Whether aged stay or flee, decision has added perils


Hurricane Rita

September 24, 2005|By Julie Bell | Julie Bell,Sun reporter

Even with Hurricane Rita bearing down, deciding whether to move elderly patients or nursing home residents is complex. Hurricanes, obviously, can kill. But so can evacuations.

There is a potential for missed medications, deadly dehydration, stress-induced heart attacks and malfunction of medical equipment.

And the challenges continue at the other end of the trip because older people adjust more slowly than younger ones to change.

Remaining can be perilous, too. In Hurricane Katrina, 34 residents left behind in a Louisiana nursing home drowned, leading the state's attorney general to charge its owners with 34 counts of murder.

"It's a real tough call when you make that decision to go or to stay," said Scott Bell, a nursing homeowner who decided to evacuate his patients in Mississippi before Katrina demolished the facility.

The agony and ramifications of such decisions were evident this week as Hurricane Rita approached.

Yesterday 24 elderly evacuees died when the bus in which they were riding was engulfed in flames, apparently fueled by their oxygen tanks. They had been on the way to Dallas from a Houston facility.

Less dramatic dangers threaten the old and infirm wherever they are moved, although all nursing homes are required to have emergency preparedness plans.

Getting started early is what made a smoother trip for 103 Galveston nursing home residents, who made the trip by bus and ambulance to a sister facility in Huntsville. By 7:30 p.m. CDT yesterday, as Rita took aim, they were bedding down for the night in the Town Creek Retirement Community.

"We were able to move our people out Wednesday before the gridlock," Marvin Kayse, Town Creek's executive director, said of the Galveston contingent, which doubled the Huntsville patient population to just over 200.

Yet even when the elderly make it to designated shelters, experts say, they are often disoriented and suffering from a condition known as transfer trauma.

"In late life, this whole process is very confusing," said Gay Becker, a University of California-San Francisco medical anthropologist who is proposing to study 180 senior citizens displaced by Katrina to see how they adjust. "People rely as they get older on the known or the familiar."

Evident even when older people are moved from, say, one assisted living facility to another, the condition is heightened in evacuations, said Alice H. Hedt, executive director of the National Citizens Coalition for Nursing Home Reform. Symptoms include confusion, withdrawal, eating problems and depression, and can lead to death, she said.

Many nursing home patients have dementia and in some cases don't understand who they are, much less where they are or why.

"Evacuation is something that should never, ever be taken lightly, and there are situations where you would shelter in place," Hedt said.

The two choices were made yesterday in Houston facilities only blocks apart. At one - M.D. Anderson Cancer Center - the decision was to close floodgates on a massive wall so that 413 acutely ill cancer patients could remain where they were. At the other, the decision was to find out-of-town hospital rooms for 25 terminally ill hospice inpatients.

A key difference: Houston Hospice isn't as well fortified and has a bayou running right behind it.

At M.D. Anderson, an affilliate of the Texas Medical Center, the hospital's chief safety officer explained the rationale for keeping the cancer patients, many of them older.

"Moving them would be more dangerous to their health and their well-being than leaving them here and assessing the impact of the storm on our resources; our ability to provide emergency power, food, water; any damage to building structures, windows," said Dr. Linda Lee in a phone interview from her post in the hospital's second-floor command center.

At the nearby hospice, Executive Director Jim Monahan spent stressful hours arranging scarce ambulance planes and beds for the evacuated patients.

"We had quite a few older people going out of here last night and today," said Monahan. "What's difficult for us, and more so for families, emotionally is that we couldn't let families on the planes with them."

Late yesterday afternoon, he remained in the hospice's storm-shuttered three-story building with about 18 staff members, all of whom had donned wrist identification bands, being aware after Katrina that they might die.

Because most of the hospice's 250 clients are cared for at home, the staff stayed behind to answer the medical questions of family members caring for those patients. Nurses will be unable to visit during the hurricane and - depending on the damage - perhaps for days afterward.

The hospice prepared the best it could, giving families many days' supplies of medicines and talking with them about how to place the dead bodies of loved ones in another room because medical examiners might not be able to immediately respond.

Dr. Michele Bellantoni, medical director for the 240-bed Johns Hopkins Bayview Care Center, said that the people in nursing homes are much sicker now than they were years ago. At the care center are 30 patients on ventilators, fragile diabetics, people at risk for pressure ulcers and skin breakdown, people with kidney failure who need dialysis and others with congestive heart failure.

Bell, the Mississippi nursing home owner, recalled a sleepless night worrying about his elderly patients last year.

As Hurricane Ivan spun toward Florida in 2004, Bell decided evacuation would be a greater threat to the health of elderly residents than the storm. The facility was spared, but the tense waiting led him to choose evacuation from Katrina in Mississippi last month.

"You're flirting with a lot of people's lives," he said. "It's a real gut check."


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