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Aging, Frail, and Refugees
from the Hurricane
By Jane Gross, The New York Times
September 18, 2005
After days spent sheltered in a gymnasium in Baton Rouge, La., Virginia Chatelain, left, and Gladys Williams were evacuated to Haven Nursing Center in northeastern Louisiana.
Photo by Monica Almeida, The New York Times
The frail residents of the Wynhoven Health Care Center fled New Orleans and the havoc of Hurricane Katrina for a high school gymnasium, where they spent four nights sleeping on the floor with just inches between them. Then they endured a 10-hour bus ride to this rural outpost in northeastern Louisiana more than 200 miles from home that might as well have been the far side of the moon.
They subsisted on bag lunches, did without their insulin or blood-pressure medicine, risked infection from catheters that were necessary when no toilets were available, and finally arrived here at the Haven Nursing Center with no medical records and only the clothes on their backs.
It would take several days to figure out whose medications were whose because all of them had been tossed into one big plastic sack for the harrowing journey. It would take several more days before proper beds arrived for the deserted wing of the nursing home that had been slated for demolition and then hastily readied to accept them. Several more days would be needed to locate relatives, many of them homeless and scattered themselves.
And they were the lucky ones, spared the fate of 32 residents of a nursing home in St. Bernard Parish who were left to fend for themselves and died in the floodwaters.
But even a successful evacuation is an ordeal with potentially deadly consequences for people in wheelchairs, or tethered to oxygen tanks, or confused by dementia, all of them at high risk of what geriatric experts call transfer trauma.
A few of the new residents at Haven Nursing Center seemed dazed and disoriented, fighting back tears and clinging white-knuckled to their rosary beads. Some asked repeatedly, "Where am I?" but brightened when told by staff members or volunteers, without confusing details, "You're here with a lot of your friends from New Orleans."
Several wound up hospitalized for urinary tract infections and high blood pressure and one with a broken hip that she guessed was a result of shuffling off to the bathroom in donated bedroom slippers a couple of sizes too big.
But many of the 46 recent arrivals, part of a diaspora of 180 from Wynhoven, in Marrero, La., who were dispersed to seven different nursing homes, had only praise for the way they had been evacuated and then welcomed here by staff members, longtime residents and volunteers from down the street and across the nation.
"They called my children so they knew where I was going," said Linah Naquin, 88. "And here, they couldn't treat us better than they have." The worst part, she said, was being hoisted from the floor at the gymnasium of the St. Thomas More parochial school in Baton Rouge each morning to make way for dining tables, and the tiring bus ride to Columbia. The best part was telling her son, himself a Katrina evacuee, that she still had her roommate from Wynhoven because "he knows we get along swell."
Mrs. Naquin, who is wheelchair-bound, had her hair done two weeks after her arrival at the Haven Center, getting ready for an ice cream social and a magic show. She fretted about her distant cousin by marriage, Agnes Malhiet, 87, a fellow resident, who had broken a hip a few nights before and needed surgery.
Geriatric experts say they will be trying to learn from evacuations like the one from Wynhoven and resettlements like the one to Haven to avoid the often tragic events that unfolded at other nursing homes when the levees broke and the floodwaters surged.
"There is no good solution," said Catherine Hawes, a professor of health policy and gerontology at Texas A&M University. "But we need to know what went well and what didn't." Experts agree that unlike many nursing home evacuations after the storm, the one at the Haven Center went as well as could have been expected. Yet decades of research on transfer trauma suggest that many of the residents will deteriorate and a few are likely to die prematurely because of their ordeal.
"I would expect a lot of premature mortality" even in the best of circumstances, Dr. Hawes said. "Their experience is unimaginable."
Dr. Hawes and her colleagues at Baylor College of Medicine in Houston are seeking funds to study the long-term effects on Katrina's nursing-home evacuees. She said that in the past nursing home patients had died on non-air-conditioned buses during evacuations, and that patients seemed to fare the best if they were evacuated along with others they knew, including longstanding roommates and familiar aides.
Mrs. Malhiet, despite her injury, said she was only grateful, for the new clothing and for the nurse she had known for years at Wynhoven, who stayed with her at a hospital 30 miles from Columbia in Monroe, La., when she needed surgery.
"She kept saying, 'I'll be O.K. by myself,' " said the nurse, Danilyn Childers, who left her own extended family in the flood zone to be with her patients here. "But I know she was glad I was there, even when I woke us both up snoring."
KaraLe Causey, the director of the Haven Center, did not let financial concerns slow the evacuation of the Wynhoven residents. At one point, she booked and paid $2,000 for tour buses in Columbia and sent them south. When the van accompanying the buses and carrying equipment broke down on the highway, she came up with $600 for its repair.
The Haven Center is part of a movement, known as the Pioneer Network, to redesign nursing homes in a less institutional way. An all-points bulletin for assistance on behalf of the center and a few other nearby nursing homes went out to health care providers, consultants and others in the network.
First on the scene was Sister Imelda Maurer from San Francisco, a gerontologist. She listened to those who wanted to tell their stories, prayed with those who didn't and took pictures to e-mail to relatives who were unable to check on them in person. Next to arrive was Willie Novotney, director of the Meadowlark Hills Retirement Community in Manhattan, Kan. He brought truckloads of supplies and several of his employees.
Sister Imelda and Mr. Novotney stayed for nearly two weeks to coordinate donations, including shipments of beds from Kearney, Neb., and walkers from New York City. Other nuns and administrators from around the country took their turns in shifts.
Then there were the local volunteers. The ambulance company greeted the exhausted evacuees when their buses pulled in and helped carry them inside on slings of bedsheets. An emergency room doctor, learning that Haven's regular doctor was on vacation, helped sort medication demands. Members of the high school football team cleaned out the long-closed wing and furnished a barren lounge with a piano, a television, a sofa and a set of Reader's Digest condensed books. An electrician repaired call lights that hadn't been used for years and installed air conditioners.
Members of a local Baptist church cleaned carpets and drove to distant medical supply companies to buy more medication carts. The 80 residents already living at the home, despite a bit of grousing about who sat where in the dining room, made goodie bags for their new neighbors with snacks and puzzle books. Local residents donated pocket money so that each resident could make small purchases - sodas from the vending machine, for instance. The most significant divide is religion; the evacuees are devout Roman Catholics in a largely Baptist environment. Accustomed to daily Mass, they make do for now with weekly services.
Mrs. Causey, who has three versions of the New Testament on her iPod, has added bingo to the activity schedule, but does not let them play for money.
A Roman Catholic couple, Royal and Helen Baudoin, followed the caravan of buses to stay near Mrs. Baudoin's mother, who has Alzheimer's and Parkinson's diseases.
Boarding with a Baptist minister, they attended his service, mostly to be polite, but were surprised by what Mr. Baudoin described as a born-again moment. "I had this feeling come over me of happiness and joy," he said. Sister Imelda overheard his story and took it in stride. "I guess we've lost two more," she said with a chuckle.
The evacuated residents said they felt a special kinship with the aides and nurses who stayed with them and shared their suffering in the shelter, dressing and bathing them with a measure of privacy by holding sheets between men and women mixed on the gymnasium floor.
Vina Annicet, a nursing aide whose home escaped the flood but was looted and burned, plans to resettle in Columbia. "The peace and quiet and the people are wonderful," she said. "It's everything I need to grow old." She has already been hired by Mrs. Causey.
Mrs. Causey is already planning - and worrying about - the return of the Wynhoven residents to Marrero once electricity and running water are restored there. The last time the home evacuated for a hurricane, only for a few days, one woman died of a heart attack during the reverse migration. Some residents are already dreading another bus trip.
Mrs. Causey hopes there is a better solution. "Another bulk transfer will put them in harm's way," she said. "It's inhumane. I'm not trying to keep them. We just need to pay special attention to how they go home."
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