Hurricane! Agencies survive Fran and live to tell about it
Follow these 8 steps to better emergency preparedness
The elderly woman in Surf City, NC, was left by her home care nurses to ride out Hurricane Fran alone. She was found the day after the storm lying on a mattress in a marsh under debris. She died the next day. Reports of the woman’s death were carried in local media and on national wire services, highlighting the need for home care agencies to better prepare their patients and their staff for disasters.
Not too far away, Cathy Therell, RN, MSN, administrator of St. Francis Xavier Home Care in Charleston, SC, thought she had prepared well for Hurricane Fran. When the official warning was sounded Sept. 2, she contacted her supervisors and managers and put the agency’s disaster plan into action.
Although none of St. Francis’ patients suffered the same fate as the Surf City woman, Therell says she waited too long to gear up for the emergency. "We like to get in touch with all our clients two days before. But we didn’t finish making our calls until the end of the day on Tuesday," she recalls. "That left us with just Wednesday to prepare for the hurricane. We had clients who did not make arrangements, and when we started trying to get them into shelters, they were full."
However, the home care agency’s affiliation with its hospital allowed Therell to get her patients admitted ahead of other agencies’ and nursing homes’ clients.
To avoid becoming a story on the wire services, Therell and many of her counterparts have pointers that can help you to prepare your agency and clients for emergencies.
• Publicize your disaster plan.
When the warnings about Fran first started over Labor Day weekend, Jeanie Stoker, RN, BSN, MPA, home health nurse manager at AnMed Homecare in Anderson, SC, began sending memos to her staff. "When we first hear there is a hurricane, we go on a standby alert," she says. Supervisors and managers review the disaster policy and check with all high-risk patients to see if they have emergency plans.
Therell requires her staff to have a copy of the disaster plan, a current census of patients, and an up-to-date list of all employee phone and beeper numbers with them at all times.
Those without disaster plans need to start by developing one, says Therell. Next month, Hospital Home Health will have a detailed guide on creating an emergency preparedness plan.
• Know your patients.
Therell recommends categorizing patients according to the severity of their conditions. Classifying patients is important, particularly in more rural areas, says Stoker. "We look at those who are in trailers, in flood zones, and those who are electrical-dependent first," she says. "Anyone who can’t do without care for two to three days is a priority."
A patient who needs wound care probably won’t die if you don’t see them for a few days, says Therell. "But an insulin patient on a sliding scale is a problem. You can’t just drop off a minimum of insulin for them to inject themselves. You have to find a caregiver or put the person in the hospital." About six of the 800 clients at St. Francis required such special needs. Therell and her staff arranged for them to go to the hospital where a caregiver stayed with them. "It wasn’t a full admission, more a place for them to stay," she says.
Mercy del Rey, director of human resources, is in charge of the disaster plan for Home Advantage Home Health in Miami. She recommends that whenever a new patient is enrolled, you note whether they would need a special-needs shelter in an emergency. "We automatically sign them up with the [Dade County] Office of Emergency Preparedness," she says. "When hurricane season starts, we get a copy of their list and make sure that all the appropriate patients are on it."
• Make sure your patients are prepared.
When there is notice of a pending disaster, Stoker and her staff make pre-storm visits to clients to help them prepare. "It’s really focused on their health," she says. "We don’t go grocery shopping, but we’ll make sure they have four weeks’ worth of prescriptions or call a family member for them. If they need to go to the special-needs shelter, we’ll help them make arrangements. We don’t help them put up storm windows or anything."
Therell shuts down her office for two to three days and calls every client. "We don’t do any other business," Therell says. The patient list is divided, and if a client cannot be reached by phone, the case manager is asked to find out what the patient has planned. A staff member asks clients a list of questions and records their answers. (See questionnaire, p. 123.) Questions include what the patients have planned and whether they will go to a shelter or be with family. The agency also requests that if patients evacuate, they let the agency know how to reach them.
• Be prepared to sell the idea of evacuation.
If clients have to be evacuated, Stoker says, you have to be ready to convince them. "There is a big problem with elderly patients who have pets. We can’t take them, the shelters won’t take them, and many won’t leave their animals. Although the decision in the end is their own, we have to help them find friends or families to take care of the pets before they agree to be evacuated." In the future, Stoker will try to get area veterinarians and animal shelters to help with this aspect.
• Work with other home care agencies to help special-needs patients.
For patients who are electrically dependent, such as those on ventilators, or those who need care but are not ill enough to be admitted to a hospital, Therell recommends working with freestanding home health agencies, with local authorities, and with state disaster planners to create special-needs shelters. These shelters can provide for those with special needs without taking up valuable space in a hospital which may itself be threatened by a storm or other disaster. Although Charleston did not have a special-needs shelter for Fran, the community is working on a plan that would provide such a facility for any future disaster.
Stoker says that during Hurricane Opal last year, the special needs shelter was overcrowded. But the hospital had a unique solution. "Because we were part of the hospital, we were able to work with them to open a special facility." The hospital was building an eye clinic on its property, she says. While functional, it was not yet occupied. This facility was opened for special-needs patients and their caregivers or family members. "We had about 100 patients in there," recalls Stoker.
• Make sure lines of communication are open.
"We were relatively lucky," says Buddy Caddell, director of the Hospital Homecare Services of Onslow Memorial Hospital in Jacksonville, NC. "We thought ahead." Caddell arranged for all of the phones to be rolled over to another city location farther inland. "We had communication throughout the storm," he says. "We let the phone company know a couple days in advance, and that allowed our patients and our staff to have communication during the worst of it. Other home health professionals provide cell phones to staff. Therell says all of her supervisors, managers, and nurses get the phones and nursing bags. This helps them keep in touch with each other when other means of communication are unavailable.
• Plan for staff needs, too.
For many of your employees, a storm poses risks to their homes and families. "Our supervisors may not want to stay when a storm threatens," says Stoker. "They are anxious for their own homes and families. I understand their fears, and I try to work with them," she says. "But we still have a responsibility to our patients." When Fran struck, Stoker put her three children on the road in the care of the eldest, a 17-year-old.
Stoker says ensuring clients are prepared helps the staff. "If they are ready in advance, we have more flexibility to let staff take care of their own homes and families. We just make sure that if they leave town, we know where and how they can be reached."
Therell had another plan to assist her workers during Fran. She brought in babysitters to take care of her staff’s children. "But that has raised some questions about liability and also whether we have to pay minimum wage." Next time, Therell will have staff sign a waiver for liability and will have to pay minimum wage to the babysitters. She also makes it clear that managers or supervisors who abandon their duties without telling her where they have gone have put their jobs in jeopardy.
• Make sure your facility is safe.
Since you and your staff will likely be working, you also have to ensure that your own building is secured. Caddell makes sure there are extra supplies on hand. Therell puts a television in her office to monitor the storm progress and moves all records to the second floor of the building high enough to avoid flood damage and low enough that roof damage would not affect them.
Those hospital home health administrators interviewed for this article agree that working with other organizations, such as the Red Cross, local authorities, and your hospital, should ideally take place prior to a disaster. Stoker says the community as a whole should be aware of disaster plans and their input should be solicited.
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