In the hurricane zone and beyond, state aging departments and emergency responders are drawing a lesson from storm death tolls and are updating their disaster plans to make special arrangements for the elderly.
More than half of Hurricane Katrina's 1,000-plus fatalities were over age 50, including 34 elderly residents who died when the owners of a Louisiana nursing home allegedly abandoned them. Twenty-four seniors died in a bus fire outside of Dallas as they were being evacuated from Hurricane Rita. Countless other seniors were stranded in nursing homes, hospitals and private homes with no way to contact their relatives or call for help.
A major goal of the post-hurricane effort is to improve state and local databases of at-risk seniors and ensure that nursing homes, hospitals and other group-living facilities are prepared to safely evacuate residents.
Advocates for the elderly are putting the issue before state legislatures, and Congress has called on experts to explain what went wrong and what went right during this summer's catastrophic storms.
AARP is holding a meeting Dec. 1 in Washington, D.C., that will cover state and local preparations for a full range of disasters, including tornados, earthquakes, flash floods, tsunamis, mudslides, forest fires, heat waves, power outages, snow and ice storms, pandemics and terrorist attacks. The meeting will assemble state and local responders to discuss best practices for protecting seniors during disasters.
Even Florida-considered a bellwether for both emergency preparedness and elder care-is under attack for its disaster recovery efforts after Hurricane Wilma. The storm, which left thousands of Floridians homeless and more than 2 million without power and water for weeks, was especially hard on seniors because it cut a swath across a section of south Florida that is densely populated by the aged.
"Hurricanes are the easiest kind of disaster to deal with, because you get lots of warning," said AARP's top public policy executive, John Rother. Even so, many elders were left stranded.
"The more you look at the response to Katrina, the more problems you see. No one knew where the seniors lived. There was no system to track family members and doctors. The state lacked adequate transportation. … There were no special needs shelters and no way to provide continuous medical care, such as generators for ventilators. On top of that, communication systems went down so seniors couldn't call for help," Rother said.
AARP and other advocates for the elderly, including several Florida legislators, want the state to require nursing home operators to follow prescribed evacuation procedures when a disaster is declared. They also want licensed home health-care providers to register their elderly patients for disaster assistance.
Skeptics question whether state legislative and policy fixes really will make a difference next time a catastrophe occurs. They argue that without additional funding and personnel, state and local responders are likely to become overwhelmed by major disasters as they have in the past and seniors will once again slip through the cracks.
But AARP policy director Dalmer Hoskins says states can make changes that will significantly improve seniors' chances for survival in a disaster, without making major new revenue commitments.
"Some of the best things that have happened for seniors have happened at the local level," Hoskins said. "The community really does work to make sure that older people don't fall victim. There's a community-based experience that goes back hundreds of years," he said.
Florida was criticized for not knowing where all of its seniors lived. Yet the state has one of the most sophisticated elder registries in the country. When a hurricane approaches, state disaster recovery experts are able to accurately estimate the number of at-risk seniors in its path and prepare accordingly.
Wilma proved that the system needs improvement.
Bentley Lipscomb, AARP's state director, said Florida should conduct outreach campaigns to ensure that every senior citizen who may need assistance is on the list, because many elders who live independently are not aware the registry exists.
While nursing homes and other group-living facilities can be mapped, it's much more difficult to locate single-family residences where frail elders may need assistance.
Complicating the situation is an effort by states in the last several years to keep seniors out of costly group-living facilities. Elderly people who can take care of their daily needs are generally happier living on their own, but they are often ill-prepared to cope with a disaster, Lipscomb said.
Maria Greene, Georgia's director of aging service, said that for the first time in many years, the aging department called a statewide meeting to coordinate efforts between local aging offices and first responders to ensure that elders are registered and accounted for.
"In some counties the list is electronic; in others it's handwritten," she said. But when local fire and police officials work with local aging-service providers, the system works, she said.
Most states require written consent from seniors or family members before sending emergency crews to their homes to evacuate them, and some require a doctor's letter. Streamlining these rules could make a big difference in the states' ability to track vulnerable elders, AARP's Lipscomb said.
Under federal law, nursing homes are required to have evacuation and disaster recovery plans, but it is up to states to ensure that the plans work.
"States should set detailed requirements for nursing-home evacuations," says Dr. Robert Butler of the International Longevity Center, a New York-based elder advocacy group. "And in states that already have requirements, state officials should review those plans and make sure that nursing home personnel know what to do."
Butler's organization developed a set of guidelines on emergency preparedness for older people after the Sept. 11, 2001, terrorist attacks. "We were horrified to find that (near) ground zero, many older people were left without services-no prescriptions, no meals. They were left alone for days. It appeared that animals were rescued faster than elders. Older people are, in a sense, invisible," he said.
In many cases, states have well-laid disaster recovery plans, but responders don't practice them and local agencies and service providers fail to follow prescribed procedures.
For example, New York law authorizes counties to keep an inventory of the elderly and others who may need help in a disaster. But according to New York state Sen. Michael Balboni (R), "They are not doing it. We need to find a way to get them to do it."
"Convenience, complacency and forgetfulness are the biggest enemies we have to fear. How do you keep reminding people without scaring them?" Balboni asked in a telephone interview.
Another problem for state emergency planners is that they are forced to spend too much time planning for terrorist attacks because most federal emergency funding has been aimed at terrorism since Sept. 11. Legislators in several states want emergency planners to put more resources into preparing for natural disasters, which are much more frequent.
Balboni says too little money is coming from the state and local level. "You get what you pay for. We need to make local jurisdictions pony up." He suggested that states offer matching funds for local emergency response efforts.
Balboni serves on the National Conference of State Legislatures' disaster planning committee, which is to meet Dec. 6 in Chicago to come up with guidelines for improving state and local emergency policies. Other issues under review are adequate transportation, specialized shelters and better tracking of elders' medical record and emergency contacts.
A major goal is to find better ways to tell people how to take care of themselves and their loved ones without scaring them, Balboni said. "When it comes to the elderly, their children are our target audience."