By Mary Helen McSweeney-Feld and Sandi J. Lane
During 2017, almost 8 percent of the U.S. population was affected by a disaster. The figures did not change significantly in 2018, during which 124 disasters were declared. A record number of weather events topped the list, prompting communities, long-term-care providers, emergency managers and government agencies to collaborate for response and recovery efforts.
At the same time, FEMA introduced its Strategic Plan for 2018–2022, which included a new emphasis on building a culture of preparedness, along with government administrative simplifications to ready America for catastrophes. How can the aging services community learn from these events?
Community Preparedness Through Shared Responsibility
FEMA’s new Strategic Plan has three key goals: to build a culture of preparedness in our communities and government; to prepare the nation for catastrophic disasters through enhancing collective readiness; and to reduce the complexity of FEMA’s interventions to meet individual and community needs. FEMA’s National Disaster Recovery Framework, which is the guideline for how the United States responds to disasters and communities affected by these events, supports the Strategic Plan. Under this plan, a population’s resiliency amid disasters hinges on shared responsibility in preparedness, and recognizes the population’s diversity, including elders, who may be more adversely impacted.
Plans and Financial Readiness
Under the plan’s first goal, individuals and families should understand their personal role in disaster preparation, and take any necessary actions, including having a personal emergency plan and a minimum of three days’ worth of supplies, water and medications, emergency documents and transportation in the event of an evacuation. Personal financial preparedness is key, including having easy access to at least $400, and having insurance coverage for property damage due to a disaster. Many elders have insufficient insurance coverage for owned property, as they are more likely to have paid off their mortgage, releasing them from homeowners or flood insurance obligations.
Long-term Care Organization Preparedness
Community collective readiness, per the FEMA plan’s second goal, extends to all healthcare organizations, including their third-party service providers. Nursing homes that participate in the Medicare program, and the majority of assisted living and continuing care retirement homes, are required to have emergency plans for their communities, which typically use an all-hazards risk-assessment approach. This assessment includes risks from natural hazards, community-based risks and facility-specific risks, and makes planning for disasters and reducing vulnerability to hazards more effective.
Technology such as geographical information systems (GIS) is one way to identify risks. A 2019 study by Wilson, Sugg and Lane using GIS found that nursing home vulnerability was predominantly attributable to geographic location, and to socioeconomic factors such as poverty, minority population, age, income and housing types.
A 2019 unpublished study by Lane demonstrates the impacts that prior planning, preparation, training and established communication networks had among southeastern U.S. long-term-care communities during hurricanes Florence and Michael. Post-hurricane interviews with long-term-care executives, from December 2018 to March 2019, showed that prior experience, disaster planning, preparation and existing communication networks were critical to the decisions made during major disaster events. Many reported that since anything could happen at any time, continual real-time planning prepared them for unknown events, and hazard- specific preparations started as early as six months prior to hurricane season.
This planning included reviewing contracts for food, water and medication supplies, plus medical equipment availability, emergency transportation services and evacuation destination locations. Also reviewed were the status of their own emergency power capabilities and communication strategies with local emergency management agencies. Administrators also reported that prior experiences with disasters contributed to an understanding of weather patterns, the possibility of flooding, types of damage to their communities, services they might need and services that might become unavailable. Understanding location risks, including proximity to bodies of water, highways, bridges, hospitals, fire stations and other support resources was important to effective response.
Communication prior to, during and immediately after storms helped to coordinate long-term-care provider response. Conference calls were used to share ideas, resources and timely information on storm status. Attendance at local emergency management meetings and having a long-term-care community representative present in the local emergency operations center were other options providers used. Information was shared with staff, residents and their families via digital updates, social media sites, phone apps and email.
Shelter-in-Place vs. Evacuation Decisions
Disaster readiness includes preparation by home-dwelling elders and their families and-or caregivers, as well as those living in long-term-care communities, to shelter in place or evacuate to a safer location. Evacuation decisions are fraught with uncertainty, and research by Dosa et al. has shown that evacuations can have serious consequences for the health status of older adults in long-term-care communities.
In the Lane study, administrators affected by hurricanes Florence and Michael indicated that their evacuation decisions were made at the last minute (latest timeframe for safe and expedient travel), as it could take more than 48 hours to evacuate buildings. It is critical in evacuations to have appropriate transportation for elders who use wheelchairs or for residents who are bedbound; this requires prior coordination with the local healthcare emergency preparedness coalition.
Sheltering in place is less disruptive than evacuation, but resources, such as emergency power, must be available to accommodate this choice. A 2018 minority staff report on nursing homes during hurricanes Harvey and Irma, generated by the U.S. Senate Committee on Finance, indicated that outdated emergency power standards exist throughout most parts of the nation. Use of emergency power is mandated and required for nursing homes that participate in Medicare, but the report found that many communities are not in compliance. While some states may require using generators for alternative emergency power, current power standards are outdated and a national approach to emergency power is essential to ensuring the safety of elders residing in long-term-care communities.
Preparedness and Resilience: Looking Forward
All hazards, community-based approaches and community resilience as described in FEMA’s Strategic Plan must include coordination of individuals and long-term-care service providers, who need to continually plan, train and communicate. Government agencies, including FEMA, will rely on community networks, including emergency coalitions and voluntary organizations, to streamline disaster response, but these providers may or may not be aware of older adults’ needs. Supportive services to facilitate sheltering in place, plus standards for operating those networks, should be developed on a national level.
Mary Helen McSweeney-Feld, Ph.D., L.N.H.A., F.A.C.H.C.A., is an associate professor of Health Sciences at Towson University, in Towson, Md. Sandi J. Lane, Ph.D., L.N.H.A., F.A.C.H.E., is an associate professor and Masters of Health Administration program director at Appalachian State University, in Boone, N.C.