As I write this in late September, the media is full of reports of disasters. Residents of Mexico City are digging through rubble following a 7.1-magnitude earthquake. Texas, Florida, Puerto Rico, and other Caribbean islands have been devastated by Hurricanes Irma and Maria, two of the most powerful storms ever to come from the Atlantic. Stark images of destruction and hollow-eyed people searching for family members and trying to save belongings fill newspapers and television screens. It's reminiscent of the scenes following Hurricane Katrina in 2005.
And once again, we've learned that vulnerable elderly people have died—this time trapped in a Florida nursing home without water or air-conditioning. While the facility had a backup generator, it did not power the air-conditioning and fans could not keep the residents cool. The elderly victims reportedly had body temperatures as high as 109°; eight residents died in the facility, while two more died later after being taken to a hospital across the street. There is an ongoing investigation as to why the power and electric company didn't respond sooner, why Governor Rick Scott's office didn't return calls for help, or why staff didn't react more quickly to deteriorating conditions and evacuate residents to the nearby hospital.
In response to this incident, Governor Scott implemented new emergency rules, which will require that within 60 days, “all assisted living facilities (ALFs) and nursing homes must obtain ample resources, including a generator and the appropriate amount of fuel, to sustain operations and maintain comfortable temperatures for at least 96-hours following a power outage.” This is already required of hospitals.
On September 22, the Florida Health Care Association (FHCA), which represents over 80% of the states’ nursing homes and assisted living and rehabilitation facilities, convened a Nursing Center Emergency Preparedness Summit to discuss implementation of the new rule.
While it might seem logical to evacuate nursing homes that lie in the path of hurricanes, evacuation is not without risk. A systematic review of six-month mortality risk among nursing home residents following emergency evacuation, published in the August issue of the Journal of Post-Acute and Long-Term Care Medicine, found that evacuation “seems to have a negative impact on survival independent of the effect of the disaster.” And on September 20, the U.S. Senate Special Committee on Aging convened a hearing on what's needed to ensure the safety of older adults during disasters. Kathryn Hyer, a professor and researcher of elder care during disasters, testified that evacuating frail elderly residents isn't without its hazards. She cited her 10 years of research, including one study in which she examined mortality rates after four hurricanes and found that “evacuation proved to be cumulatively more dangerous than sheltering in place.” She offered eight recommendations designed to improve care for older adults, including mandating generators and fuel for adequate climate control, more disaster training, and better oversight.
After Hurricane Katrina, I attended a similar summit, also convened by the FHCA. The 10 recommendations from that meeting a decade ago are very similar to what was proposed in the recent Senate hearing. Among them was that nursing homes should be considered on par with hospitals in terms of priority disaster response needs; facilities and their power systems need to be improved to withstand severe storms and make sheltering in place possible; facilities need to have an evacuation plan that's tested and coordinates with emergency management operations; communication system capabilities need to be improved; and plans need to include follow-up after the event. (See http://links.lww.com/AJN/A83 for an AJN report on the summit's recommendations.)
As point-of-care professionals and patient advocates, nurses need to ensure that the facilities in which they work have plans in place that meet regulatory requirements for disaster management, including training and drills. And during disasters, nurses need to take the lead to ensure safe care for residents and take action when conditions make that impossible. Residents’ lives depend on it.