We had barely recuperated from Hurricane Katrina when we received phone calls from the City of Austin Emergency Management Center about the need to open a special needs shelter for Hurricane Rita evacuees. Nursing homes and homebound elderly individuals from across eastern and coastal areas of Texas were being evacuated by the state and moved to various cities.
For Hurricane Katrina, the need to identify evacuees who would need more attention was almost an afterthought Although Austin responded admirably, the City of Austin Emergency Management Division had not had experience with mass shelters for thousands of evacuees.
The shelter was located in the Austin Convention Center, a large cavernous building, whose sections were removed to provide space for 5,000 cots and inflatable mattresses. In theory, it is a great idea to provide safety and temporary housing this way. However, in reality, the bathrooms were almost half a block away and there were no showers. A make-shift shower was built outside the Convention Center, but it was difficult to use for those with mobility problems, those who were frail, and women, unless they were in groups.
In the Convention Center, the frail elderly individuals were mixed with older children who ran and played in between cots, parents with babies, and groups of men I often would conduct " cot" rounds. Many told me that they left behind their cardiac, diabetic, inhalers, blood pressure, asthma, anti-psychotic, and/or anti-depressant medications. Pharmacies were destroyed, their providers also evacuated. Most could not name their medications, nor did they know dosages. Each evacuee had to be evaluated individually and new orders were written.
One 80-year-old woman had insulin syringes all over her cot and in her bag. She was tired, slighdy confused, thirsty and could not see to give herself her own insulin because of the lighting in the Convention Center. Usually her granddaughter administered her insulin, but she was put on a different plane and ended up somewhere in Dallas. However, most of the time, families tried to stay together and would watch over each other. I was impressed with grandchildren who would not leave their grandparents until they were assured that some of my nursing students would stay with their grandparents so they could take showers. I was impressed by how healthy the older adults were. They were frail, but they were part of a family and whole family cared for each other.
I felt some were suffering in silence and could be easily overlooked. Depression or not wanting to complain could hamper their ability to care for themselves and get needed resources. It was obvious that a special section was needed. Special needs shelters provide medical care to individuals with physical or mental disabilities or serious medical conditions that require observation, assessment, or maintenance. A shelter is designed to provide a safe environment It is not a hospital, nor is it a nursing home because shelters staffed with volunteers and supplies and equipment are not readily available.
The woman with the syringes in her purse was one of the first relocated to the special needs section. Others included a man who had not eaten for 2 days. He had an old stroke and no one around him knew that he hadn't eatea What they did report was that he was incontinent Another evacuee brought his own nebulizer and would request treatment in between smoking his cigarettes. One father stayed with his son who had Down's syndrome and a tracheostomy.
Houston, TX, 9/3/2005 - Many seniors from New Orleans were evacuated to the Houston Astrodome following Hurricane Katrina. FEMA photo/Andrea Booher
By the third night, many of the frail elderly individuals and their families were placed in motels. Those who could not be placed in a nursing facility or did not have family members to care for them, stayed. It was difficult to find qualified staffing of nurses, aides, and physicians. There was no privacy, including when using bedside commodes.
By the time Austin was recovering from the onslaught of Katrina evacuees and had successfully placed them in more appropriate quarters, volunteers were being asked to return to help staff for Rita evacuees. Whereas many Katrina evacuees had very little with them, many Rita evacuees had time to pack suitcases and were told to include their medications and special equipment such as wheelchairs and walkers.
On the first night with the Rita evacuees, I met 57 tired and hungry evacuees who were triaged as having physical or mental disabilities or serious medical conditions that were not serious enough to require hospitalization. Among the 57, the most memorable were 3 middle-aged women whose average weight was 450 to 500 pounds each. We had no special beds and no lifts, and they stayed in their wheelchairs all night Another memorable group was 3 individuals who were older than 100. 1 usually try to meet each individual and make my own assessment My experience moved me to see who I thought would need the most help. On this first night, I found them alert, oriented, and continent They were medically stable, but in circumstances like a shelter, extraordinary conditions often stress individuals.
Ms. B was in her cot, which was too low and too creaky, but that was all we had. Her voice was gravelly, possibly from old strokes, but understandable. She smiled at me and proudly announced to me, when asked, that she was 104 years old. She wanted me to meet her younger brother at the next cot - he was 100! With minimal assistance, they were able to get up from the cots themselves and transfer to wheelchair and then to commode. Before evacuation, they were living independendy in their own house with help from neighbors and home health.
The next centurion, Ms. G, 101 years of age, provided a good history and a wry sense of humor. She corrected me when I happened to mention that she was from Wheeler, Texas ("No, I am from Warren, Texas! "). Warren is a rural town in east Texas. It appeared that the whole town was placed in several buses and transported to Austin. On a normal day, the whole town knew each other and helped each other. That is one of the reasons why older adults have been able to remain in their homes. The social support was built from years of living and surviving.
The next night, we had 157 individuals admitted to our special needs area-medical unit in the Convention Center. In another section of the Convention Center was space for approximately 250 patients evacuated from a flooded psychiatric hospital. In another section was space for 190 evacuees from two nursing facilities. The nursing facilities sent their staff with their residents, so there was a lot of help. We needed to augment the staffing for the psychiatric patients.
In our medical unit, we had older adults who had angina, congestive heart failure, asthma, emphysema, diabetes, incontinence, old strokes, seizures, limited mobility and paralysis, and a couple requiring dialysis. We tried to admit only those who were stable, but we could not tell who would remain stable in the hours to come. We were also not sure if the evacuees could accurately tell us their history, specifically infectious diseases such as tuberculosis, hepatitis A, or HIV. We told those evacuees with strokes that they needed to have their equipment and a caregiver with them. We did not perform any intravenous therapy or suctioning.
I saw Mrs. G. again, in the medical unit, but this time she was not as conversant She was confused and combative. I attributed this to dehydration and she probably had the beginning of a urinary tract infection Unless offered, she would not ask for anything to eat or drink. It would take astute assessment and knowledge of normal and abnormal aging changes to make good decisions. Mosdy individuals did not complain, and were grateful when offers of food and water came around. When there are so many needy individuals, sometimes some are missed, especially when they are weak and quiet.
SPECIAL NEEDS SHELTER PLANS FOR THE FUTURE
In making evacuation plans, individuals requiring special care need to plan to determine whether a temporary admission to a hospital is necessary. If not, they should evacuate with certain equipment (e.g., wheelchairs, canes, walkers) and medications (at least a 7-day supply). A special needs shelter is not a hospital, nor an assisted living facility, and should be seen as a last resort It will be established only to provide a safe environment for those needing special assistance or surveillance because of pre-existing health problems. When a nursing facility is to be evacuated, the best solution is for families to pick up their elderly family member and be responsible for them.
Before Hurricane Katrina, planning for special needs shelters was not taken seriously. Hurricanes Katrina and Rita showed that scores of elderly individuals needed extra help because their homes were damaged or without electrical power. Some of the elderly adults have been placed in assisted living or nursing facilities far from their homes. There is a definite need to have formal policies and include "emergency response teams " specifically to help local governments with shelters, and especially in relocating the elderly. Gerontological nurses, especially advance practice nurses in gerontology, can help significandy, not only in planning but also in responding.