Eight Nursing Home Residents Died — We are ALL to blame
This isn’t the first time; can we make it the last?
I must first express my condolences to those who have suffered and those who have lost loved ones in nursing homes affected by the recent disasters.
The headlines are grim and heartbreaking; The New York Times report was just one, “Eight Dead From Sweltering Nursing Home as Florida Struggles After Irma” The New York Times also reported the predictable responses:
“State officials, utility executives and the Rehabilitation Center spent Wednesday trading blame over why and how its patients were left to endure such conditions, even though state and federal regulations require nursing home residents to be evacuated if it gets too hot inside.”
Let’s please take the surprised look off of our faces
We consistently leave behind those unable to keep up
Lest I appear to harsh, I would like to review some recent cases of people who are consistently disproportionately affected by disasters — children under five; adults over 65; the economically disadvantaged; and people with disabilities and access and functional needs.
1. Case 1: Nursing home patients sitting in waste-high flood water in the aftermath of Hurricane Harvey. While responders reported they were working a solution, the rescue only came after the image of the people went viral on social media.
2. Case 2: Just two years ago, during the Butte and Lake fires in California, people with disabilities and access and functional needs died in their homes and/or endured undue suffering at shelters that were not prepared for them. In the Los Angeles Times, L. Vance Taylor, chief of the Office of Access and Functional Needs at the Governor’s Office of Emergency Services, told of his frustration in getting accessible showers to shelters. The State of California had just five accessible showers and four of them were at a music festival in Southern California. Those with access and functional needs had to wait for days to use the showers and clean the fire-driven grime off of them.
3. Case 3: The New York Times Reported “…Judge, Jesse M. Furman of Federal District Court in Manhattan, found that the city, through “benign neglect,” was in violation of the Americans With Disabilities Act…” The lawsuit was brought as a result of Tropical Storm Irene in 2011, but further validated by undue suffering in Hurricane Sandy a year later.
4. Case 5: Hurricanes Katrina and Rita: The National Council on Disability reported, “As this report will demonstrate, people with disabilities were disproportionately affected by the Hurricanes because their needs were often overlooked or completely disregarded.” The Los Angeles Times also reported, “…Hurricane Katrina in 2005 — when nearly three-fourths of those who died in the New Orleans disaster were older than 60…”
“Fool me once, shame on you; fool me twice, shame on me.”
OK, you get the point. These are just a few examples, but the disproportionate suffering by a known and well-defined segment of our population occurs disaster, after disaster, after disaster. Without even knowing what the investigation will turn up in Hollywood, Florida, I can state that we, as a society, simply have not prioritized caring for those who need some extra assistance. It may have happened “somewhere else” this time, but can occur in any of our communities. Until we fix the problem, we as a society, must accept the blame.
I am guilty
I have not done my part
As I read the stories of the fatalities in the nursing home in Hollywood Florida (right across the street from a functioning hospital), I must admit to my own failings and must own part of the solution. You see, my 93-year-old grandfather landed in a nursing home that was less than scrupulous. I soon realized their basic technique was to quickly get residents in diapers and make sure they were bed-ridden. If they weren’t mobile, they were easy to track. I took two approaches to getting him out of there. On one front, I battled with a…yes I’ll say it, evil administrator. First, they over-billed us — my grandfather did not have insurance. Furthermore, they told us they would not discharge him until the bills were paid in full. It took me two years of battling — one year after his death — to resolve the case. In the end, a reputable company and honest administrator took over the facility, admitted to the overcharge, and refunded us $20,000. On the other front, I worked to get him into the California State VA hospital and another private facility. My grandfather had become quite stubborn and would not cooperate — a requirements to gain entrance and or show self sufficiency. The private care facility simply ended their interview early when he would not answer their questions. In my mind, I play back the scenario and I do one of those corny, movie scenes in which we break grandpa out of the nursing home. Of course, I was a federal employee with a security clearance, so not too hard to track me down. The bottom line is I regret the conditions my grandfather endured at the end of his life while I fought administrative battles.
I am also guilty of not prioritizing work with people with disabilities and access and functional needs enough in my time with the federal government. While I was still in government service last year, I had once again committed to work more with people like Vance Taylor from the State of California on his efforts; and Daniel Homsey on San Francisco’s Vulnerable Populations Resilience project. I write, “once again” because it seems like I made that pledge every year. I think it was 2009 or 2010 when FEMA coined the term, “Whole Community.” We saw a lot of that mentioned in Hurricanes Harvey and Irma as we called on citizens, the private sector, and non-governmental relief agencies to help where the government fell short. Calling all hands for response and recovery is just one half of the Whole Community. The other half is looking after EVERYONE. I brought this up on a conference call a few years ago when headquarters was working the response and recovery Whole Community part of disasters. I asked about the other part — serving everyone. The answer from headquarters was, “we’ll get to that in a couple of years.” It has been a couple of years…
Don’t get me wrong, FEMA, states, territories, tribes, and local governments are doing better. We just aren’t there yet. I know I did not push hard enough.
Perhaps we should act like Indians
This is not meant to be confusing or a slight to the country of India, but I have a great amount of experience working disaster preparedness with Native Americans tribes. Truth in advertising — working with tribes was one of the favorite parts of my job — I loved it! Here is a typical story.
I was way out in northeast Nevada checking on a tribe after heavy rains back in February of 2017. I happened to walk in when the emergency manager was out in the field and the elders were just sitting down for their lunch. They invited me and I joined them. We had a nice time as I learned a little about them and their tribe. I learned from the health director about the grant she got to teach people to prepare nutritious meals. They would not accept money for the meal (American Indian tribes are quite generous), but happily they accepted a donation for their health program. This is a typical scene that plays out daily at more than 500 tribes (567 federally recognized) across the nation. In every meeting I have attended, I have witnessed great respect and deference paid to elders. I have seen it in youth workshops when there were no adults making them be respectful when an elder entered and spoke. And when an elder speaks, no matter what the subject he/she would like to address, everyone listens attentively and responds appropriately.
Elders are first on the people’s minds in disaster
The typical calls I received from tribal members during a disaster went like this:
“Hello, Randy Brawley, FEMA Region IX, how can I help you?”
“Randy, we need FEMA’s help. We have flooding/heavy snow/fire, and we are evacuating our people. We have 30 elders, 5 people on oxygen, 20 with diabetes who need medication….”
I could go on, but you get the point. The first people that tribal emergency managers discuss are their elders and people with disabilities and access and functional needs. These are also the FIRST people to be evacuated in a disaster. When there isn’t an evacuation, tribal volunteers span out and do in-person checks on those that may need assistance. The tribe knows who needs extra help, what kind of help, and where they are. They don’t wait for a call — they go see. I have witnessed this time and time again in tribal nations. Imagine the different outcome if we had people go deliberately check on, without being asked, people with disabilities and access and functional needs in Hurricane/Tropical Storms Katina, Rita, Irene, Sandy, Harvey, and Irma; and Butte and Lake fires.
Where do we begin?
The U.S. Department of Health and Human Services, as well as state, territorial, tribal, and local governments already have requirements and guidance for care facilities, even for disasters. I will not address their work. Rather, I will discuss disaster preparedness in general.
1. Prioritize helping those who are historically disproportionately affected by disasters. Enough said.
2. Scope the issue — find out how many people in your community need additional assistance. I found in my work that I had no idea what the scope of the issue was. I did not know how many people were in hospitals, in care facilities, in their homes. Now, I do not think the government should, or needs to know the particulars. And I never wanted to track all the people with disabilities and access and functional needs in my region of 40 million. We just need to know the big numbers for planning purposes and we need to have our critical partners in our emergency operations center during disasters. These critical partners are representatives from hospital associations, Meals on Wheels, paratransit — those groups that already know who we need to look out for and where they are.
3. Actually put Access and Functional Needs specific details in emergency operations plans. For years, FEMA has required “Whole Community” considerations in their emergency operations plans. And, of course, all of these plans are not created equally. But, I have seen my share of plans that just drop in the words “Whole Community” here and there for effect and don’t really say anything. Many do speak to disabilities and access and functional needs at a general level, but don’t go to any level of planning detail. For example, what is the size of the access and functional needs population? Where are they generally located? Do we have appropriately equipped and staffed shelters within a reasonable distance? Do we have enough vehicles on call/contract? It isn’t hard to see that going into another level of detail will help communities determine exactly how many resources they need and where they need to be. Many communities are starting this. If you haven’t, check out the California Office of Emergency Management’s OAFN Web Map for an example of what a map of identified resources can look like.
4. Budget for the additional resources needed. This will only happen if, of course, we go back to step 1 and prioritize this segment of our population. We can use volunteers, relief agencies, the private sector, and others to help. But, chances are, we will have to spend some money on this.
5. Actually include people with disabilities and access and functional needs in exercises. Once the demographics are known, it isn’t hard to include their considerations and needs in an exercise scenario to validate the planning. Determine if people can access the resources they need in a reasonable time frame — paratransit vehicles, medical supplies, medical personnel, etc.
6. Update your plans based on what you learned in the exercise or real-world event. Speaking of real-world event, we just had a couple that highlighted shortcomings. This is a great time to use what we are seeing in Texas and Florida to energize our own preparedness efforts wherever we are. You know what they say:
Just Pay attention
The City of Hollywood, Florida reported that they asked the nursing home if they needed help. The nursing home declined. This is pretty common; I have seen it in many exercises. At a higher level, we could see a jurisdiction needed more assistance than they were asking for. We prodded them and they declined. I think they were often too overwhelmed at the time to know they needed to be asking for more help. I’ll even give the nursing home the benefit of the doubt and assume the staff were so busy with attending to their patients, they just didn’t ask for help soon enough. We all get in over our heads and can’t see to ask for help. That is why we, as a society, must prioritize looking after those who need a little extra help. And like the American Indian tribes I know, we need to actively go check on people. It could make all the difference.