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Officials
Admit Better Plans Needed for the Elderly, Frail
By Todd Ackerman and Melanie Markley, Houston Chronicle
USA
September
30, 2005
With more than two-thirds of Harris County's Hurricane Rita deaths involving seniors, most trying to evacuate, local officials are acknowledging their disaster plans need to do more to ensure the safety of the frail and elderly.
The deaths - 22 of 35 documented so far in a medical examiner's report that doesn't include 23 killed in a bus fire - stand in contrast to Florida, which last year evacuated 10,000 nursing-home and assisted-living residents because of four hurricanes. Not a single such evacuee died, according to state records.
"Rita underscored that we have some holes in hurricane preparedness," said Diane Persson, an expert on aging at the University of Texas Health Science Center at Houston who also works for the city. "It showed, for instance, it isn't realistic to put a lot of frail seniors on buses and haul them around."
Already, state and local officials are saying they plan to look into ways to improve the evacuation of the elderly and infirm. Persson said suggestions are already coming in, and Baylor College of Medicine aging expert Dr. Carmel Dyer said she, the Harris County Hospital District and a consortium of providers to the aging are preparing a report for county, state and national officials.
The biggest factor in Harris County's Rita elderly-evacuee death toll may have been Hurricane Katrina. When Rita posed a Category 5 threat to the Houston area, few in the nursing-home industry could dismiss the memory of the 34 elderly residents found dead in New Orleans and the negligent-homicide charge subsequently filed against the nursing-home administrators.
Rush to evacuate
Many nursing homes hurried to evacuate, even though emergency officials mandated evacuations only in coastal counties and along Harris County's Ship Channel.
"It would be interesting to know how nursing homes came to the decision to evacuate," said Dr. William Winslade, a bioethicist at the University of Texas Medical Branch at Galveston. "Was it fear of liability, medical liability, a government order, panic or policy?"
Whatever the case, the result caused anguish to nursing-home residents' loved ones. Belinda Piazza of Dickinson said if another hurricane threatens the Houston area, she'll keep her 91-year-old mother with her at home rather than let her nursing home evacuate her.
"She is a hospice patient that is oxygen-dependent," said Piazza. "I am prepared for my mother to die, but I am not prepared for her to suffer on a bus and die that way."
The U.S. Department of Health and Human Services requires nursing homes to have disaster plans that include education of employees, unannounced drills and evacuation plans. But there is no medical component to determine whether certain residents might be better off staying because they wouldn't survive if moved.
Such consideration is important because geriatric specialists say the elderly are more vulnerable to dehydration and heat-related problems and are already in nursing homes because of poor health.
In addition, disaster planning is different from disaster reality. Persson describes local plans as "paper plans" and says they needed more operational practice. Florida experts said that might be one explanation for their success last year - it gave them practice.
Specifically, in Hurricane Charley, Florida suffered 33 deaths, 12 of those involving senior citizens, none of whom was evacuating or staying in nursing homes, said Kathryn Hyer, a professor of Aging Studies at the University of South Florida.
Others noted that Harris County's evacuee death toll reflected a larger population and a shorter time frame. Florida evacuated 10,000 nursing-home residents across the state over 44 days; Southeast Texas evacuated 11,000 such residents in fewer than four.
That scale of evacuation caused confusion in Harris County, where nursing-home officials say they didn't get clear guidelines from state or local officials.
Heritage Sam Houston Gardens in the Spring Branch area evacuated late Thursday even though the facility, in an old hospital building, isn't prone to flooding.
The director of operations for the nursing home's parent company said facility officials didn't want to evacuate but were informed that emergency officials had ordered the evacuation of all special-needs people countywide. Emergency officials said that was the first they'd heard of anyone ordering such an evacuation.
Still, some officials concede, no one was telling seniors in nonvulnerable areas not to evacuate.
"We had eight buses filled with elderly people and staff that was unnecessary," said Joe Griffith, with Ambassador Health Care of Brady Inc.
Among the issues to be discussed by officials in coming months will be how and who should make the decision to move a nursing-home resident - their physician, their loved ones, the nursing home - and whether to instead simply move them to closer temporary clinics. Another matter for debate will be whether evacuation orders should give priority to special needs.
'Traumatic experience'
In the meantime, bad memories remain.
Shirley Holguin of Seabrook had tried to arrange an ambulance evacuation for her mother, Maggie Weikleenget, 78, who has had multiple strokes and has been bedridden since 1999. The ambulance never came. So Holguin and her son loaded Weikleenget in the family car and started driving west. Weikleenget died along the way, in Waller County.
"It was a traumatic experience," said Holguin. "I don't have any ill will or blame anyone. I'm just heart-broke, because if there had been a way to arrive in a reasonable amount of time, she would have survived."
Chronicle reporter Ed Hegstrom contributed to this report.
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