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Caring for Elders During a Natural Disaster: We Can Do Better—but Are We?
posted 07.11.2011

Editor’s Note: This article appears in the July/August, 2011, issue of Aging Today, ASA’s bi-monthly newspaper covering advances in research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store. Photo courtesy of Irene Collins.

By Jenny Campbell

As I write this, the waters of the Mississippi are lapping over the levees in Louisiana and Mississippi. It seems impossible that so many disasters could befall one area: following the devastation of hurricanes Katrina and Rita, there was Gustav, Ike, an oil spill, biblically fierce tornados and now a river that will not be contained. And it’s not just this region. According to FEMA, the United States has experienced 381 disasters since Hurricane Katrina. Since 1954, every state has experienced a disaster—an average of 34 per state. Everyone has a stake in disaster planning.

Some disasters happen in slow motion. Some happen quickly. Some are repeat offenders. But no matter the venue, the results will be exponentially more devastating to older adults. When it comes to needing to move quickly and strategically out of harm’s way, frailty can instantly become a terminal condition. In New Orleans, older adults made up only 15% of the population, but accounted for more than 71% of the dead. In Japan, the images of crowds running for high ground, and the trail of older adults inexorably lagging behind, haunt us.

It is the most marginalized—older minority adults with few fiscal resources—who bear a disproportionate burden in disasters. But disaster planning is challenging, not unlike playing multidimensional Sudoku. What works in one set of circumstances may not work in another.

Learning from Katrina

So what have we learned since Katrina? In a brave challenge, AARP issued a post-Katrina report, We Can Do Better. It cited the failings of disaster preparedness at all levels that resulted in the death, devastation and long-term trauma for older adults that was Katrina’s legacy. Six years later, are we doing better?

One of the major failings in the case of Katrina was a lack of coordination between federal, state and community entities. On the federal level, planning has made great strides. Legislatively, the Pandemic and All-Hazards Preparedness Act of 2006 opens the door for requiring organizations involved in disaster planning to include State Units on Aging with financial incentives. Another two laws—each enacted after Katrina—encourage greater coordination of services (National Response Framework, January 2008; Homeland Security Presidential Directive 8).

But in a discouraging development, a new FEMA directive issued November 2010, Guidance on Planning for Integration of Functional Needs Support Services in General Population Shelters, lacked input from the professional aging network. FEMA admirably sought membership in its workgroup from the disabilities network, and included the Administration for Children and Families. But the needs of older adults are not subsumed under these agencies. The prevalence of multiple chronic diseases and a high degree of frailty result in older adults having distinctly different risks and needs than the disabled population.

An elder who is evacuated may be fully independent and functional on day one, with diabetes and hypertension well under control, but by day three, in the heat, noise and chaos of a shelter, can quickly become fatigued and dehydrated. Lack of proper medications or access to medical records can exacerbate issues. Add to the mix emergency meals typically high in salt, and suddenly both diabetes and hypertension spiral out of control.

Despite setbacks, there is progress. In May 2011, The New York Times ran this headline on a tornado story: “Government’s Disaster Response Wins Praise from Those Affected.” In that article, a victim whose house was in shambles is quoted saying, “It ain’t like Katrina … we’re getting help.”

After Katrina, Shirley Laska, from the University of New Orleans Center for Hazards Assessment and Technology, organized an interdisciplinary group to identify and address problems with cross-systems evacuation for older adults. The evacuation of New Orleans in the face of Gustav demonstrated there had been vast improvements.

Progress is also being made on restoring a sense of community after a disaster; this is both more important and more difficult to achieve than we had previously understood. HelpAge International has developed a model that establishes support and structure for older adults to rebuild their sense of community, which is arguably as important as food and shelter in the healing process.

But we haven’t made much progress in providing trauma-informed care to address the emotional impact of a disaster. Although we know a good deal about how elders respond to disasters, we lack systems to provide ongoing trauma-informed care. Two federally funded endeavors focus on the needs of children who have been traumatized in a disaster, and provide a template for resources that could be developed for older adults (National Child Traumatic Stress Network, The Children’s Health Fund).

Looking Ahead

So what can be done to prepare? Plan for an all-hazards disaster: although your area may be prone to flooding, you need a plan that will also work in a fire, or a tornado. Use one of the toolkits to develop a disaster plan for your family, including regularly updating medications and contact information. Sign up with the Red Cross or a VOAD (Voluntary Organizations Active in Disasters) and get training. Inquire with your Area Agency on Aging about disaster planning, and volunteer to participate in drills. Encourage elected officials to hold community-based disaster drills, where specific scenarios are explored. All are designed to heighten preparedness and promote inter-agency communication.

Since Katrina, it has become clear there is no one point of ultimate responsibility for older adults in a disaster. There are roles for everyone: individuals; community groups; and local, state and federal government agencies. But the professional aging network has to be included in planning. And elected officials must find the courage to invest in disaster preparedness services we hope to never use. To answer AARP’s challenge, are we doing better? Yes, we are. And there is still work to be done.

Jenny Campbell, Ph.D., teaches social work at Bryn Mawr’s Graduate School of Social Work and Social Research in Pennsylvania, and consults for nonprofits. She was the director of the Hurricane Fund for the Elderly, an initiative of Grantmakers in Aging that raised money to help rebuild senior services after Hurricane Katrina. Contact her at jwcampbe@brynmawr.edu.


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