More On SNF Residents and Hurricane Evacuations

Ok, this is not Irma-specific but it is hurricane-specific.  Although a Florida-specific publication, I thought the information important to all of us.  Health News Florida reports on a recent study coming out of the University of South Florida. Study: Evacuating Nursing Home Patients Before A Storm Not Always Safest Option references that there are risks when evacuating residents of nursing homes with this “[n]ew research… [suggesting] evacuating nursing home patients before a storm increases the chance of both hospitalization and death.” The study is hurricane-specific; keep in mind many states may be hit by hurricanes and recall the events from Katrina and Harvey, as well as Irma.   Here’s a description from the author of the study: “[W]e looked at four different hurricanes. We looked at the hurricanes that were affected Texas and Louisiana, hurricanes Katrina, Rita, Ike and Gustav. Those were hurricanes in 2004 and 2008. In those studies, we carefully looked at the nursing homes that sheltered in place or stayed where they were before the storm, versus the nursing homes that are evacuated. Our work indicated that regardless of whether places evacuated or sheltered in place, hurricanes created an increased rate of death. In fact, we found that an extra 277 deaths occurred and 872 hospitalizations occurred during those storms as a result of the hurricanes.” 

Why is evacuation harder on the residents than sheltering in place? According to the author, it’s not just that residents are vulnerable and have higher and diverse levels of needs and services.

 They are in a nursing home because they require 24-hour care from skilled clinicians. So they’re very sick. They have high levels of co-morbidities, these residents have high levels of diseases, and many of them suffer from congestive heart failure or diabetes. And many of them have cognitive impairments — severe cognitive impairment — Alzheimer’s disease and other conditions that make it difficult for them to be able to be cared for outside of this skilled 24-hour care place.

The important part as well is that these individuals when they’re in a nursing home receive, on an ongoing basis, carefully crafted care. They get their medications at normal times. They have an environment that is cooled and warmed the way it should be. They have food delivered on a normal basis and lots of skilled services being delivered. During a hurricane, during a disaster situation, those carefully scheduled routines obviously aren’t able to be conducted in the way that you would love. And as a result, we believe that that kind of careful work is not able to be done during a disaster. So they are at risk. It is also true, and we know this from other studies, that there is a tension level within a facility that’s getting ready to evacuate or getting ready just to prepare for the storm.

The study offers several recommendations, including sheltering in place, requiring generators (the subject of an earlier post), public availability of evacuation plans (and have them be more detailed, recognizing that there may need to be various options to meet the levels of residents), more funding and considering transfer in lieu of evacuation.   Here are two that I thought were worth quoting from the author

Another recommendation we have is that nursing homes and assisted living be built in places where they can sustain storms. We have too many nursing homes and assisted living in floodplains and those buildings are not prepared. It appears that some are not prepared to deal with storm surge or to deal with even flooding on what could be easily a normal summer day in Florida….

I believe, and I think my colleagues believe, that we also need some degree of litigation protection for people who are trying to do their job well after a disaster. There’s a lot of Monday-morning quarterbacking and there are cases where people who have tried very hard and heroically tried to work in the nursing home, or in assisted living, are sued because there are bad outcomes.

There is a lot more covered in the article, and I think it is well worth reading, even if you live in a land-locked state.