Your Local Risks · With Cognitive or Developmental Needs
The plan built around how this person actually lives.
Dementia. Autism. Intellectual disability. Traumatic brain injury. Severe mental illness. The diagnosis is different for each household, but the planning questions are the same: can this person understand the alert, follow the plan, communicate their needs, and stay safe without constant supervision?
Get the preparedness checklistThe baseline
What cognitive and developmental needs actually change about your plan
The universal pillars still apply: water, food, light, communication, documents, medicine. What changes is that one or more people in the household may not be able to understand the situation, follow instructions under stress, communicate their needs to unfamiliar people, or remain safe without direct oversight. The plan must account for these realities without reducing the person to a diagnosis.
Communication barriers
Some people cannot process a verbal alert, understand a siren, or explain what hurts to a stranger in a uniform. Your plan must include alternative ways to communicate: picture boards, written instructions, a one-page profile card, or a medical ID that speaks when the person cannot. First responders rely on what you prepare in advance.
Supervision requirements
A person with advanced dementia, severe intellectual disability, or certain psychiatric conditions cannot be left alone during an evacuation, at a shelter, or in a disrupted environment. The plan must name who provides supervision at every stage and what happens if the primary caregiver is unavailable. This is the structural equivalent of a backup adult.
Routine disruption
For many people with cognitive or developmental disabilities, routine is not a preference. It is a regulatory system. Disrupting it produces anxiety, behavioral changes, wandering, refusal to eat, or aggression that compounds an already difficult situation. Preserving as much routine as possible during an event is a preparedness strategy, not an accommodation.
Medication continuity
Psychiatric medications, seizure medications, and behavioral health prescriptions cannot be interrupted without risk. Some have withdrawal effects that produce medical emergencies. A 72-hour backup supply, kept current and properly stored, is not optional. Your plan must also include the pharmacy's contact information and a current medication list a provider who does not know your household member can use.
Wandering and elopement
People with dementia, autism, or certain intellectual disabilities may wander from a safe location, especially when routines are disrupted or environments are unfamiliar. Shelters, evacuation routes, and even your own home during a power outage become wandering risks. Identification, tracking devices, and physical supervision strategies are plan items, not afterthoughts.
Sensory and behavioral triggers
Sirens, flashing lights, crowded shelters, unfamiliar food, and disrupted sleep are triggers for people with autism, PTSD, or certain cognitive conditions. The resulting distress is not a behavioral problem. It is a predictable response to an environment the person cannot process. Noise-canceling headphones, familiar objects, and a quiet space in the plan reduce this before it escalates.
The supplies
What to add to your kit for cognitive and developmental needs
Build the standard 72-hour kit first. Then layer these additions. Every item below addresses a specific functional need that standard kits do not cover.
Communication
Tools for when words are not enough
- One-page profile card: a laminated sheet with the person's photo, name, diagnosis (optional but helpful for first responders), medications, allergies, behavioral triggers, calming strategies, and your contact information. Hand this to anyone providing care when you cannot be present. Keep one in the go-bag and one on the person.
- Medical ID bracelet or tag: worn at all times, not packed in a bag. Should include the person's name, condition, emergency contact number, and any critical medical information (seizure disorder, non-verbal, do not restrain). This communicates when the person cannot.
- Picture communication board or visual schedule: for non-verbal individuals or those who process visual information better than verbal. Simple images showing "safe," "go," "stay," "water," "bathroom," and "help" cover the most critical needs during a disruption. Laminate it and keep it in the go-bag.
- If the person uses a speech-generating device or communication app on a tablet, keep a backup charger and a waterproof case in the kit. The device is a medical necessity, not an accessory. Treat it with the same priority as medication.
Medical
Medications, records, and provider access
- 72-hour medication supply in a labeled, waterproof container. Include exact dosing instructions written for someone unfamiliar with the person's routine. Psychiatric and seizure medications must not be abruptly stopped. Note any medications with withdrawal risks on the profile card.
- Printed medication list with the prescribing provider's name and phone number, pharmacy name and phone number, and the person's insurance information. If pharmacy access is disrupted after a disaster, the ACL Rx Open tool helps locate nearby open pharmacies in affected areas.
- Behavioral crisis plan: a written set of instructions for what to do if the person becomes severely agitated, disoriented, or aggressive during the disruption. Include what works to calm them (specific music, a weighted blanket, a particular phrase, physical space) and what makes things worse (being touched, loud voices, restraint). Share this with every backup caregiver.
- If the person receives regular therapeutic services (occupational therapy, behavioral therapy, day programs), note the provider's emergency contact and have a plan for the gap. Extended disruptions to therapeutic routines can produce behavioral regression that takes weeks to recover from.
Comfort and sensory
Familiar objects and sensory management
- Noise-canceling headphones or earplugs: shelters, evacuation vehicles, and disrupted neighborhoods are loud. For a person with sensory processing differences, the noise alone can produce a crisis. These are not comforts. They are functional tools that prevent escalation.
- One or two familiar comfort items: a specific blanket, a fidget tool, a weighted lap pad, a particular music player with headphones. These regulate the person's nervous system in a way that no amount of verbal reassurance can replicate. Pack them, not generic substitutes.
- Preferred foods: sensory-specific food preferences are common in autism and some intellectual disabilities. A person who will only eat certain textures or brands may refuse unfamiliar shelter food entirely. Pack a 72-hour supply of foods they will actually eat, not foods you wish they would eat.
- A written daily routine in simple steps, laminated: wake, eat, take medication, activity, eat, rest. When everything else is disrupted, following a visual schedule provides structure that the person can anchor to. This reduces anxiety and wandering in unfamiliar environments.
Identification
When the person cannot identify themselves
- Medical ID bracelet worn at all times: name, condition, emergency contact, and any critical instructions ("non-verbal," "seizure disorder," "do not restrain"). This must be on the person's body, not in a bag they may leave behind or lose during a disruption.
- Current photograph: keep a recent photo on your phone and a printed copy in the go-bag. If the person wanders, a photograph is the fastest tool for reunification. Update it every six months or when appearance changes significantly.
- GPS tracking device or phone app: for people with a history of wandering, a wearable GPS tracker provides location data when visual supervision is briefly interrupted. This is especially relevant during evacuations, shelter stays, and power outages when doors may not have their usual locks.
- Register with your county's voluntary special-needs registry if one exists. This alerts emergency services that your household includes a person who may need additional assistance during an evacuation or welfare check. The CDC advises that this should supplement your plan, not replace it. In a large-scale event, responders may not reach every registrant.
A note on scope
This guide covers cognitive and developmental needs across a wide range: dementia, Alzheimer's disease, intellectual disabilities, autism spectrum, traumatic brain injury, Down syndrome, and severe mental illness. No single guide can address every individual's needs. Use the C-MIST framework (Communication, Medical, Independence, Supervision, Transportation) to evaluate your household member's specific functional needs and adjust the plan accordingly.
The plan
The household plan, built around functional needs
The standard household emergency plan assumes every adult can understand the situation, follow instructions, and act independently. When someone in the household cannot do one or more of those things, the plan needs these specific adjustments.
01
Build a support network with specific knowledge
Identify two to four people who know the person, understand their needs, and can provide care if you are unavailable. This is more specific than a general emergency contact. Your backup caregivers need to know the person's medications, behavioral triggers, calming strategies, food preferences, and communication methods. A willing stranger cannot fill this role. Choose people who have spent time with the person.
Give each backup caregiver a copy of the profile card, the medication list, the behavioral crisis plan, and a key to your home. Walk them through one caregiving routine so the transition from you to them is not the person's first experience with a different caregiver during a crisis.
02
Prepare the person for changes in routine
For people who can understand some level of preparation, practice simplified versions of your plan using their communication style. Visual schedules, social stories (for autism), or repeated verbal walk-throughs work better than a single conversation. The goal is not mastery. The goal is enough familiarity that the process is not entirely new when it happens.
For people with advanced dementia or severe intellectual disability who cannot engage with the concept of preparation, the plan lives entirely with the caregiver. In that case, rehearse your own sequence: how you move this person, how you carry the bag, how you keep them oriented while managing everything else. Your fluency is their safety.
03
Plan for shelter and unfamiliar environments
Public shelters are crowded, loud, bright, and unpredictable. For a person with sensory processing differences, cognitive rigidity, or dementia-related agitation, a shelter can be harder to manage than the event itself. If possible, identify alternative shelter: a friend's home, a family member, or a quiet motel along your evacuation route.
If a public shelter is the only option, inform staff immediately about the person's needs. Most Red Cross shelters designate areas for people with functional needs, but you must ask. Bring the headphones, the comfort items, and the visual schedule. These are not extras. They are what makes the shelter usable.
04
Address wandering and elopement risk
During a disruption, the normal physical and environmental cues that keep a person oriented may be gone: the lights are off, the doors are open, the locks do not work, the familiar layout is damaged. For people with a history of wandering, this is a high-risk period. The medical ID bracelet and GPS tracker are the baseline. Beyond those, a door alarm or door chime can alert you if the person leaves a room or building while you are attending to something else.
If the person wanders during the event, call 911 immediately and provide the recent photograph, the clothing description, and any known patterns (drawn to water, tends to walk in one direction, goes toward familiar locations). Time matters. Do not search alone for more than a few minutes before calling for help.
05
Document legal authority and care instructions
If you are the legal guardian, conservator, or hold power of attorney for the person, keep certified copies of those documents in your go-bag. Hospitals, shelters, and first responders may need to verify your authority to make medical decisions or consent to treatment. Without documentation, the process slows at the worst possible time.
Include a signed letter authorizing your backup caregivers to make decisions if you are unavailable. This is similar to the temporary guardianship letter used by single parents, adapted to your legal arrangement. Consult your state's requirements for the proper form.
During the event
What to do, in order, when supervision is part of the plan
The sequence below assumes a sudden-onset event. Every step accounts for the fact that you are managing the emergency and the person simultaneously. The order is designed to keep the person safe while you make decisions.
01
Secure the person first
Move them to a safe, enclosed space before assessing the situation. For a person who wanders, this means a room with a closed door. For a person who becomes agitated, this means a quiet interior space with their comfort items. An unsupervised person with cognitive needs during the first chaotic minutes is the highest-risk scenario in your plan.
02
Communicate simply and calmly
Use the communication method that works for this person: short sentences, familiar phrases, the visual schedule, pointing, or simply modeling the action you want them to take. Do not explain the situation in detail. "We are going to the safe room now" is more effective than a description of the weather event. Calm, steady repetition works. Urgency in your voice does not.
03
Administer medications on schedule
A disrupted medication schedule can produce a secondary crisis within hours. Seizure medications, antipsychotics, and certain mood stabilizers have narrow timing windows. Keep the medication kit accessible, not buried in the go-bag. If you miss a dose, follow the prescriber's instructions for late doses, which should be written on the medication list in your kit.
04
Shelter-in-place with supervision
Set up the safe room with the person's comfort items, preferred food, and visual schedule. Maintain the routine as closely as possible: meals at the usual time, sleep at the usual time, activities that approximate the normal day. If the person becomes agitated, use the calming strategies from the behavioral crisis plan. Do not attempt to reason through the emergency. Redirect to familiar activities.
05
Evacuate with planning
The person goes in the vehicle before the supplies. Use familiar language: "We are going for a car ride" works better than "We are evacuating." Bring the comfort items, headphones, and preferred snacks. If the person resists, use the approach that works during their most difficult moments at home. This is not the time for a new strategy. If you need physical assistance, call your backup network before you are in crisis.
06
Notify shelter staff immediately
If you arrive at a public shelter, inform staff of the person's needs before settling in. Hand them the profile card. Ask about quiet areas or functional-needs accommodations. Keep the person within your line of sight until you have assessed the environment and identified wandering risks, exits, and noise sources. If the shelter cannot accommodate the person's needs, ask about alternative placements.
Recovery
The first 24 to 72 hours with cognitive or developmental needs
Recovery for a person with cognitive or developmental needs is measured by how quickly their routine returns, not by how quickly the house is cleaned. Behavioral regression, sleep disruption, and increased anxiety are common after a disruptive event and may persist for weeks. Restoring the daily structure is the first recovery action, not the last.
You cannot provide care and manage recovery logistics at the same time. Activate your backup network early. A few hours of relief while you handle insurance, repairs, or cleanup is not a luxury. It is what keeps the caregiving sustainable.
Restore routine first
Re-establish the person's daily schedule as close to normal as possible, even if your living situation has changed. Meal times, medication times, bedtime, and familiar activities provide the structure that helps the person regulate. This matters more than cleanup. A person who is stable is one fewer problem during a difficult period.
Watch for behavioral changes
Increased agitation, sleep disturbance, withdrawal, regression to earlier behaviors, refusal to eat, and increased repetitive behaviors are all normal stress responses in people with cognitive and developmental disabilities. They are not signs of a new problem. They are signs that the person's system is overloaded. Patience, routine, and familiar environments resolve most of these over days to weeks.
Reconnect with providers
Contact the person's prescribing physician, therapist, or day program as soon as services resume. If medications are running low and the pharmacy is closed, call the prescriber's emergency line or use the ACL Rx Open tool to find an open pharmacy. If day programs or respite services are disrupted, ask about temporary alternatives. Extended gaps in services affect the person and the caregiver.
Caregiver well-being
Caregiving through a disaster is exhausting in a way that compounds the baseline fatigue of daily caregiving. SAMHSA's Disaster Distress Helpline (1-800-985-5990) provides free crisis counseling for anyone affected by a disaster, including caregivers. The ACL Disability Information and Access Line (888-677-1199) connects people with disabilities and their families to local support resources. Asking for help is a recovery action.
Resources
Authoritative sources for cognitive and developmental needs
These are the sources this guide draws from. Bookmark your state emergency management agency and your county's developmental disability services board separately. Local resources vary significantly by state.
Ready.gov: People with Disabilities
FEMA's guidance for people with disabilities and their families, including tips for creating a support network, packing a go-bag with items for unique needs, and registering with local special-needs registries.
ready.gov →
CDC: Emergency Preparedness and Disability
Resources from the CDC's National Center on Birth Defects and Developmental Disabilities, including state-specific brochures and guides for people with cognitive, intellectual, and developmental disabilities.
cdc.gov →
ACL: Emergency Preparedness
Administration for Community Living resources including the Disaster Preparedness Guide for Caregivers, the DIAL hotline (888-677-1199), and Rx Open for finding open pharmacies during disasters.
acl.gov →
SAMHSA: Disaster Behavioral Health
Disaster behavioral health resources and the Disaster Distress Helpline (1-800-985-5990) for crisis counseling. Includes guides for parents and caregivers helping people with mental illness cope during disasters.
samhsa.gov →
Inclusive Emergency Preparedness Guide
Utah State University's 2024 guidelines applying the C-MIST framework to emergency planning for people with mobility, hearing, visual, and cognitive disabilities.
usu.edu →
HHS: Emergency Preparedness for Disabilities
U.S. Department of Health and Human Services resource hub linking to Ready.gov, CDC, and ACL preparedness materials for people with disabilities and their caregivers.
hhs.gov →
New World Survival is an independent resource. We are not affiliated with or endorsed by FEMA, the CDC, ACL, or SAMHSA. Our content is based on their publicly available guidance.
Next steps
Your household plan starts with 72 hours.
This guide is specific to households with cognitive or developmental needs. The foundation it builds on is the standard 72-hour household plan. If you have not built that yet, start there. Then layer these adjustments on top of it.