Weston & Tokesky: Older Persons in Emergency and Disaster Situations

Older Persons in Emergency and Disaster Situations
A case study of Hurricane Katrina in the United States of America in 2005

by Michael M. Weston
President, Servision Inc.,
Disaster Consultant, U.S. Administration on Aging

George M. Tokesky
Vice-President,
Alzheimer’s Community Care Inc

Background:

As the impact of landfall was felt, there was little chance that the vulnerable population, with few means to evacuate from the fierce winds and rising waters, would escape the suffering that had been predicted for years by hurricane experts. Ironically, what proved to be a mere six months prior to the devastation and loss of life brought on by Hurricane Katrina, a national assembly of government officials and hurricane experts had gathered to contemplate this bleak possibility in, of all places, the shadows of the Superdome in New Orleans, Louisiana.

In the final hours of the 2005 National Hurricane Conference, an attentive audience of emergency-management officials from all over the world listened as speakers discussed the needs of vulnerable populations in disasters. A clear message was conveyed: the ability to meet the emergency needs of the frail, aged, and disabled population was far less than what was perceived, and those with little or no capacity to self-preserve had expectations of life-saving assistance that were too high. Yet, despite the warnings, the lessons learned from previous hurricanes, and good forecasting of hurricane activity in the Atlantic in 2005, Hurricane Katrina highlighted that weaknesses in disaster preparation and planning for vulnerable populations continue to exist at every level.

Major hurricanes have become one of the top concerns for all emergency management officials along the Gulf Coast and the Eastern United States. Hurricane activity in the United States in the past decade has become routine in frequency. This unusual activity has had a profound effect on the residents of hurricane-prone areas, to the point that the majority of residents who live in those regions anticipate experiencing some level of hurricane activity each year. Although the level of devastation caused by Hurricane Katrina is unprecedented in the United States, other major storms, such as Hurricane Andrew in 1992 and the four major hurricanes that hit Florida in 2004, have tested the United States’ ability to plan for, respond to, and recover from multiple disasters on a large scale.

When it comes to disaster planning and response, the State of Florida is widely considered one of the most experienced and well prepared of the 50 states. During the 2004 and 2005 hurricane seasons, Florida was impacted by seven hurricanes within a 15-month period. Of those seven storms, four were considered “major” hurricanes, with wind speeds in excess of 130 mph. The 2004 storms combined caused an estimated $42 billion in damages and 144 deaths in just six short weeks. Prior to Hurricane Katrina, the most costly hurricane to hit the United States was Hurricane Andrew in 1992, which made landfall in Florida as a Category Five hurricane just south of the heavily populated city of Miami. Hurricane Andrew caused more than $36 billion in damages and resulted in 65 deaths. At the time, it was the most costly natural disaster in United States history.1

Preparedness – The Contribution of the ‘Aging Network’

Development of the ‘Aging Network’ Response

The level and frequency of hurricane activity in the past few decades has given Florida and other states the unique opportunity to incorporate lessons learned from previous hurricanes into all aspects of disaster planning and response. As far back as Hurricane Hugo in 1989, the aging network, comprised of state units on aging, area agencies on aging, local service providers, and other non-governmental organizations dedicated to serving older populations, has been developing and enhancing best practices and emergency response strategies for the vulnerable populations they serve. After Hurricane Hugo, the South Carolina Department of Aging championed this initiative by enhancing the aging network’s level of preparedness through creating planning templates for local service providers, area agencies on aging, and state units on aging.

It was not until Hurricane Andrew that the importance of these planning tools was universally recognized. After the destruction caused by that hurricane, the State of Florida, in partnership with the United States Administration on Aging, elevated the level of awareness to all state units on aging by hosting the first national conference solely focused on issues related to aging in disasters. Since that time, all state units on aging have developed and adopted basic emergency management plans, and many have formalized relationships with emergency-management officials and related organizations at the local, state and federal levels. These nontraditional partnerships have made it possible for the aging network to participate in emergency planning exercises and have reduced the confusion regarding roles and responsibilities before, during and after a disaster.

Shortcomings

Despite the elevated level of awareness and the extensive cooperation between aging networks and emergency-management organizations, Hurricane Katrina demonstrated that states’ levels of preparedness were not uniform. Within days of landfall, it became apparent that many vulnerable population groups, including seniors, did not have personal emergency plans in place and were not aware of the emergency resources available. Many of the elderly victims had dismissed the multiple, highly-televised, warnings about Hurricane Katrina as it passed through the Gulf of Mexico. In other cases, older residents clearly understood the warnings; however, they did not have the financial means or the knowledge of emergency resources to ensure their survival.

Hurricane Katrina revealed that older individuals were more likely to require emergency assistance, as a result of information, regarding special emergency services designed to accommodate specific populations, not being communicated prior to the storm. The elderly simply did not know how to access such resources, and, in many cases, did not even know that any special accommodations were available. For example, many seniors did not know where to take shelter before, during and after the storm. Those who did not end up at the Superdome ultimately had to be saved through often heroic measures by emergency responders. Those who did find their way to the Superdome discovered that it was not adequately equipped to handle this large and highly vulnerable population. The harsh conditions at the Superdome forced elderly evacuees with special needs to survive without the life-sustaining supports and services (e.g., portable oxygen tanks, medications, medical services) that they required. Seniors’ lack of preparation and lack of knowledge of emergency resources caused numerous challenges for emergency-management officials and, ultimately, unnecessary loss of life.

Hurricane Katrina also highlighted a major breakdown in communication between first-responder organizations and the aging network. Complications increased when communication lines became overloaded and both landline and cellular connections were unreliable. As a result of this lack of communication, much needed life-saving and life-sustaining resources from local, state and federal agencies were sadly delayed or never made it to the intended recipients. Hurricane Katrina clearly exposed weaknesses in communications between responding organizations trying to assist the at-risk populations.

Seniors’ perception of risk also caused many challenges for emergency-management officials. In many cases, older hurricane victims who quickly found themselves in life-threatening situations had simply not prepared adequately because they did not believe Hurricane Katrina was to be the catastrophic event that was predicted, despite the repeated warnings issued by hurricane experts and government officials. Many of the older residents in Louisiana felt that, because they had survived Hurricane Camille in 1969, they had seen the worst and would also survive Hurricane Katrina.

Impact of Disasters on Seniors

Data regarding Hurricane Katrina reveal a common trend in disasters: generally speaking, seniors have been disproportionately affected by large-scale catastrophes worldwide. It is estimated that Hurricane Katrina displaced more than 1.36 million residents. In Louisiana alone, the Department of Homeland Security reports a total of 1,464 deaths. Of the 910 Hurricane Katrina victims who were recovered and processed through the Disaster Mortuary Operational Response Team (DMORT) morgues, 64% were over the age of 65.2 A closer look at data for the city of New Orleans reveals similar findings. In New Orleans, persons 60 and older made up about 15% of the total number of residents; the same age group, however, made up 74% of the known victims.3

Data gathered from the hurricanes impacting Florida in 2004 also support the Katrina findings. There, elderly persons or elderly households filed more than 30% of the 1.25 million applications made under FEMA’s (Federal Emergency Management Agency) Individual Assistance Program,4 and 40 to 60% of the total number of deaths (144) caused by the four hurricanes were of persons over the age of 60.5

Methods of Response

Although Hurricane Katrina will always be remembered as the event that highlighted weaknesses in disaster response and mistakes made, there were many things done well that, today, serve as examples of best practices. In many cases, these now best practices evolved as a result of unprecedented response efforts executed during an unprecedented storm. Because the aging network serves seniors who are often frail and both socially and economically disadvantaged, the disruption of life-sustaining services caused by Hurricane Katrina quickly led to life-threatening circumstances throughout the impacted states.6 This disruption of services required quick and highly coordinated efforts to ensure that much-needed relief was delivered to thousands of frail elderly disaster victims.

Successes

Prior to the 2004 hurricane season, the aging network in the United States was generally considered a supporting entity in disaster response. During Hurricane Katrina, however, aging-network staff, consisting of social workers, case managers and service providers from multiple states, were recruited and deployed directly into impacted areas to locate and assist elder disaster victims. This tremendous effort was facilitated through the execution of an Emergency Management Assistance Compact (EMAC). EMAC is a commonly used, pre-arranged agreement between states that outlines emergency services and supports to be provided during times of disasters. This EMAC enabled the various impacted states to quickly access and utilize the expertise and resources of multiple non-impacted states.

This pre-established partnership between states helped to facilitate the response and recovery efforts by the aging network. This saved valuable time and, ultimately, hundreds of lives. EMAC also made it possible for aging-network staff from various states to quickly partner with the aging-network staff of impacted states to expand the area of disaster operations, to restore life-sustaining services, and to provide valuable information regarding various long-term recovery resources. In addition to saving lives, this unprecedented coordinated movement of hundreds of primarily geriatric casework specialists resulted in the rapid assessment of over 8,000 vulnerable, mostly poor, frail and disabled victims.7

Another best practice that has evolved as a result of Hurricane Katrina and prior disasters is a formal partnership between the aging network and emergency-management organizations. Once the impact of Hurricane Katrina was understood, the aging network was able to successfully advocate for the priority allocation of emergency federal and state resources for elder disaster victims. This working partnership between emergency-management officials and aging-network professionals working in the impacted communities and at the state and federal levels provided much needed life-saving and life-sustaining resources. These resources ensured immediate relief to many who could not have survived without such intervention.

Failings

Despite the countless successful efforts that often went unnoticed, some highly publicized mistakes were made. Many response efforts failed as a result of factors such as: inadequate communication between emergency-management agencies; incomplete or non-existent evacuation plans for special populations who did not have the means to evacuate; and a general lack of knowledge regarding disaster response and recovery resources by individuals who required assistance.

Hurricane Katrina clearly emphasized the need for more formal disaster planning within all levels of government and non-governmental organizations as had been previously identified and discussed. An enhanced relationship between human-service entities such as the aging network and emergency management would improve the initial response to disasters in order to better assist victims. When there are opportunities to train and exercise together, a relationship of trust and respect can result in an improved and better coordinated response when disaster strikes.

Unexpected Outcomes

Many unexpected outcomes came about from the response to Hurricane Katrina. In addition to the deployment of multiple aging-network professionals to impacted states for the purpose of effectively assisting with local response efforts, the mass migration of evacuees to nearby states created new challenges for hosting states.

Not since the attack on the World Trade Center in New York City had the will and strength of a nation been tested like it was during Hurricane Katrina. Evacuee movement affected all 50 states, especially the State of Texas. Many cities in Texas were forced to quickly become hosts to thousands of evacuees seeking short and long-term emergency accommodations. The city of Houston was provided only hours of advance notice prior to the arrival of the first wave of evacuees out of the now infamous Superdome. Hour by hour, the heroic leadership exhibited by local and state government organizations, supported by a wide and diverse assembly of faith-based organizations, volunteer organizations and other non-governmental groups, led to the successful sheltering and care of thousands of displaced hurricane victims under an extreme set of circumstances.

As evacuees streamed into Texas from Mississippi and Louisiana, it was almost as if the
United States suddenly had 48 rather than 50 states. Such a sudden and dramatic shift can certainly create problems and challenges. If the circumstances in the Superdome were chaotic, which they were, the movement of that population to the Houston Astrodome created a sudden and immense responsibility. Hour by hour, that city got better and better at meeting a set of needs that no other city in the U.S. had ever faced. It met those short-term challenges head-on. Today, more than a year and a half after the events, Houston and many other communities across America struggle with the long-term responsibility of caring for evacuees who have chosen not to ever return to their distant and damaged or destroyed homes. This has placed even greater pressure on social service networks that are not funded or structured to support this ongoing burden.

Contributions of Seniors

There are many examples of contributions by older persons in disasters, both as formal disaster-response and -recovery volunteers, and as neighbours, friends and family residing in the impacted communities. In this disaster, as in others, FEMA relied heavily on the use of trained reservists in virtually all aspects of response activities; over half of those reservists are retirees. Through coordinated volunteer efforts involving local area agencies on aging, many seniors provided various services to disaster victims of all ages. In other cases, they assisted vulnerable or frail neighbours, friends and family by being trained members of “community emergency response teams.”

This concept of trained community response teams has evolved from lessons learned from previous disasters, including the multiple hurricanes that have impacted the United States in the past few decades. Federal and state emergency-management organizations have recognized this important resource and have developed and adopted formal training procedures for these individuals before, during and after a disaster.

Inclusion of Seniors in Planning – As Beneficiaries and as Contributors

Large-scale catastrophes, including acts of terrorism, hurricanes, floods, deep freezes, earthquakes, tsunamis, etc., have highlighted the need for better planning and response capabilities on the part of governments and non-governmental organizations to ensure that the needs of vulnerable populations during times of disasters are met. Each disaster has also provided the unique opportunity to learn and analyze what worked well, as well as what may have gone disastrously wrong. Whether it be the thousands of elders displaced during the recent hurricane seasons, or the threat of a pandemic outbreak worldwide, one universal fact remains: frail elders living in the community or in long-term-care settings are disproportionately affected by natural and/or manmade disasters and require unique and often heroic efforts to minimize the loss of life and to expedite the response and recovery process.

Progress is being made and efforts must continue in order for emergency management to work and plan with agencies charged with the care of elders. Ensuring that seniors are at the planning table will result in a better plan and produce a product that was developed with them rather than for them.

Policy Recommendations

• To facilitate the application of the lessons learned from recent disasters, planning and response authorities must modify or re-write the current policies in place.

• Aging networks must be funded at all levels to budget for the training necessary to support emergency activations and deployments into impacted regions.

• Work must continue with the development and utilization of a rapid needs assessment system to identify vulnerable disaster victims.

• A database of aging-network staff available for deployment and trained to respond should be created.

• Funding resources should be allocated to develop and distribute an “All Hazards Guide for Seniors” that would provide information to elders residing in the community before a disaster strikes.

• Funding mechanisms need to be enhanced in order to support all aspects of extended-sheltering operations, including funds to ensure storage services are readily available and accessible for elderly disaster victims who are required to evacuate.

• Guidelines for the temporary or long-term relocation of elder disaster victims need to be created by aging-network professionals in partnership with federal response agencies.

• This level of enhanced planning and coordination must result in making existing state and federal benefits more portable when evacuation between states in necessary.

• Finally, elders’ access to needed medications and medical supplies in times of disasters needs to be streamlined.

Conclusion

The facts and information set out in this paper support the belief that older adults need and require special consideration in times of disaster. The disproportionate suffering experienced by elders and the high death rate for this group in times of disasters have been documented and must be addressed and reduced. Response must be far better and faster than current standards. Additionally, seniors must be viewed as an underutilized resource rather than solely as a responsibility. Frail elders in harm’s way must be the first to be evacuated, only to be returned when the community has restored the capacity to support their level of independence. Quite simply, we must apply the lessons we have learned.

References

1 Gill, Kathy. Most Costly, Deadly Hurricanes on Record. About.com: U.S. Politics, August 30, 2005 [Retrieved February15, 2008]. Online: http://uspolitics.about.com/od/electionissues/a/2005_hurricane_3.htm

2 Louisiana Family Assistance Center. Reuniting the Families of Katrina and Rita. Louisiana Department of Health and Hospitals, August 30, 2006 [Retrieved February 15, 2008]. Online: www.dhh.louisiana.gov/offices/publications/pubs-303/Full%20Report.pdf

3 Young, Kathy. Katrina Wasn’t Really About Race. 2006. Boston Globe, Janaury 18, 2006 [Retrieved February 15, 2008]. Online: www.iht.com/articles/2006/01/18/opinion/edyoung.php

4 Florida Department of Elder Affairs. 2004 Hurricane Report. 2006.

5 Florida Department of Health. CDC Report. 2006.

6 U.S. Administration on Aging. Emergency Response Lessons Learned. 2005.

7 Ibid.

Michael Weston is typically described as the “spirit and conscience” of any organization that he has been a part of, and has been creating and directing programs across the expanse of Human Services for the past thirty years. His accomplishments have been varied and diverse. He has been responsible for piloting a statewide initiative to enhance the quality of care in Florida nursing homes by expanding community involvement. He has created and directed numerous community based initiatives, and is the former and founding Director of Disaster Planning and Operations for the state’s Department of Elder Affairs. He currently serves as a Disaster Consultant to the U S Administration on Aging and in that capacity has been tasked by the Department of Homeland Security as the Federal Coordinating Officer over many recent presidential declared disaster events. As President of Servision, Inc. he has invented, patented and is producing the WESTCOT, the only affordable completely portable folding hospital-type bed in the world. Other products include the Special Needs Picture Board which readily facilitates communication with victims in times of disaster. With a commitment to continuous product improvement the Servision line of products are already being utilized throughout the United States. Currently, marketing efforts for worldwide expansion are underway through trade partnerships. Evidence of Mr. Weston’s impact ranges from programs targeted to decrease infant mortality to the implementation of a National Demonstration Project, which dispatched and coordinated 24-hour emergency in-home services for the frail elderly at the onset of crisis. As Hurricane Andrew approached Miami-Dade County, Mr. Weston then Director of Clinical Services for the Channeling Project (the nation’s oldest and largest nursing home diversion project) activated and fully implemented their disaster plan over 72 hours before landfall occurred. Then, as the lead Red Cross volunteer at Dade County’s Emergency Operations Center he coordinated and broadcast what history recorded as the largest civilian evacuation ever undertaken at the time. Mr. Weston is recognized as one of the nation’s foremost experts on Special Needs populations. He has chaired the Disaster Services Committee for the American National Red Cross, has served on the Statewide Human Research Subject Review Board and has made numerous presentations at the national and international level. He holds a Master of Science Degree in Human Services and is constantly utilized as a consultant and educator.

George Tokesky has extensive policy, program management and fiscal management at local, state and national levels. Mr. Tokesky managed the Community Care Services Department for the largest Alzheimer’s service provider in Florida. He procured and managed grant-based and contracted programs, including the Family Nurse Consultant Program, 24-hour Crisis Response Service, special needs shelter operations and various community based programs and special projects. Mr. Tokesky was responsible for for the state Special Needs Shelter Program, including policy development, budgets and operations. He developed and supervised training and educational programs for emergency management officials. Mr. Tokesky led the State of Florida Special Needs Shelter Interagency Committee. He was a consultant to multiple county governments, State SpNS Interagency Committee and state, national and international emergency management officials, legislative groups, healthcare organizations and service providers. Mr. Tokesky served as lead project manager for the state’s Alternate Site Discharge Planning Resource Guide and other highly visible projects related to disaster planning, community outreach and education. He
acted as subject matter expert for the State Emergency Response Team, Emergency Support Function 8. Mr. Tokesky was the Emergency Coordinating Officer for the Florida Department of Elder Affairs. He deployed to impacted states as a member of the U.S. Administration on Aging Disaster Response Team to assist state units on aging and Area Agencies on Aging to develop and implement rapid response and recovery strategies. Mr. Tokesky developed “First-in-the-Nation,” rapid needs assessment system to assist federal agencies in prioritizing emergency housing and services for more than 8,000 elder disaster victims. He acted as a consultant to U.S. Administration on Aging regarding the agency’s Operational Influenza Pandemic Plan. He is a member of the International Steering Committee, World Forum on Aging in Disasters.
Mr. Tokesky earned his B.A. in Psychology from West Virginia University.