gulf Coast region were relo- cated again because of the threats from Hurricane Rita. In response to Hurricane Rita, the East Texas com- munity was asked to care for patients with special needs, such as displaced nursing home residents, per- sons with mental retardation and long-term physical disability, and persons who could no longer be man- aged in homes that had been destroyed by the storms. Nursing home residents needed shelter and accommo- dations to meet their complex health care needs; staffs of those facilities required accommodations as well. How and why specific nursing homes ended up in various locations varied. One nursing home adminis- trator knew a local pastor and sent staff and residents to a church where care was continued by staff, as well as local nurse and student nurse volunteers. The Texas Department of Health Services Special Needs shelter housed the residents and the staffs of several different nursing homes in a local college gym. A total of 348 persons designated as special needs were cared for in 2 shelters in the city limits of Tyler. The number of special-needs patients fluctuated, with a maximum number of 275 at any time in both of the Tyler shelters. Approximately 80 group home residents with varying degrees of mental retardation and physical disabilities were sent to a church camp in a rural area. Patients were returned to their original facilities as soon as local hospitals and nursing homes re-opened or relocated. As the shelters closed, and the need for volunteer nurses ceased, nurses who volunteered began to realize the value and importance of Belinda Joy Deal is Senior Lecturer, University of Texas at Tyler, College of Nursing and Health Sciences, Tyler, Tex. Rebecca A. Fountain is Senior Lecturer, University of Texas at Tyler, College of Nursing and Health Sciences, Tyler, Tex. Carol Ann Russell-Broaddus is Senior Lecturer, University of Texas at Tyler, College of Nursing and Health Sciences, Tyler, Tex. Melinda Stanley-Hermanns is Senior Lecturer, University of Texas at Tyler, College of Nursing and Health Sciences, Tyler, Tex. Reprint requests: Belinda Joy Deal, RN, MSN, CEN, The University of Texas at Tyler, College of Nursing and Health Sciences, 1715 Sampson Drive, Tyler, TX 75701. E-mail: bdeal@mail.uttyl.edu Disaster Manage Response 2006;4:100-5. 1540-2487/$32.00 Copyright Ó 2006 by the Emergency Nurses Association. doi:10.1016/j.dmr.2006.08.001 DMR 100 Disaster Management & Response/Deal et al Volume 4, Number 4