CHARM Roadmap: People who are disabled, homebound, or who rely on medical equipment

In Lake County, 22.2% of the population has a disability compared to 11.7% for California. These disabilities include hearing (6.8%), vision (6.2%), cognitive (8.6%), ambulatory (11.7%), self-care (5.8%), and independent living (12.7%) difficulties.

Durable medical equipment (DME) is medical equipment prescribed by a doctor for use in the home. It is designed for repeated use and may be essential for survival (such as ventilators or oxygen tanks) or used to improve quality of life (such as wheelchairs or CPAP machines). In Lake County, 5% of Medicare recipients (about 900 individuals) use electricity-dependent DME and 2% of Medicare recipients (about 300 individuals) receive home oxygen tank delivery services and use electricity-dependent DME.

Definitions of “homebound” vary, and the State does not track homebound status. However, there is likely to be significant overlap between disabled, medically-dependent, senior, and homebound populations, and the challenges presented to these groups in CDEs are similar.

Vulnerability to climate-driven events

• Dependence on electricity- Many individuals rely on DME such as ventilators, oxygen concentrators, or power wheelchairs that require electricity to function. During climate-driven events like wildfires or heatwaves, power outages are common and can become life-threatening for those dependent on this equipment. Many people do not have access to generators or other backup power systems, further increasing risk.

• Limited mobility and evacuation barriers- People who are homebound or have mobility impairments may face significant challenges evacuating quickly or independently during emergencies. Rapidly evolving disasters, such as wildfires, often require immediate evacuation, which may not be possible without assistance or specialized transportation. Even when evacuation centers are available, they may not be physically accessible or adequately equipped to meet the needs of people with disabilities.

• Increased health vulnerability- Extreme heat poses serious health risks for individuals with chronic conditions, impaired thermoregulation, or those taking medications that heighten sensitivity to heat. In addition, wildfire smoke can severely impact people with respiratory conditions, particularly those who require clean indoor air or oxygen therapy. These environmental stressors compound existing health vulnerabilities, placing certain populations at even greater risk.

• Communication barriers- Disabled or elderly individuals may struggle to receive or act on emergency alerts due to hearing, vision, or cognitive impairments. Often, alerts and critical information are not provided in accessible formats such as captions, braille, audio, or plain language, making it harder for these individuals to understand and respond to threats in a timely manner.

• Social isolation and limited support- Homebound individuals are often socially isolated and may lack strong support networks, making it harder to get help during a disaster. Many are not registered with emergency services, meaning they may not be identified or prioritized by responders during an emergency, further increasing their risk.

• Inequities in emergency planning- Emergency preparedness and response systems frequently fall short in addressing the needs of people with disabilities. This includes a lack of accessible transportation, insufficient shelter accommodations, and inadequate planning to ensure continuity of care for medical needs during disruptions. As a result, disabled individuals often face systemic barriers to safety and resilience during climate-related events.

Who works with this community

In Lake County, a network of agencies and organizations supports people with disabilities, those who are homebound, and individuals who rely on DME. County programs like In-Home Supportive Services and Adult Protective Services provide in-home caregiving, financial support, and protective services for low-income and vulnerable adults. Redwood Coast Regional Center offers case management and services for individuals with developmental disabilities, while the regional Area Agency on Aging coordinates Meals on Wheels and support for aging residents living independently in partnership with non-profits like Community Care. Health providers such as Adventist Health offer home care and help with medical equipment needs, often in partnership with DME suppliers like Norco or Apria. Transportation for individuals with mobility limitations is supported through Lake Transit Authority’s paratransit and Dial-a-Ride services. These organizations collectively help meet the daily living, medical, and mobility needs of some of the county’s most medically and socially vulnerable residents.

Selected survey findings

• 39% of respondents of the general public survey identified with having at least one disability (personally or someone in their household)

  • 18% had a mobility or balance issue (sitting down or standing up)
  • 13% had a physical disability
  • 13% used in-home equipment for their disability
  • 9% had a cognitive/neurodevelopmental disability

• Evacuation support: 52% needed evacuation support some or most of the time.

• Home-based support. 53% needed help with meals some or most of the time. 45% needed help with chores some or most of the time.

• Social and informational support: 50% needed support with getting information or helping to understand a problem some or most of the time.

• Errands and appointments: 51% needed help with errands some or most of the time. 44.4% needed help with making appointments most of the time.

Compared to other respondents, respondents with disabilities were more likely to report needing help "most of the time" or "all of the time" across nearly every type of support listed — suggesting a broad, consistent reliance on external assistance during emergencies, heatwaves, or other CDEs.

Community voices

"I remember during COVID when we're all in lockdown, there was like a big fire...it was near Clear Lake, and they were going to be doing evacuations. So I was calling my disabled elderly, people in wheelchairs, people on oxygen, trying to figure out what the plan was to get them out. Or how they were going to get out. I ended up working with the fire department in Clear Lake and actually went through and called every patient and... gave the fire department the list of all of our people who were immobile or couldn't get out."

"Yesterday, they had a fire up in Ukiah and my mom, you know, she was ready to go, but she didn't know what direction to go in, you know. So since I'm disabled, you know, I don't know if PG&E will help me out, or who will help me out."

[Interviewer] "In an evacuation situation, where would you go, what would you do?"
[Interviewee] "I'd probably just stay in my house until the last possible moment."

"Our apartment is kind of small and tight and doesn't really accommodate a walker or a wheelchair very well, so I act as her crutches... I really can't conceive of a good outcome of another evacuation."

Ensure power continuity

• Backup power solutions: Provide access to generators, battery backups, or solar power for those with power-dependent medical needs.
• Medical baseline programs: Enroll individuals in utility programs that offer priority restoration, advance notice of shutoffs, or financial aid.
• Community-level energy resilience: Develop microgrids or resilience hubs with power supply for at-risk residents during outages.

Improve emergency planning and communication

• Inclusive emergency plans: Local and state agencies should include people with disabilities in disaster planning, with attention to accessibility, medical needs, and mobility.
• Accessible alerts: Use multiple formats (e.g., text, voice, braille, plain language) to ensure everyone receives timely information.
• Registry systems: Create voluntary registries to identify individuals needing assistance during emergencies, while safeguarding privacy.

Strengthen social and medical support networks

• Community check-in programs: Organize buddy systems, phone trees, or volunteer responders to check on isolated or high-risk individuals.
• Faith-based or neighborhood groups: Leverage trusted local organizations to conduct outreach before and during crises.
• Medical and service providers: Encourage clinicians, social service providers, and others to integrate emergency preparedness into patient care.

Enhance access to safe shelters and transportation

• Accessible evacuation transportation: Ensure accessible vehicles are available and drivers are trained to assist individuals with disabilities or DME.
• Shelter accommodations: Stock shelters with medical supplies, power sources, cots, oxygen, and staff trained in disability support.

Support home modifications and adaptations

• Fund programs for retrofitting homes to stay cool during heatwaves or safe from wildfire smoke (e.g., with insulation, air filters, or window coverings).
• Offer cooling and air purification equipment to vulnerable residents, with guidance on use during emergencies.

Provide preparedness training and education

• Provide tailored emergency planning resources that help people prepare their own kits, back-up plans, and medical information sheets.
• Offer disability-specific preparedness workshops, ideally through healthcare providers or disability organizations.

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