Hurricane Irene tests healthcare disaster response plans

Last weekend’s hurricane left in its turbulent wake dozens of healthcare facilities dealing with the aftermath of a massive evacuation effort. It left operators assessing the effectiveness of their disaster response protocols. And, it highlighted the stress that is placed on the surrounding community and local government to find refuge for a facility’s residents when protocols are inadequate or nonexistent.

When New York City Mayor Michael Bloomberg last Thursday ordered nursing homes and hospitals in the city’s Zone A low-lying areas to evacuate by the following evening in anticipation of Hurricane Irene, facilities scrambled to action.

Chris Gilbride, press secretary at the New York City Office of Emergency Management (OEM), says close to 10,000 people were moved from healthcare facilities before and during Hurricane Irene. Most residents of nursing homes and similar facilities in the designated unsafe zone were brought to other senior communities or hospitals. The OEM also sheltered an additional 10,000 of the city’s general population. Gilbride says this shelter system includes 509 school buildings that can provide cover to 605,000 people.

“Overall I think that we received overwhelmingly positive feedback,” Gilbride now says of OEM’s work during Irene. “It’s the first time in New York City history that this has been done.”

NURSING HOME OPERATOR EVACUATES

Metropolitan Jewish Health System (MJHS), operator of two oceanfront skilled nursing facilities, Menorah Center for Rehabilitation and Nursing Care and Shorefront Center for Rehabilitation and Nursing Care, evacuated more than 650 residents over eight hours, reports Malika Granville, public information officer. Residents were sent to facilities throughout New York’s five boroughs.

“We really maximized our relationships to have these facilities take all our patients,” says Granville. “We transported people according to their needs. Some were bedridden and some were higher functioning. Everyone was under pressure and it was daunting but we have a diligent staff and they worked up to the final hour to be sure [residents] were placed where they needed to be.”

MJHS had earlier worked with NYC’s OEM and the Greater New York Hospital Association to put an emergency plan in place. MJHS also posted an alert on its website with directions to help loved ones locate residents.

“We worked with the social workers to go over the care plans and to be the conduit between families that had questions,” says Granville. “It was all hands on deck—we even had people working on Saturday.”

As for assuring residents that they’d be well cared for, Granville says the most important thing was “helping people realize that we’re transporting them for their own safety. I think the overall sentiment was we don’t know what’s coming but we’re going to plan for the worst and hope for the best. That kept spirits high. You’d expect pandemonium but it worked.”

Granville says no damages to either facility were sustained during the storm and that as of this past Monday, residents were being transported back to their facilities.

ASSISTING OUTSIDE FACILITIES

The North Shore-Long Island Jewish Health System is a comprehensive system with many hospitals and care centers in the New York City area—including two long-term care facilities—and features one of the largest hospital-based ambulance services in the country. While neither of the North Shore-LIJ long-term care facilities required evacuation during Hurricane Irene, the system’s fleet of more than 80 ambulances and emergency response vehicles were called upon by the city’s OEM to assist in the transportation of residents from outside nursing homes to designated safe zones.

“We assisted in the evacuation of approximately 70 patients from seven nursing homes in the Far Rockaway and Long Beach areas of New York,” says Terry Lynam, vice president of public relations at North Shore-LIJ. “Thirteen of our ambulances were involved in the evacuation of these patients late into the evening between 9 and 11 p.m. on Saturday, when the hurricane had not yet hit, but it was storming considerably at that hour.”

After the storm, North Shore-LIJ assisted along with other ambulance companies in transporting those 70 residents back to their home facilities after each was certified for reoccupation by the state.

NEED FOR PLANNING

North Shore-LIJ routinely practices disaster scenarios, and patients who were fit for discharge at any facility were sent home in the days leading up to Irene. This cleared up available beds for an anticipated transient population during and after the storm.

Lynam says the health system itself has a robust Network Emergency Management program that was activated several days before Irene had reached New York.

“Each of our individual facilities, including the long-term care facilities, have their own emergency management centers set up, so there’s a constant flow of information,” Lynam says. “From our standpoint, the key in all of this is planning.

“For instance, we had to evacuate more than 1,000 patients from three hospitals—that in and of itself was a pretty major undertaking. And we did that with very minimal assistance from outside agencies. The fact that we were able to do that was attributable to some advance planning we have in place.”

Then there are facilities with disaster protocol in place but never had to deal with the unique nature of a hurricane. Robert DeVito is director of finance/assistant administrator at Saints Joachim & Anne Nursing and Rehabilitation Center on Coney Island. The biggest challenge this 200-bed facility faced during its evacuation involved residents and, as echoed by Lynam, the logistical problems that immediately surfaced.

“The hang up was really on the part of getting the right transportation and making arrangements with the receiving facilities,” DeVito says of moving his residents to 17 facilities within the city’s five boroughs. “The two main issues were finding places for them to go and how were we going to get them there.”

Thirty residents went home with family members instead, DeVito says, while those who remained went out on ambulettes or ambulances. The evacuation process itself took all day, with the last resident leaving at 1 a.m. Saturday morning. Three days’ worth of medications and clothing, as well as each individual’s medical record, had to be transported with the residents—a last-minute administrative nightmare.

“There was so much information that had to go,” DeVito says. The OEM also required additional paperwork to be filled out detailing how people were leaving the facility and where they would go.

The financial effects of Irene are still nebulous, DeVito says. On top of the overtime paid to the staff who went along with residents—and all staff cooperated as part of a “loyal” team effort—there were other personnel, such as security guards and management officials, who remained at the facility during the hurricane. And then there’s that matter of reimbursement.

“We’re not 100 percent sure how this is going to play out, but those individuals that were on Medicaid, I believe we will continue to get paid when they were out, and the receiving facilities might get paid as well,” DeVito says.