Robert F. Bukaty/Associated PressA wheelchair outside St. Rita’s Nursing Home in St. Bernard Parish, La., in 2005. The facility flooded during Hurricane Katrina.As hailstones the size of golf balls beat thunderously on the roof of the nursing home, an urgent announcement rang out from the loudspeakers.
“Everyone needs to go out into the halls now,” Kaye Russell, 70, remembers a nurse’s assistant saying. Staff members began rolling patients in wheelchairs through the doorway. “Put your heads down; arms over your head, everyone.”
“Everybody was crying and praying,” said Ms. Russell, who has multiple sclerosis and had been recovering from a bout of pneumonia at the facility, Green Oaks Nursing and Rehabilitation Center in Arlington, Tex.
Suddenly, the roof began to shake, windows blew out and the nursing home was filled with a trainlike roar. Ms. Russell’s daughter, Lori Coakley, a physical therapist at the facility, rushed down the hall and threw herself on top of her mother.
“I thought, well, this is it, we’re gone,” Ms. Russell said.
On that day last month, Green Oaks took a direct hit from one of several tornadoes ripping through the greater Dallas/Fort Worth area. Astonishingly, all 131 residents and nearly 40 workers in the facility emerged alive and relatively unscathed.
Luck played a role, surely, but so did good planning and quick responses. Without exception, employees moved patients safely out of their rooms and away from windows, and rapidly triaged residents’ injuries once the tornado had moved on. Within five hours, all residents were evacuated to other nursing homes or a nearby hospital, most with bags on their laps containing medical records and medications.
“This event vividly illustrates why it’s so critical that nursing homes have well-trained staff and updated and detailed emergency procedures in place,” said Allison Lowery, media relations manager for the Texas Department of Aging and Disability Services. “It quite literally saves lives.”
Unfortunately, a recent government report finds that disaster planning at most nursing homes is sorely lacking. That’s distressing news as communities confront unusual, unpredictable weather, which many experts believe is linked to climate change.
According to the new report, by the Department of Health and Human Services, 92 percent of nursing homes have plans for handling tornadoes, hurricanes, floods or fires, and 72 percent have staff members trained in emergency procedures, as required by federal law.
But after conducting in-depth inspections at 24 institutions, officials found significant gaps in preparations. Each of the homes had experienced a flood, a hurricane or a wildfire from 2007 to 2010, and 17 reported substantial challenges responding to these disasters. Yet 22 homes failed to specify how patients’ medical records and medications would be dealt with in an emergency. Twenty-three had no plan for handling the illness or death or a resident in a disaster.
None of the emergency plans in place in these nursing homes included measures to ensure an adequate supply of drinking water for workers and patients. At 19 of them, there was no strategy to ensure an adequate fuel supply for backup generators. Ten homes had not addressed the need for adequate staffing during emergencies; 15 didn’t detail how patients’ needs for items such as feeding tubes, ventilators or oxygen would be handled.
One home had no procedures for dealing with floods, even though it was in a flood plain. None of the homes had participated in drills or exercises run by community emergency preparedness managers.
The results were a disappointing repeat of a similar government report issued in 2006 — the first major study to track nursing homes’ ability to respond to disasters after Hurricane Katrina struck the Gulf Coast in August 2005. In one tragic incident outside New Orleans, 35 residents of St. Rita’s Nursing Home perished, some overcome by floodwaters in their beds.
“It’s very troublesome to see that we haven’t made more progress with problems that have been clearly identified,” said Robyn Grant, director of advocacy for the National Consumer Voice for Quality Long-Term Care in Washington.
“The unfortunate reality is that until something happens, people are stuck in denial,” said Dr. Charles Cefalu, chief of geriatric medicine at Louisiana State University School of Medicine and chairman of the American Geriatrics Society’s disaster preparedness committee.
Dr. Cefalu was medical director for four nursing homes in New Orleans when Hurricane Katrina hit. The facilities hadn’t done much to prepare for emergencies, he said, and were fortunate that residents were evacuated without harm.
Now, long-term care institutions throughout New Orleans have detailed, regularly updated disaster plans, and many conduct mock disaster drills every year.
According to the Federal Emergency Management Agency, the states most likely to experience natural disasters are Texas, California, Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas and Missouri, in that order. More than 1.1 million nursing home residents, or about 36 percent of the nation’s total, live in those areas.
Florida became a leader in disaster planning after five dangerous storms wreaked havoc across the state in 2004. The Florida Health Care Association, an industry group, realized that nursing homes were not on emergency managers’ radar screens, unlike hospitals, said April Henkel, a project manager at the organization.
So, the association set about arranging regular meetings with the state’s Department of Health, energy providers and emergency response managers, and recommended that local homes do the same in their communities. The advice Ms. Henkel now offers to nursing home administrators: “Get out there, get to know people in the community, assert yourself into the local emergency planning system.”
One retirement community, Village on the Isle in Venice, Fla., has taken preparedness to extraordinary lengths. Each year, it evacuates more than 10 percent of independent living residents by bus to a site 145 miles away in an effort to learn how to deal with the unexpected.
Few people think to ask about disaster preparedness when selecting a nursing home — but they should, said Ms. Grant of National Consumer Voice for Quality Long-Term Care. The organization has compiled a list of questions that families might want to ask.
As for Green Oaks, the home hit by the tornado in Texas, 103 residents recently moved back into the facility, and executives there are busy conducting an analysis of what went right and what could have gone better. Matching patients with their medical charts and medicines was more time-consuming than expected, and Green Oaks could have had a better understanding of Arlington’s emergency response system, said Mark McKenzie, president of Senior Care Centers, a privately held company that owns the home.
“Everyone is glad to be back,” said Ms. Russell, who expects to stay another few weeks in rehabilitation before she goes home. “The fact that we went through it together and we all survived, well, that’s something you never thought would happen and that you’ll never forget.”