Issues Of Concern
for long term care facilities
Index:
- Authority of Order Evacuations
- Evaluation of Facilities for Survival of Storms for In-Place Sheltering
- Identification of Evacuation Destinations for Facilities Mandated to Evacuate
- Communication Issues During and After an Evacuation
- Transportation Issues Concerning Evacuation of Facilities
- Financial and Legal Issues Concerning Evacuation
1. Authority of Order Evacuations
Who can order an evacuation?
2007:
There are no updates for this item at this time.
2006:
Under current legislation, the top county official (judge) may order mandatory evacuations during a hurricane emergency. The task force appointed by the Governor to study the Rita evacuation has recommended that this power be taken away from the local officials and given to him to order evacuations. This will require a change in the law by the legislature, which may or may not be proposed in the upcoming school finance special session of the legislature. In the meantime, the Governor is said to be issuing an executive order to get as much control of the situation as possible.
Under this proposed model, the order would come from the Governor to the district “incident commander” who would relay information to their liaisons in each emergency management center. Presumably, information about local conditions would go up the chain in the same manner.
Recommendation: The task force should carefully follow the development of the new state structure and educate all facilities about who is authorized to give the order.
How is an evacuation order communicated to the facilities?
2007:
There are no updates for this item at this time.
2006:
This was an issue during Rita. Most facilities got their information about a mandated evacuation from the media, and apparently the information that they conveyed was either incorrect or incomplete in many cases.
There was also confusion among facilities when DADS and the Attorney General’s office began calling facilities and either asking them to leave or asking if they were leaving. DADS representatives last week told the HGAC that they were only calling for informational purposes, but some facility administrators say they took it as an order to leave.
Recommendations: The task force should insist that the local official who receives the order to evacuate an area communicate directly with the facilities affected. The local emergency management center should have a person specifically tasked to oversee special needs people, which includes “fixed facilities” such as nursing homes. Nursing homes should not be left to hear about an evacuation in the media.
Other state agencies need to coordinate with a central authority so that facilities are not getting inaccurate and/or conflicting messages from different state offices.
The timing of special needs evacuations is also something that requires further discussion with officials. It has always been the standard procedure for special needs persons to be urged to leave early before the general evacuation. HGAC discussed the idea of evacuating them last after everyone is gone and the path of the storm is better understood. There are significant issues with this plan.
How do facilities educate officials to the risks of evacuation vs. not evacuating?
What role can officials play in aiding facility evacuation?
2. Evaluation of Facilities for Survival of Storms for In-Place Sheltering
2007:
There are no updates for this item at this time.
2006:
Various methods of giving executive director of facilities comfort in making a decision about sheltering in place have been discussed by the task force group. The best way is to have the facility evaluated by a structural engineer to determine the wind load it could expect to withstand during a storm. Any facility that is danger of flooding from the storm surge must make plans to evacuate. Other facilities must consider fresh water flooding, wind tolerance, and the ability to air condition at least some part of their building for residents until power is restored or an orderly evacuation can be made after the storm passes.
A task force work group continues to refine this topic.
3. Identification of Evacuation Destinations for Facilities Mandated to Evacuate
2007:
No further progress can be reported in the development by officials of any mass care shelters. At the present time Red Cross shelters do not allow "co-location" of persons with special or medical needs. The Task Force continues to urge officials to designate large public buildings suitable to receive nursing homes and their staff. If these facilities could be identified within 50 - 100 miles from the surge zones, a multitude of difficulties would be eliminated. The shortage of buses to move residents would be eased because buses could make short multiple trips. Shorter periods of time spent by residents in buses in heat would greatly benefit their condition. In addition, officials could wait longer before deciding to move frail people.
2006:
In discussions with Steve Vaughn, DPS person in Austin assigned to special needs evacuation, the subject of suitable places to receive surge zone facilities that evacuate was discussed. It was pointed out to him that the state requires facilities to make a plan for a place to go, but sometimes that place is no longer available when the buses get there because it has been opened as a public shelter. He is willing to work with the task force to find facilities to receive nursing homes IF one has been unable to find a place on its own. The task force could help coordinate this.
Vaughn was unclear on the role of DADS in locating a place to evacuate to. It is the understanding of the task force that the state has a plan to help find vacant beds for the long term, but not to relocate whole facilities. This was confirmed with the Region 06 DADS office. In case of a permanent relocation ( if a nursing facility is destroyed), they can help locate vacant beds across the state to transfer residents. The task force will need to work with Vaughn and surge zone facilities to find evacuation host places.
4. Communication Issues During and After an Evacuation
2007:
There are no updates for this item at this time.
2006:
Cell phones and land lines are often overloaded during an evacuation and after a storm may be out for sometime, depending upon the damage to cell towers and other
infrastructure. Satellite phones may be useful, but are expensive. Emergency management centers use amateur radio operators to communicate with each other and state agencies if the infrastructure is damaged. Nursing home facilities could also locate radio operator volunteers and use this method.
5. Transportation Issues Concerning Evacuation of Facilities
2007:
Senior Care Providers trying to renew their 2006 bus agreements with Coach USA in 2007 received a letter from the bus company saying that they had become the prime contractor for the State of Texas, and during hurricane evacuations they would be assigned by the State for moving people who live in the community. Coach USA suggested the nursing facilities could "register" with them and might get buses if they evacuate 96 hours before landfall, if buses were available at the time. Many facilities hesitate to evacuate that early because the location of the hurricane landfall at that point is highly uncertain, and moving frail elderly persons unnecessarily is very likely to have negative effects on their health. The Texas Building and Procurement Commission who contracted with Coach USA has suggested that facilities locate other bus companies, but few have been able to get any kind of firm commitment from other companies. The Task Force has been in constant communication with DADS about the concerns over bus availability.
2006:
The state of Texas will be letting a contract on April 28th for 1000 buses for use along the Gulf Coast. Of those buses, 100 have been designated for the Houston area. These buses, according to the Houston/Galveston Area Council of Governments at a meeting on 3/15, will be to evacuate the home-bound, elderly, and disabled in the community. “Fixed facilities,” such as nursing homes and assisted living facilities, have to make their own arrangements for buses if they are within the storm surge zone and have their own evacuation plan. Bus contracts for nursing homes will be protected according to Steve Vaughn, the person at the DPS who is assigned to special needs evacuation, IF the facility is within the surge zone. Contracts for those outside of the surge zone may not be protected. The method the state will use to protect these contract has not been communicated with the task force.
All emergency facility plans should be submitted to the local OEM and discussed with the local person in charge of nursing home evacuation. That is the only possible way that the OEM can help a facility if a serious crisis happens during an evacuation.
In a discussion with officials of Coach USA last week, the assignment of their 120 buses in the Houston area was discussed. They said that it would be first come-first served as to those with contracts with them. They would be requiring a credit card or payment when the buses were dispatched, since they are still owed money by some nursing homes from the Rita evacuation. Their suggestion was to leave as early as possible while buses were still available, because when the evacuation is announced, those buses will take residents out but will not be able to return to the Houston area due to the contra flow plan. They will send buses to wait at a facility to see if an evacuation in needed, but they will charge for that time.
(note: as of 4/10/06 Coach USA was not taking any new contracts)
Steve Vaughn of the state DPS emergency management group emailed this information in reply to the question about how the state planned to protect nursing home bus contracts:
The action we are taking to protect institutions that have bus contracts is:
Our contract requires that the company signing with us not double book. If an institution does not have a contract in place before our bid is let there is nothing we can do. If a bus company “double books” they will be in violation of our contract. We will have remedies for those who violate the provisions of our contract. We have no control on the leasing contracts between institutions and bus companies or provisions on how they will be paid.
6. Financial and Legal Issues Concerning Evacuation
2007:
There are no updates for this item at this time.
2006:
The task force, at this time, has not looked extensively into this topic, as more urgent issues have been discussed.