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Are Elderly Ready for
'Big One'?
By Kirsten Stewart, The Salt Lake Tribune
September 26, 2005
New Orleans Police Department officers transport
91-year-old Audrey Thompson, after she was rescued from flooding in the
9th Ward district of New Orleans after Hurricane Katrina made landfall
Monday, Aug. 29, 2005.
Photo by Willie J. Allen Jr., St. Petersburg Times
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.
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