Disasters: Are elderly ready for ‘big one’?
Utah says yes, but until major disaster strikes, ‘Who knows?’
By Kirsten Stewart
The Salt Lake Tribune
Of all the human suffering laid bare by Hurricane Katrina, one of the most painful accounts is of the 34 elderly men and women who drowned in a Louisiana nursing home.
Abandoned by their caregivers, their plight contradicts portrayals of storm victims as stubborn holdouts, and reflects poorly on how society’s most vulnerable citizens were treated.
But long before Katrina hit, other catastrophic events had revealed that older people were often overlooked in an emergency response. It happened in a New York City evacuation amid power outages after the Sept. 11 terrorist attacks, and in Paris during a 2003 killer heat wave, when hundreds of older people perished.
It could happen here, say state officials and advocates for the elderly and poor.
Looking toward the principal local threat - a massive earthquake - planners here say they are as prepared as they can be. Lessons from Sept. 11 and the 2002 Winter Olympics have led to seismic upgrades on numerous buildings. Two multimillion-dollar bioterrorism grants have enabled the state Health Department to build a comprehensive plan for evacuating and transferring patients to and from hospitals.
But when asked if nursing homes and other long-term care facilities are equipped to withstand or recover from a major disaster, the sobering assessment of one state official was: “Who knows?”
“We have plans, but how well those work in practice . . . ,” said Alan Ormsby, director of the state Division of Aging and Adult Services.
Under federal law, Utah’s 105 nursing homes are required to have evacuation and disaster safety plans and have backup generators. They also must have five days of food and water on hand. Assisted-living facilities and residential health care facilities, which cater to mostly healthy and mobile populations, are presumed to be able to self-evacuate.
But Katrina proved that successful evacuations hinge on having enough transport vehicles to transfer people and safe havens to take them. And Hurricane Rita proved even the best evacuation efforts don’t always go as planned.
On Friday morning, a bus load of elderly evacuees from an assisted living facility in Houston exploded into flames on its way to Dallas, killing at least 24 people.
A major earthquake could force evacuation of all or most of Salt Lake County health centers at once, said Ormsby. “If the entire city is destroyed, there are no contingency plans to ship nursing home residents, say, to Payson.”
More alarming: In 1998, a University of Utah nursing student studied the long-term care industry as part of his master’s thesis and found they are no more prepared for a disaster than the average homeowner. U.S. Army Maj. Noel Mathis surveyed 35 nursing homes, three assisted-living facilities and 22 residential health-care facilities.
He discovered half lacked emergency generators for life support and heat, a third failed to secure water heaters and a quarter had not trained employees how to turn off natural gas. Roughly 40 percent had not performed annual emergency drills.
When the study was published, an industry representative disputed the findings.
Jan Buttrey, the state Health Department’s emergency medical services director, also doubts its accuracy. She said no shortcomings have surfaced in annual licensing reviews of long-term care facilities.
Utah scientists have long warned that a major temblor centered in this region is overdue. The worst-case scenario would be for the “big one” to hit the portion of the Wasatch Fault abutting Salt Lake County. Walter Arabasz, director of the University of Utah’s seismograph stations, said there is a 3 percent to 9 percent chance of that happening in 50 years.
That may seem like distant odds. But Arabasz said, “The annual probability is roughly in the same ballpark for everyday risks,” such as a heart attack or stroke.
Bob Carey, the state’s earthquake manager, argues preparedness is more imperative for earthquakes than for hurricanes, which are far more predictable.
Based on computer models of the worst earthquake scenario - a magnitude-7 on the Salt Lake segment of the Wasatch Fault - Carey predicts 2,200 dead, 29,100 injured and $28 billion in damage and economic losses.
Of the 15 major medical centers in the Salt Lake Valley, only two will be functional on day one, predicts Carey, stressing most will rebound soon after.
Buttrey said hospitals are well-equipped to transfer patients across county or state lines if necessary. Utah also is equipped to stage emergency medical centers in public buildings constructed to withstand large earthquakes.
But emergency planner Scott Westbroek acknowledged long-term care facilities fall below hospitals on the disaster priority list, because they serve larger and more acutely ill populations.
Taking action: Westbroek said one guideline is to have enough food, water and warm clothing to last 72 hours. He believes Utahns, steeped in a culture of self-reliance, are well-rehearsed on that rule.
But seniors who are disabled or live on fixed incomes can’t always afford to stockpile basic necessities. Further complicating any rescue or relief effort is the fact that 88 percent of Utah’s 190,531 elderly live in homes or low-income high-rise apartments scattered throughout communities, making it hard to keep tabs on them.
Advocates for low-income people and senior center staff probably know best who lives where. But Judi Hilman, health analyst at Utah Issues, said low-income advocates talking after Katrina realized “we don’t have a handle on our systems.”
“There has been almost no thinking about preparedness and the needs of older populations,” said Michael Gusmano, associate professor of health policy and management at Columbia University.
He is co-director of the World Cities Project, an effort to assess how well major cities (using New York City, Paris, London and Tokyo as prototypes) are prepared to cope with aging populations.
Among its projects: mapping out neighborhoods, using Census tract data, where at least 20 percent of the population is 65 and older - information that could prove crucial for emergency responders in a disaster. In New York City, for example, the mapping project identified 138 Census tracts with such populations.
The data can be refined further to reveal concentrations of residents 85 and older, as well as those who, based on poverty status, may be most in need of assistance.
“It doesn’t tell you everything, but it’s useful to get a conversation started,” said Gusmano.
The World Cities Project expects to issue a report on its work by year’s end that it hopes will be a catalyst in developing similar projects across the country.