Disaster Planning in Residential Care Settings

1. Disaster Planning in Residential Care Settings Niurqui Imbert-Mariano Alzheimer's Association New York City Chapter http://www.alz.org/nyc/ 646.744.2920 Nmariano@alznyc.org

2. Dementia and Disasters People with dementia are particularly vulnerable to physical/emotional trauma related to the chaotic situations around disasters both large and small scale

3. Hurricane Katrina • Nearly half the deaths were of people aged 75 or older • 141 People are still registered as missing • 5,500 – 6,000 residents were displaced and evacuated as a result of Hurricane Katrina • First hurricane-related deaths occurred the day before Katrina struck when three residents died while being evacuated to Baton Rouge. • Majority of the bodies found after the storm were discovered near nursing homes or hospitals

4. Tornadoes • Every state is at some level of tornado risk • Approximately 910 tornadoes occur in the U.S. each year • Safety pre-cautions recommended during a tornado are difficult or impossible for the frail elderly.

5. Disaster Prone States

6. Fire Safety • 2300 nursing home fires are reported each year • 1 in 7 nursing homes will have a fire in the coming year • In the last 25 years at least 500 residents have died as a result of a nursing home fire. • Large kitchen and laundry operations put long-term care facilities at a greater risk for fires • Cognitive and physical impairments make evacuation difficult during a fire

7. Other Disasters May Include • Earthquake • Power Outage • Flood • Chemical Spill

8. Local Stats

9. Reactions may include: • Limited ability to understand what is happening or being communicated with them • Forget what they have been told • Decreased ability to negotiate new surroundings • Varied reactions

10. Catastrophic Reactions: Occurs when a situation overloads the mental ability of the person to react rationally. May result in exaggerated response such as striking out, yelling, making unreasonable accusations, or becoming agitated and emotional.

11. Be prepared for residents to… • Hide • Fight • Pacing • Refuse to leave • WANDER

12. Dementia and Wandering It is estimated that in the United States, at least one long term care facility resident will wander away and die each week if wandering behavior is not seriously addressed.

13. Dementia and Wandering Aimless or purposeful motor activity that causes a social problem such as getting lost, leaving a safe environment or intruding in inappropriate places. Wandering can occur on foot, in a car or on public transportation

14. Dementia and Wandering • Confusion • Inability to recognize familiar people, places or objects • Fear arising from misinterpretation of sights and sounds • Looking for an object

15. Wandering Behavior • 4-26% of nursing home patients wander • Up to 67% of community residing patients wander • If not located within 24 hours up to 50% risk serious injury or death

16. What we know about wandering • 95% of people are found within 1.5 miles • The majority of people wander on foot • When wandering in a car, will go until they get stopped or run out of gas • Cannot always prevent the triggers that may cause wandering

17. The Urban Wanderer • 25% fatality rate if not found within 24 hours. Rate higher in hot or cold, rainy climates • The majority of people are found in structures (35%) or along roads (36%) • 80% of those reported missing survive uninjured, 14% survive but are injured and 6% result in a fatality • Due to ease of travel along roads the distance that people wander grows: 25% found within .2 miles, 50% within .7 miles, 75% within 2 miles and 95% within 7.8 miles

18. Disasters: Working with the Individual • Respond to the emotion that the person is experiencing • Be patient • Be calm • Be thorough • Remember that each person is an individual and may react differently

19. Facility Wide Disaster Concerns Insufficient Plans Unclear responsibilities  Lack of resources  Unreliable transportation  Distracted Caregivers Unprepared or confused residents Additional crises during relocation

20. Recommendations • Within the facility: • Identify most vulnerable residents • Identify staff members with close relation to those residents • Identify words, objects, etc that bring comfort to each resident • Incorporate into disaster plan • Train staff on disaster plan

21. Recommendations • Work with local emergency response • Develop facility plan • Familiarity with facility • Assistance from trained professionals • Community registry?

22. Recommendations • In the event of an evacuation: • Work in conjunction with emergency responders • Remember that everyone MUST be accounted for • Remember to bring medications, medical papers, etc • May want to bring a pillow, photo or other familiar object • If the person is a MedicAlert + Safe Return member, notify the service regarding the events and the person’s whereabouts. • Be prepared to deal with wandering!

23. Recommendations • Other things to keep in mind: • Catastrophic reactions may require additional staff • Emergency receiving facility/respite • Transportation plans • Contacting families • Medical records

24. Case Study #1 • Ms. Jones • 84 y/o • Widowed • Raised 3 kids- 1 lives in area • Loves cooking and assisting with cleaning Facility fire alarms are going off- staff suspects that the fire began in the kitchen. Fire is contained but there is a lot of smoke and all residents must evacuate. When firefighters knock at Ms Jones door she thanks them for coming and is insistent that they help her change her lightbulb.

25. Case Study #2 • Garden Village of Valley Park • Assisted living facility • 15 residents in lower level dementia unit • Wide range of functional levels and levels of cognition. At 5:30 a.m. police come to facility and notify staff that all residents must be evacuated to to a chemical spill in the area. As detailed in your facilities emergency plan, a bus will be coming to transport residents to a nearby school for temporary shelter.

27. 1.800.272.3900 www.alz.org