Protecting the Elderly in Times of Disaster: The Critical Need for Comprehensive Disaster Planning and Exercise Design
Hagen, James C., Forum on Public Policy: A Journal of the Oxford Round Table
Recent disasters in the United States, especially Hurricane Katrina, have proven the inadequacy of planning for the protection and safety of our vulnerable populations. The vulnerable, or special, populations can be categorized in many ways, including those with physical disabilities, who have cognitive impairment or mental illness, who are incarcerated, who speak English as a second language or not at all, and who are elderly. This paper concerns primarily the elderly who live in congregate care settings, including independent living, assisted living, long term care, or continuing care retirement communities (CCRF). Concern for quality of life of older residents must today, more than ever before, include intensive planning and preparation for emergencies and disasters that would compromise the safety of our most at-risk elderly. As a striking example from Hurricane Katrina, of the 1330 deaths, nearly half of the victims were over 75 years of age, and approximately 71% of those who died were over 60 years of age (AARP 2006).
Five factors most negatively affect the ability of LTC communities to adequately respond to disasters: 1) Mobility and functional limitations pose serious challenges for the elderly receiving LTC services should there be a disaster, whether that be man-made or natural. Sixty three percent of elders living in assisted living/retirement living communities have limitations in one or more activities of daily living (ADL's). 2) Cognitive impairment from many causes limits the understanding and ability of elders to rapidly respond in an emergency situations. 3) High turnover rate of nurses, nurse assistants, and LTC administrators requires constant training of staff. 4) Appropriate care of the elderly in emergency situations requires geriatric training of medical professionals, and is a serious lack in this area. 5) There is a lack of training and education concerning how to prepare emergency plans and exercise those plans appropriately.
The most effective approach to improving the ability of LTC communities to respond lies in creating appropriate all hazards plans and targeted hazard specific annexes, and then practicing (exercising) these plans appropriately. This will create a cadre of trained professionals to respond to, and recover from, disasters.
In collaboration with the American College of Health Care Administrators (ACHCA), a web-based survey was sent to nearly half of their national LTC members by Mather Lifeways Institute on Aging in March 2005. There were respondents from 194 of these facilities across 30 states. Half of the respondents were from CCRF, while the other half were from nursing homes. This was done to determine the need for training within the LTC workforce. Questions were aimed at preparedness for public health emergencies, including the threat of bioterrorism (BT). Very little thought has been given to the serious ramifications of BT on senior populations (Root et al. 2007). Although at that point, the challenges of a potential Pandemic Influenza were not being considered, this risk is now also being addressed by the training. Avian Influenza has continued its march across Europe and remains a serious threat (Revill 2007; Shaikh 2007). In this survey, 91% of senior living (SL) and long term care (LTC) administrators felt ill-prepared to deal with public health emergencies and BT threats. Eighty percent of the respondents reported that their LTC communities did not have any training (either educational or exercise based) for their workforce in this area. Moreover, 81% were not aware of emergency plans for older adults in their states. When asked what the key issue was in their state or region related to emergency/BT preparedness, 82% said that there is a lack of coordination of emergency and social service networks in their states/regions to provide and comprehensive resources to LTC communities. The PREPARE train-the-trainer program was created in response to the lack of emergency preparedness by SL and LTC residences. …