Hurricanes Katrina and Rita taught painful lessons
Hospice staff reduced by 56 percent in hardest-hit area
New Orleans-area hospices continue to struggle more than a year after Hurricanes Katrina and Rita devastated the Gulf Coast area.
Prior to Katrina, which struck the area on Aug. 28, 2005, New Orleans region hospices surveyed by the Louisiana-Mississippi Hospice & Palliative Care Organization (LMHPCO) of New Orleans, LA, employed 336 fulltime hospice workers. But in January, 2006, there remained only 165 employees, and an October, 2006, survey found that only 148 fulltime employees remained, says Jamey Boudreaux, MSW, MDiv, executive director of LMHPCO. Boudreaux will discuss the hurricanes' impact on regional hospices at the annual assembly of the American Academy of Hospice & Palliative Medicine and Hospice and Palliative Nurses Association, held Feb. 14-17, 2007 in Salt Lake City, UT.
"There is a 56 percent reduction of hospice staff," Boudreaux says.
Hospice professionals left the area after the storm, and not enough have returned, he says.
Eighty-one hospice professionals from New Orleans lived in temporary shelters in January, 2006; by October, 2006, 19 hospice professionals continued to live in shelters, he says.
Along the Mississippi/Louisiana Gulf Coast, more than 200,000 homes were deemed uninhabitable. In the New Orleans parish, 55 percent of the homes were still without electricity at Thanksgiving's Day, 2006, Boudreaux says.
"We have opened 10 hospitals with a total of 2,200 beds, but there still are six hospitals with 1,000 beds that are closed," he adds.
The same grim facts can be found in all facets of health care. Boudreaux provides these details:
- Twenty-four nursing homes have re-opened, but 18 are still closed, leaving the area with a 2,200 nursing home bed deficit;
- Three inpatient hospices are closed in the metro New Orleans area, and they'll never reopen, meaning 58 percent of inpatient beds are lost;
- Nearly 60 percent of the city's physicians have left, and 78 percent of psychiatrists are gone;
- Of 400 psychiatric beds in the New Orleans metro area, only 167 are open;
- There is a critical shortage of neurologists, urologists, and ophthalmologists;
- Blue Cross/Blue Shield report a 51 percent reduction in filing claims by active physicians;
- The Louisiana Board of Nursing reports a 27 percent decrease in the number of registered nurses renewing their licenses;
- The Mississippi Department of Health reports that 25 percent of physician manpower has been lost on the Mississippi Gulf Coast, and 25 percent of the remaining physicians say they are looking for staff or are having difficulty finding trained applicants;
- One third of nurses along the Gulf Coast are considering leaving, and more than 60 percent say they've been contacted by recruiters offering competitive pay for out-of-state jobs.
For hospices, one of the big problems is finding volunteers, Boudreaux says.
Hospice administrators who were surveyed by LMHPCO reported they had increased staff burden because of the lack of volunteers, who had been displaced, he says.
"Programs are talking about how it's really difficult to find volunteers today because they either moved or are busy rebuilding their lives and don't have the leisure time they had to donate to hospice," Boudreaux says.
"As people finish their rebuilding projects, I hope they will come back," he says. "But that's why staffing is hard because the professional staff has been doing the work of volunteers."
The LMHPCO doesn't have funding for recruiting and training volunteers, so each hospice agency is left to find its own volunteers, despite the overwhelming nature of the problem, Boudreaux says.
Although ongoing infrastructure problems have preoccupied hospices and health care organizations since Katrina hit in August, 2005, some attention also must be paid to planning for future disasters.
"There are things we're looking at doing for 2007," Boudreaux says. "There is a group of people who have formed a coalition for at-risk patients, including dialysis patients, transplant patients, and hospice patients."
The goal is to create a database for those three categories of patients and using the database to track the patients in the event of another hurricane, he explains.
The database would include evacuation plans that would give agencies a way of keeping in contact with patients and to direct them to resources in the event they were kept from their homes for more than the three days that was the standard evacuation time before Katrina, Boudreaux says.
"It's for when the next hurricane comes — it's not a question of 'if,' it's a question of 'when?'" Boudreaux says. "We had less than 40 years between Camille and Katrina."
The state of Florida was hit four times by hurricanes in 2004, and after Katrina, the Gulf Coast was slammed again by Hurricane Rita less than a month later.
Prior to Katrina, hospices were prepared for a brief evacuation period, and they'd make certain patients had access to a two-week supply of medication, Boudreaux says.
"Hospices were encouraged to help families develop plans to leave the area for hurricane events," he says. "Hospices were excluded from presenting themselves at emergency shelters because the Homeland Security decided they didn't have personnel with hospice and end-of-life training, and, secondly, they didn't want people dying in the shelters."
No one anticipated a hurricane with the deadly impact of Hurricane Katrina.
"They changed the policy after Katrina," he says. "The Louisiana legislature made a formal request to Emergency Preparedness not to exclude hospice patients and have shelters available for them."
While surveying hospices along the Gulf Coast since Katrina, LMHPCO asked hospice administrators what were the greatest challenges post-Katrina.
"The reports were multilevel grief for patients and staff resulting from personal losses of jobs, family, and friends," Boudreaux says.
Administrators also expressed concern over the loss of volunteers and admitted to anxiety about current and future evacuation plans by the state, he adds.
"Administrators reported increased post-traumatic stress disorders, increased referrals to employment assistance, high turnover of hospice staff with people moving from the area, increased responsibilities within agencies due to staff moving out and difficulty in hiring, and the stress of coping with rebuilding your home post-Katrina," Boudreaux explains.
Hospice staff were as greatly impacted by the hurricane as the general population.
"The scope of the losses becomes unfathomable at times," Boudreaux says. "Most people think we should be over it 15 months after the event, but the problem is that now the area looks very much like it did then: you have to remember that insurance companies have not yet settled with a lot of folks."
There continue to be disputes over whether house damage was caused by the winds of the hurricane or waters of the floods, and the people who didn't have flood insurance often are left with no insurance reimbursement, he says.
"We're very grateful to communities across the country for their donations," Boudreaux says. "We received $92,000 in donations which we distributed to hospice employees and patients who were affected by the hurricane."
For many people who lost a home, the check for $500 from the LMHPCO Foundation was the first money they received, he adds.
Need More Information?
- James Boudreaux, MSW, MDiv, Executive Director, Louisiana-Mississippi Hospice & Palliative Care Organization, 717 Kerlerec St., New Orleans, LA 70116. Telephone: (504) 945-2414 or (888) 546-1500. Email: [email protected]; Web site: www.lmhpco.org.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content