You don’t have to look far to see the effects of climate change these days. But those effects are all the more acute for vulnerable seniors, especially those living in nursing homes. The reality is that nursing home administrators must now include disaster planning as a key part of their risk management planning.
There have been numerous incidents lately in the U.S. that highlight the need for this. During a recent heat wave in the north-east, a New Jersey nursing home’s air conditioning broke down, necessitating an evacuation. Although a repair was made and all were safe, these types of emergency evacuations can stress both staff and residents. It’s not only physical health that can be at risk, it’s mental health as well.
Climate change also means that hurricanes are becoming more intense and occurring more often. Harvey and Irma, two hurricanes that arrived late in the summer of 2017, shone a light on how prepared nursing homes actually were — or were not. Irma was the catalyst for the death of 14 nursing home residents in Florida after electricity was knocked out by a fallen tree and residents went without air conditioning for several days.
When Harvey hit Texas, floods caused mid-storm evacuations of a number of nursing homes, putting both staff and resident lives at risk. There is a fine line between deciding to shelter-in-place and weathering a storm or initiating a risky evacuation. There are no easy answers, but better preparation and planning could save vulnerable lives.
These two hurricanes and their effects on nursing homes even caught the attention of the Senate, which in November of 2018 published a report entitled Sheltering in Danger. Recommendations from this report included improvements to residents’ temperature protection, sheltering-in-place/evacuation processes, emergency planning, communications and prioritizing power restoration for at-risk populations, including nursing homes.
On the other side of the border, Canada, too, has had its fair share of disasters due to changing climate. An elderly man from Ottawa spent most of the winter of 2018-19 – a particularly harsh one — snowed in, unable to leave his home, and surviving on canned food. During the summer of 2018 in Quebec, an abnormally hot summer led to the deaths of 54 people, many of them older adults. And in 2013 in Calgary, seniors’ communities had to be quickly evacuated during 100-year floods. The residents sat and slept on crowded chairs and cots for three days.
Impacts from disasters like these for nursing homes residents can be catastrophic and are amplified as many residents are classified as frail. Frailty can be defined as a state of increased vulnerability and functional decline. Individuals who are frail are more likely to have multiple medical problems, take multiple medications and be limited in their ability to get around and carry out activities of daily living, all of which increases risks during an emergency event.
When the power goes out, many electrical medical devices that seniors rely upon — such as mobility scooters, CPAP machines, nebulizers or dialysis machines — won’t work. And if elevators can’t operate in a power outage, how can residents be evacuated safely and quickly?
As seen from the Florida incident, frail seniors have challenges regulating their body temperatures during extremes of heat or cold. They’re more susceptible to dehydration, infections, respiratory and cardiac problems from weather events and pollution. And in northern states, falls and fractures are a real threat due to ice and snowstorms.
Mental health consequences from disasters should not be underestimated. Older adults can suffer from depression and anxiety due to increased social isolation or even PTSD from experiencing a severe weather event. For a frail senior, such mental health problems lead to further disability and even premature death.
So, what has Canada learned from its climate-related disasters?
Good planning and preparation are key. An emergency plan has to be in place and be updated annually. There has to be training for staff on all elements of an emergency plan so that the plan becomes a living document. Test the emergency plan on at least an annual basis to give staff and residents an opportunity to practice. Knowing the location of every resident is key to this plan. Don’t forget that family may decide to evacuate their loved one before you make that decision for them.
The ability to communicate is paramount. If landlines, the internet and cell service are not available, then alternate methods of communication must be in place to stay in contact with emergency services and the families of residents.
Partnerships with emergency service providers are critical. When and if a decision to evacuate is made, these people must be on hand to help the most vulnerable leave the nursing home and everyone must know where to go after that. Families also need to be able to find their loved ones.
Ongoing discussions and preparations with local government and partner agencies or facilities can help identify emergency sheltering locations that will be suitable for frail seniors as well as emergency resources for them. Having a well-prepared pharmacy partner can also ensure life-saving medications will follow the resident wherever they go.
If sheltering-in-place is the better option, make sure staff are trained to look for signs of distress and know what to do and who to call if people are at risk. Check on emergency supplies and make sure they are up-to-date and not expired. These can include flashlights, medical supplies, back-up generators, food and water.
When it comes to climate change, we will all have to try and adapt to the new normal. Although disaster planning for nursing homes is not new, it is becoming ever more important as natural disasters escalate as a result of climate change. The time to prepare is now. Not when the next disaster hits.
John Muscedere, M.D. is the Scientific Director of the Canadian Frailty Network and a Professor of Critical Care Medicine at Queen’s University.
George Heckman, M.D.m is the Schlegel Research Chair in Geriatric Medicine, an associate professor at the University of Waterloo and a researcher with Canadian Frailty Network.