Attempting to Protect Seniors, Probably the most Vulnerable, From Formidable Foe Florence

Perhaps no other human population is as vulnerable throughout a hurricane as frail, older adults, particularly those who're homebound or living in nursing homes. With Hurricane Florence predicted to slam the North Carolina coast Friday, nutritionists are already scrambling to help keep older residents safe.

Seniors “are not only the most likely to die in hurricanes, however in wildfires and other disasters,” said Dr. Karen DeSalvo, a brand new Orleans native who served as health commissioner in that city after Hurricane Katrina and continued to become named acting assistant secretary for health at the Department of Health insurance and Human Services for the Federal government. “The seniors always appear to bear a large brunt from the storms.”

Older people could have a harder time evacuating because they do not have their own cars or are homebound, said Lauren Sauer, director of operations in the Johns Hopkins Office of Critical Event Preparedness and Response in Baltimore.

In the aftermath of Hurricane Katrina, an analysis of 986 Louisiana residents who died showed the mean chronilogical age of victims was 69 and nearly two-thirds were older than 65, DeSalvo said. The dead included 70 individuals who died in assisted living facilities during the storm or just after the storm made landfall.

And this past year, 12 residents overheated and died at a facility in Hollywood Hills, Fla., in the immediate aftermath of Hurricane Irma, which bumped out the facility's air conditioning and also the temperature climbed to over 95 degrees. The tragedy led Florida to pass through legislation requiring nursing homes and assisted living facilities to possess backup generators capable of keeping residents cool.

“Unfortunately, the best wake-up call happens when an emergency occurs,” said Dara Lieberman, senior government relations manager in the Trust for America's Health, a nonprofit. “Hopefully, nursing facilities and emergency managers taken notice of losing life within the long-term care facility in Florida this past year and realize the risks they face by not preparing. Every facility must have a plan.”

Some studies suggest communities aren't much better prepared than in the past, however.

A 2021 study from the nation's Academy of Sciences discovered that “we are just marginally more ready to evacuate vulnerable populations now than i was during Hurricane Katrina,” Sauer said.

Deciding whether or not to stay or go could be more difficult than it sounds, said J.T. Clark of the Near Southwest Preparedness Alliance, a coalition of hospitals along with other public health services in southwestern Virginia.

“There is a chance of moving people and there's a risk of remaining in place, and you've got to weigh those risks,” Clark said.

Evacuations pose a number of dangers for fragile patients, some of whom may need oxygen or intravenous medications, said Sauer. She pointed to a 2021 study that found a sharp increase in mortality among elderly care residents who evacuated due to an urgent situation, in contrast to people who sheltered in position.

She noted that leaving a facility is only area of the challenge; it may be equally difficult to find a secure place ready to house evacuated elderly care residents for several days at any given time, she said. Clark asserted nursing facilities once commonly assumed they could simply transfer their residents to local hospitals. But that can impair a hospital's ability to care for individuals who need emergency and urgent care, he explained.

Many nursing homes in the Carolinas are evacuating residents to areas outside the storm's direct path.

South Carolina had evacuated 32 nursing homes and assisted-living facilities by Wednesday afternoon, said Randy Lee, president from the South Carolina Healthcare Association.

On the Outer Banks of North Carolina, Sentara Healthcare evacuated 65 residents from the nursing home in Currituck towards the company's medical centers in Hampton Roads, Va., spokesman Dale Gauding said.

Source: Centers for Medicare & Medicaid Services, National Weather Service(Caitlin Hillyard/KHN and Lydia Zuraw/KHN)

Hurricane Florence poses risks beyond the coasts, however. Sentara also moved five intensive care patients from a medical center around the Pasquotank River in Elizabeth City, N.C., because of the chance of flooding. Those patients also visited hospitals in Hampton Roads, Gauding said.

With Norfolk, Va., now expected to escape the brunt from the storm, the 88 residents in the Sentara Nursing Center you will find sheltering in position, Gauding said.

Nursing homes in Charleston, S.C., complied with mandatory evacuation orders, said Kimberly Borts, director of communications and charitable giving for Bishop Gadsden retirement community on Charleston's James Island.

She said the ability conducts annual evacuation drills to continually improve its capability to safely relocate residents and coordinate with the company that gives ambulances.

However, Hurricane Florence's expected landfall caused a slight change in evacuation plans, that have been to become completed by Monday, Borts said. The evacuation had to be delayed until Tuesday since the ambulances were diverted to Myrtle Beach, which remained in Hurricane Florence's sights.

As of Wednesday afternoon, New Hanover Regional Clinic in Wilmington, N.C., was directly in the storm's path. But hospital officials see the building as strong enough to resist the storm, said spokeswoman Carolyn Fisher. They were less confident about a building housing a skilled nursing facility in Pender County, N.C., whose residents are now being moved from the hurricane's projected course.

Senior citizens who live in your own home are also in danger, particularly if they lose electricity.

More than 2.5 million Medicare recipients – including 204,000 people in Virginia, North Carolina and South Carolina – rely on home ventilators, oxygen concentrators, intravenous infusion pumps along with other electrically powered devices, based on the Centers for Medicare & Medicaid Services. The agency has created something called emPOWER 3.0 to help states check into them.

Patients who lose electricity may need to go to their local emergency room to power their medical equipment, said Mary Blunt, senior vice president at Sentara Healthcare in Norfolk, Va., and interim president of Sentara Norfolk General Hospital. Patients with kidney failure may also need to receive dialysis in the ER if their regular dialysis center is closed, she said.

Virginia, North Carolina and South Carolina will open emergency shelters for those who have special medical needs. These facilities provide “limited support,” but not health care, for those who have special needs, according to the Sc Emergency Management Division. Residents must bring a grownup caregiver to remain together all the time, according to the Sc agency.

Residents should sign up for these shelters ahead of time, said DeSalvo, who said that getting people to go can be difficult.

“People do not want to leave their houses,” she said.

Bert Kilpatrick said she's not concerned about Hurricane Florence and was planning to stay in her house on Charleston's James Island, where she is just a stone's throw in the Stono River, a huge tidal estuary that runs to the Atlantic.

“I've been here since 1949. I'm accustomed to these hurricanes,” the 87-year-old said. “Me and my cat, Maybank, we're staying.”

She even stayed during Hugo, a huge, Category 4 hurricane that devastated Charleston in September 1989. She worked in a downtown hospital then and was there once the storm hit; but her husband, who died recently, rode out Hugo in the house, which was undamaged except for one broken storm window.

Kilpatrick asserted so far as she knows all of her nearby neighbors also were staying put. Among those, Patsy Cather, 75, said she and her husband, Joe, were likely to remain. “I'm staying here while he won't leave.”

She said they might decide to leave later when the storm reports look worse for Charleston. “It's a no-win situation. You depart, you stay safe; but your home may be gone.”

Databases and registries can help with another challenge: the aftermath from the storm.

“When the wind passes and also the water starts going down, they really need to mine the data: That has ambulatory challenges? Who's on chemotherapy? Who have an opioid dependency?” DeSalvo said.

DeSalvo said she believes the states in the path of Hurricane Florence are in good hands.

“I think the good thing is, for a state like South Carolina or New york, they have strong, seasoned leadership in place who are able to not only building a complex logistical challenge, but who are good humans,” she said. “It takes both.”