Community connections and quarters: How one nursing home responded to a 45-day water crisis
In its forthcoming emergency preparedness guidelines for long-term care facilities, maybe the government should include this directive: The facility is to cultivate strong relationships with area businesses and keep a supply of quarters on hand. At least, this is one idea I took away from a conversation with Michael D. Gore, MBA, CNHA, FACHCA. He is executive director at a 60-bed Lincoln Nursing & Rehabilitation Center facility in Hamlin, WV — which was hit hard by the recent chemical spill that tainted the water supply in and around the state capital of Charleston.
Needless to say, I'm being tongue-in-cheek about creating this regulation: A good nursing home administrator of course will forge positive relationships with other business leaders in the course of running the facility. (As for the quarters, more on that shortly.) However, in talking with Gore, I was struck by how his community connections and knowledge enabled him to effectively respond to the disaster.
Some background: An unpronounceable substance used in coal mining (4-methylcyclohexane methanol) leaked from a Freedom Industries chemical storage tank on Jan. 9. The poison traveled downriver a mile to the state's largest water treatment plant, and a licorice smell began to permeate the air hours before Gov. Earl Ray Tomblin announced that 300,000 people no longer had safe tap water for drinking, cooking, bathing or laundry.
McKnight's reported on the disaster at the time, and it seemed to be the rare instance (after such catastrophes as Hurricanes Katrina and Sandy, and the Joplin tornado) when an emergency response went as planned. The Federal Emergency Management Agency swung into action, and a nursing home administrator told me her facility had “plenty of water.” The story faded from the headlines relatively quickly.
But it was back in the news last week, thanks to an in-depth New Yorker article. In his piece, “Chemical Valley,” Evan Osnos revealed that the spill was worse than initially reported and that recovery still is ongoing. I read the article while traveling to the annual meeting of the American College of Health Care Administrators, where I talked to Gore.
He confirmed that the disaster response was far from seamless and the consequences of the spill were very extended. His facility went seven days without water under the official ban, then went roughly two weeks without using piped-in water for showering, and 45 days without using it for eating or drinking. (This was not merely from an overabundance of caution; the licorice smell persisted in some areas after the official ban was lifted, and became overpowering in his facility when the nursing home "flushed" its pipes, Gore said.)
In terms of the response, FEMA did not immediately sweep in like a white knight with truckloads of potable water. In fact, the agency threw Gore a curveball because it seized water from suppliers that were his planned backups, and distributed the water according to its own priorities (read as: hospitals first). Here's where Gore's community connections became crucial. He knew he could call Tyler Mountain Water, a local company that bottles water from a fresh spring that would be unaffected by the spill. The company responded to Gore's urgent phone call at midnight with a very welcome message: Bring a van early in the morning and fill it up with as much water as it will carry.
You might argue that any bottler with a heart (or interested in its image) would deliver water to a nursing home in a crisis. But it certainly didn't hurt that Gore and Tyler Mountain had established a positive working relationship, because the Lincoln nursing home got some of its water coolers from the company.
Gore also leveraged his community knowledge to get laundry done. He realized that about half the county is on local water systems that would be safe, and he thought of a recently opened Laundromat in a nearby town — he knew of the Laundromat because it has connections with a Mexican restaurant he frequents. He asked to use two machines, but the Laundromat went above and beyond. It essentially closed down during the day to become the nursing home's off-site laundry center.
Hence the potential rule about quarters. A nursing home should keep a supply of quarters on site, in case it needs to do laundry in coin-operated machines when banks are closed, Gore recommended. A facility no doubt is thinking about how to cover the potential big-picture costs of an emergency (Gore estimated he doled out $10,000 in the first week after the spill), but as Gore's experience demonstrated, cash on hand should include coins on hand.
Lincoln has amped up its emergency preparedness in light of the spill. For example, it now keeps roughly five days of water rather than the mandated three. Considering he already is going beyond the government's recommendations in this area, I expected that Gore would support more stringent disaster prep regulations. But he does not.
The current regulations are an adequate framework, he told me, although administrators and other leaders should see them as a baseline only. A facility should assess the particular risks it faces, such as hurricanes, floods or industrial accidents, and scale up its emergency planning accordingly, he advised.
Lest you think that Gore is a stereotypical West Virginian who is reflexively distrustful of government regulation (see the New Yorker article for some background on this stereotype), let me add that he does think the all-powerful coal industry could use more oversight. Although he has an MBA's appreciation of what big coal contributes to West Virginia, stricter inspections might have prevented the spill in the first place, he suggested.
Finally, I think I would be remiss if I did not share Gore's praise of the whole team at Lincoln for its crisis response. Just one example of their ingenuity and teamwork: They rigged up a temporary shower system by putting large containers on the top of carts and connecting hoses to them. The maintenance team brought in water from the supply delivered by the West Virginia National Guard, the dietary team boiled the water and brought it to the correct temperature, and maintenance then transported it to the improvised showers, where caregivers would bathe the residents.
If it's true that an emergency proves the quality of a team, Gore said, “I have the best.”
Tim Mullaney is a Senior Staff Writer at McKnight's. Follow him @TimMullaneyLTC.