You probably saw the headline: Six die in a Florida nursing home in the wake of Hurricane Irma. They won’t be the last frail elders to die needlessly.
Many frail seniors who were living on the edge are going to die in southeast Texas and Florida in the coming weeks. We will probably never know how many because most will die in their homes or in hospitals—one at a time. Unlike the attention-getting visibility of six deaths in one facility, these will be silent deaths, unnoticed by all except their families and friends.
Some deaths will be inevitable, of course. Frail elders die. But many deaths could be prevented. And because they were not, they are an indictment of how poorly we care for older adults—not only in the worst of times, but in the best.
Seniors will die
Seniors will die because we have no good emergency management system for caring for the frail elderly in the midst of natural disasters. But they will also die because we have no good system for caring for older adults even absent massive hurricanes such as Harvey and Irma.
Think of the millions of seniors who live alone, or perhaps with a spouse who is also impaired. Many are in homes where they have lived in for decades. Even in an emergency, they are reluctant to leave what they know, including family mementos and pets. They don’t know where they’d go. And, even if they do, they often have no way to get there.
Even in normal times, public transportation is useless for many seniors. They can’t get to a bus stop. And without special vehicles, they can’t get in and out of the bus. In a flood (or blizzard), public transportation often doesn’t run at all. Without a ride or even the ability to get out of their homes, many are trapped.
It is the same with communications. Social media has revolutionized emergency response in just a few years. People in Houston used their mobile phones to not only call for help but send GPS coordinates. But how will that work for frail elders?
What about caregivers?
The Federal Emergency Management Agency (FEMA) is not unaware of these challenges. It even has an Office of Disability Integration and Coordination. But, as we are seeing, we have a long way to go to get it right.
What about caregivers? In 2017, many adult children live far from their parents. But even those who are close faced enormous challenges during Harvey and Irma. Imagine trying to find a safe place for yourself, your kids, and spouse, while figuring out how to assist a frail parent who lives across town and does not want to leave her home.
Paid aides faced their own challenges. Many home health aides, who are paid scandalously low wages, were probably displaced themselves. I suspect many were living in shelters, caring for family members, and unable to work during Irma and Harvey. Others may not have been able to get through floodwaters to visit clients, lost access to crucial public transportation, or could not get gas for their cars.
Then there is the lack of access to critical goods and services. In a crisis, people run short of medicine and equipment such as oxygen tanks. No electricity means no air conditioning, no lights, and no power to operate life-sustaining equipment. Imagine being 85, with dementia, alone and in the dark.
The high-profile facility-based tragedies will get most of the attention. There were those who died in the Hollywood FL nursing home. And there was the viral photo of residents of a Dickinson, TX assisted living facility who sat in water up to their chests before they were rescued. And the Florida assisted living facility where residents went days without electricity because the power company did not list it as a priority customer.
And it is a good bet that once everything dries out, Congress will hold hearings. Outraged lawmakers will blast facility managers, utilities, or first responders for failing to protect seniors. And with good cause. But they’ll be missing a big part of the story—the risks to 80 percent of people who need long-term supports who live at home. And little will change.
What could we do to better care for frail older adults in the midst of disasters such as Irma and Harvey?
- Map at-risk seniors living at home. Use that information to better identify who will need help and plan how to get it to them.
- Create easy-to-use technology so seniors can request assistance.
- Make shelters accessible and comfortable for older adults. Shelters must now accommodate pets. How about seniors?
- Develop an emergency transportation system (including volunteers and community organizations) to get seniors to shelter.
- Focus government and utilities on the needs of residents of assisted living facilities and other senior communities. ALF residents are often as much at risk as patients in nursing facilities or even hospitals.
But these are all stop-gap measures. The real scandal is that our system of caring for frail elders barely functions when everything goes right. Add a family crisis and it easily falls apart. With a widespread natural disaster, it becomes a killer.