Evacuating the elderly poses set of challenges

Though nursing homes are required to have plans, effectiveness is not known.
LONG ISLAND NEWSDAY
They need walkers and wheelchairs and insulin and diapers. They need caretakers and blood pressure cuffs and oxygen tanks. Today's nursing home patient, older and more acutely ill than past generations, poses a unique set of issues for emergency rescue teams.
"It is an enormous problem, and I don't know how to resolve it," said Dr. Gisele Wolf-Klein, head of geriatric medicine at Long Island Jewish Medical Center, of the challenge of evacuating the elderly and frail in an emergency.
There are 35 million Americans over 65, and the numbers will grow as the Baby Boom generation ages. Dr. Wolf-Klein said there are no comprehensive national or local plans to ensure the safety of the elderly in a crisis.
Federal laws mandate that hospitals and nursing homes have general evacuation plans, but just how effective those individual plans are is not known.
"The nursing home industry needs to prepare for such disasters," Dr. Wolf-Klein said, adding that staffs receive training for fire safety, but bioterrorism and natural disasters have not been adequately addressed.
About 25 percent of people older than 65 have diabetes. Many require routine blood glucose monitoring and access to insulin. Many have some degree of heart disease. Hypertension is also high in the elderly, and a disaster could easily send blood pressure climbing.
Then there are the medicines. Experts estimate the average nursing home patient receives eight daily medications.
Acute illnesses
With more people living at home or in assisted living facilities, the face of the nursing home patient is changing. They are more acutely ill. Many are bedridden. Without proper hygiene, public health officials warn that patients and nursing home staff relocated to makeshift quarters are at high risk for disease.
Dementia is also a problem when considering how to evacuate elderly people, Dr. Wolf-Klein said. Half of the population older than 85 suffers from Alzheimer's, making it virtually impossible to know the needs of a patient in the midst of mass transport.
These patients may become agitated, paranoid and confused when taken out of their everyday settings. Falls are also a concern, the physician added.
There are no federal guidelines in place to help facilities decide what to do in a disaster situation.
"It is a difficult judgment call," said George Linial, president of the Texas Association of Homes and Services for the Aging. "Sometimes it is more damaging to move them than to let them stay."
He said administrators make evacuation decisions for their own facilities.
The hurricane tragedies in New Orleans will bring agencies back to the drawing board to rethink those plans, he added.