Recent hurricanes show how hospices need to continually strengthen disaster plans
Hospices that have been there pay attention to details
If there is anything positive that comes out of the natural disasters of recent years, including hurricanes Katrina and Rita, it's the lessons hospices and other health care providers have learned about disaster planning.
The recent Gulf Coast disaster forced some hospices to enact two disaster plans back-to-back. First, some Texas hospices had to find ways to accommodate additional patients among hurricane evacuees, and then the same hospices had to engage in their own preparations for Hurricane Rita, says Robin Kruth, BSN, vice president of hospice operations at VITAS Healthcare Corp. in San Diego, CA.
"We received 18 transferred patients from Hurricane Katrina into our Houston program," Kruth says. "Some patients were from other hospices, and others were evacuees who, due to stress and the situation, saw their conditions worsen, and so they became hospice patients."
Several weeks later, all 125 patients served by the Houston office were under mandatory evacuation and had to be relocated, Kruth says.
"We transferred a lot of patients to sister programs in Dallas and San Antonio and Fort Worth," Kruth explains. "We transferred patients to facilities where we had partnerships."
More recently the hospice provider had to evacuate staff and patients in California because of fires, Kruth says.
Whether the disaster involves fires in California, hurricanes in the Gulf Coast or Florida, or something else, the 27-year-old hospice corporation has seen it all.
"Being a Miami-based company, we have pretty detailed procedures and protocols for how to get ready for a natural disaster," says Mark Cohen, vice president of communications and public relations for VITAS Healthcare Corp. of Miami.
Even so, there are some disasters that are such a surprise that only fast action afterward can provide necessary help.
For example, Brighton Gardens, a nursing home in Bellaire, TX, evacuated 53 residents in preparation for Hurricane Rita, using charter buses to take them to a sister facility in Dallas. Unfortunately, one of the buses caught on fire, probably related to patient oxygen tanks, about 16 hours into the long, slow journey. More than 20 people died in the fire.
While a VITAS hospice in the area had some patients at the nursing home, which was operated by Sunrise Senior Living of McLean, VA, a chain with hundreds of facilities across the United States and world, none of the hospice's patients were on the bus that caught fire, Kruth says.
However, as soon as the hospice received word of the fire and deaths, managers sent chaplains and social workers to the Dallas facility where the Brighton Gardens nursing home residents were being transferred during the evacuation, Kruth says.
"Our folks were in there all night, assisting with bereavement services," Kruth explains. "We played a significant part in assisting in bereavement with their staff, families, and care providers at the nursing home."
Some Florida hospices have dealt with so many disasters in recent years that disaster preparedness has become a continuous improvement project.
During Hurricane Ivan last year, Covenant Hospice of Pensacola, FL, lost its corporate and clinical offices, and 14 members of the staff had lost their homes, says Dale O. Knee, MHSA, president and chief executive officer.
Previous disaster had taught hospice managers to have cash on hand for emergency purposes as a hurricane approaches because ATMs will stop working and banks might be destroyed, Knee says.
The money can be used for any legitimate purpose, including giving it to employees who were victims of the disaster and are in need of financial assistance, Knee says.
"The next day after Ivan hit I was standing in the parking lot distributing money to employees, and they signed and acknowledged receiving $500 or whatever I paid them," Knee says.
VITAS hospices also had cash on hand for employees' financial burdens, and managers handed out gas cards prior to the hurricane's landfall to ensure the staff had full gas tanks, Kruth says.
Covenant Hospice also will pay staff ahead of time if a storm is expected before the pay day, Knee says.
"Most of these good ideas come out of bad experiences and lessons learned unfortunately," Knee notes.
For instance, Hurricane Katrina ushered in a new problem of gasoline shortages, Knee says.
"Katrina did impact us, but not as bad as Ivan," Knee says. "But it was still significant, and we had more staff members lose their homes and more than 150 patients evacuated."
Power outages hit about half of the Pensacola hospice's service area, and the hospice in Mobile was out of power for several weeks, and this problem was compounded by gasoline shortages, Knee explains.
"We have gone together with two hospitals in Pensacola to have a contingency plan where if a gas station loses power but still has gas in its tanks, we can hook up the station to a generator, so we can pump gasoline for our staffs," Knee says. "It could be used exclusively for the three of us, and we're looking to do that in other areas."
Hospices have to be prepared for having patients spread far and wide during an evacuation process, Cohen says.
"We have 2,500 patients in South Florida, and there are 2,000 different answers to how an evacuation goes," Cohen says. "Some move in with family and friends who have power; some might be put in our inpatient units, which all are part of hospitals or nursing homes."
Also, Miami has critical needs shelters where people register at the beginning of the hurricane season, and those shelters are staffed with medical personnel, Cohen explains.
"If patients in Miami are in an evacuation zone, they might go there," Cohen says.
VITAS hospices recovered quickly from Hurricane Rita, thanks in large part to the careful disaster planning, Kruth says.
"After Rita we were back up the next day," Kruth says. "Our advantage was we had a lot of folks who stayed local and were able to get back in the swing of things quickly."
Within two weeks, all of the patients who were evacuated because of Rita were able to return, she notes.
The problem with Hurricane Katrina, which blew across Miami and Dade County, is that there was little time to prepare because it was born in the Bahamas, Cohen says.
"We didn't have much more than 24 hours notice between the time it grew from a tropical depression to a storm," Cohen notes.
"Generally, this time of year you're getting storms that come off the horn of Africa and travel across the Atlantic and end up in the Caribbean," Cohen says. "And we have a lot of advance notice."
The other problem with Katrina is that it moved slowly over Florida, causing some areas to experience 12 hours of tropical storm-force winds that left power outages and disaster in their wake, Cohen adds.
"My observation is that 12 hours of a 75 miles per hour wind can do as much damage as two hours of 140 miles per hour wind," Cohen notes.
Need More Information?
- Mark Cohen, Vice President of Communications and Public Relations, VITAS Healthcare Corp., 100 S. Biscayne Blvd, Suite 1500 Miami, FL 33131. Telephone: (305) 374-4143.
- Dale O. Knee, MHSA, President and Chief Executive Officer, Covenant Hospice, 5041 North 12th Ave., Pensacola, FL 32504. Telephone: (850) 433-2155.
- Robin Kruth, BSN, Vice President of Hospice Operations, VITAS Healthcare Corp., 9655 Granite Ridge Drive, Suite 300, San Diego, CA 92123. Telephone: (858) 503-4661.
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