In 2018 alone, the United States was bombarded with 14 catastrophic climate and weather-related events, including wildfires, hurricanes, storms and floods—and the intensity and frequency of these disasters is expected to increase over time.
While all older adults feel the impact of extreme weather, those needing full-time care are especially vulnerable. Many people in this population have chronic health problems, such as heart disease, diabetes and Alzheimer’s disease. Being forced to leave familiar surroundings and risk periods of time without food, water, shelter and adequate rest can be physically and emotionally harmful. Even a heat wave can be deadly if air conditioning systems fail.
As a result, long-term care facilities are facing unprecedented challenges in emergency management for aging residents.
During an impending emergency, the most critical decision for care facilities is whether to shelter in place or to evacuate residents.
It’s always better to stay, if possible. Evacuations can be traumatic for residents, many of whom are frail and may have dementia, says Paul Bach, Executive Vice President and Chief Operating Officer at Genesis Healthcare, which operates approximately 400 skilled nursing centers and senior living communities in 29 states nationwide. “Sometimes we have to make the decision on our own, but, more and more, emergency medical services are helping providers make the call,” he says.
The nature of the event also informs the decision. For example, hurricanes are often predictable, so there is time for providers to ensure that staffing needs are met and supplies are stocked. Wildfires tend to move faster; mixed with their unpredictable nature, it’s important to act quickly and efficiently.
Needless to say, making the decision to evacuate does not come lightly. “It’s not like ‘let’s just get in the car and go,’” says Kristen Knapp, Director of Communications at the Florida Health Care Association, which oversees 650 nursing homes and assisted living facilities in Florida.
Once the decision is made to evacuate, facilities must arrange transportation and coordinate with local hospitals and other communities that can accommodate residents.
“We faced a significant challenge during the 2017 fires in Santa Rosa, which I can only describe as a cataclysmic event,” says Kevin Bowman, Senior Regional VP of Operations at Brookdale Senior Living; the company owns five communities in the region, in addition to many more across the country.
The staff at Brookdale immediately started working with the local EMS. “We were lucky because, due to our large presence in that market, we had access to ambulances and local buses, as well as a number of our community-owned vans,” says Bowman. Residents were evacuated to a local community center first. From there, the company was able to coordinate with their other communities in Northern California to find accommodations for the residents.
Then there is the significant challenge of making sure residents have necessary medications and medical equipment like oxygen, walkers and wheelchairs.
“Residents are always assessed by a doctor or nurse practitioner upon being received at the next facility,” says Bach. “If we’re sheltering in place, we bring in more staff, assess for change in condition and step up communication with loved ones.”
Care facilities don’t wait for a crisis. Advance planning is an important part of emergency preparedness.
Bach notes that having generators is critical. In fact, after Hurricane Irma in 2017, the governor of Florida issued a rule that senior communities must have generators and 96 hours’ worth of fuel. Florida also has an Emergency Status System, a web-based platform that facilities can log into during an emergency, and another site with training resources called LTC Prepare.
In the California Association of Health Facilities Disaster Preparedness Program, employees are presented with specific scenarios and asked how they would respond. Questions include:
The federal government now requires long-term care facilities to submit a comprehensive emergency preparedness plan to the state’s regulatory agency. Included are tabletop exercises and drills that staff must participate in regularly.
“The safety of our residents is our primary concern,” says Knapp. “That’s always our top priority in a crisis.”