Chances are, your aging parents have probably experienced more than one disaster in their lifetime. This kind of experience can be a real asset during a disaster. Having an actual, real-world frame of reference and life experience and the ability to call upon their prior know-how, wisdom and mental resilience to survive, can help them care for others around them, and provide reassurance to those who are panicked, frightened or depressed by the events.
But certain aspects of the aging process can make older adults particularly vulnerable during a disaster— especially if they have one or more chronic illnesses, functional limitations, or dementia. As a practicing gerontologist, working with the homebound elderly for over 30 years, I’ve experienced— first hand— the types of unforeseen problems that arise when disaster strikes a community and their elderly.
Despite urging by disaster preparedness experts, very few people and families have planned for a disaster or stocked supplies they might need during a natural disaster, national crisis, public emergency or severe weather emergency. For evidence, all one has to do is watch the last minute hordes rushing to clear off the shelves at the local grocery store at the threat of a snow storm. And the sad fact is, most elderly are even less prepared.
Some government surveys say as few as about 45 percent of Americans say they have taken any steps to prepare for an emergency. But the Disaster experts I’ve consulted with, in preparing this article, suspect that of those who THINK they are prepared, only a scant fraction actually are.
Having dealt with Superstorm Sandy and its aftermath, when it devastated the community I practice in, I can attest to the suspicions of the preparedness experts. Even with a five day advance warning of the storm, there was an almost total collapse of the area preparedness plans that sent shock waves through area hospitals, nursing homes, home care agencies and hospices, and retirement communities, during the storm and for many months afterward. We learned a lot about what can and does go sideways during that time, and I’d like to share some of the lessons learned with you, so you might be better prepared when the need arises.
I’ve sifted through a mountain of information and consulted with a number of noted preparedness experts, to compile a short list of simple ways to help you and your aging parents plan for a potential disaster.
Most of the boxes on the checklist are real easy to tick off. Most items on the preparedness list can be had for under ten-bucks and only take a few minutes to get online. The good news is, once you’re done, you and your aging parents will be more at ease, knowing that you have done everything you can do.
There’s an old Italian saying: Quando porti un ombrello, non piove, “When you bring an umbrella, it will not rain.” So take the short amount of time to prepare and then relax and get on with life.
WHY ARE OLDER ADULTS MORE VULNERABLE?
Our aging parents are more vulnerable during a disaster because they are more likely to have impaired physical mobility, diminished sensory awareness, chronic health conditions, or socioeconomic limitations, that interfere with their ability to prepare for, respond and adapt to the rapidly changing conditions that are inherent in times of social crisis.
More than half of older adults have some kind of functional limitation, according to the Centers for Disease Control and Prevention (CDC). A Harris poll estimates, over13 million people aged 50 and older, would need help evacuating during a disaster, and over half of these people would need help from someone outside the household.
Older persons, who are hard of hearing or cognitively impaired, might have trouble understanding information or following directions. They might feel more easily overwhelmed by a disaster, especially if they also have difficulty moving around, standing in line, or sleeping on a low cot in a noisy shelter.
Those who rely on wheelchairs, canes, or walkers can’t climb stairs, if elevators stop working due to a power outage. Aging parents who no longer drive or do not own a car will likely face additional difficulties evacuating.
Older adults are also more prone to ill effects from extreme temperature, especially if local electric utility or gas distribution services are disrupted for an extended period of time.
Seniors living by themselves might not have a support system and many lack sufficient income or other resources to help cope with the after-effects of a disaster.
Thanks to advances in portable medical equipment and advances in Home Health Care technology, many seriously ill people continue to live in their own homes with support from caregivers and professionals. These people need a well- thought-out emergency plan to accommodate medical devices and medications.
Frail older adults, with certain chronic diseases or disabilities, require assistance to survive and recover from a disaster, especially if they are dependent on caregivers for assistance with their daily activities. Exposure to conditions associated with many disasters — such as lack of safe food and water, extreme heat or cold, stress, or exposure to infection — can aggravate chronic conditions that are common to older adults.
Furthermore, adverse events can and do cause an interruption in vital medical services—such as pharmacy, visiting nurses and medical care. Even emergency personnel, who will likely be overburdened with rescue efforts, may be unable to respond to an elder in need.
Pharmacies may be closed or quickly run out of certain essential medications for chronic diseases, such as insulin or blood thinners during an emergency.
During Hurricane Sandy in 2012, hospitals in the area of my practice were overrun with patients suffering serious injuries sustained by the storm and evacuation, and for weeks following the aftermath, they saw huge spikes in heart attacks, strokes, and blood clots in the lung, as well as people with diabetic emergencies, as a result of the lack of available blood thinners, insulin and certain other essential medications. People on dialysis and those on chemotherapy were also adversely affected.
If people who are evacuated do not have the medications, that have kept their heart disease, diabetes, or breathing problem stable, in three days, many of them could have life-threatening medical emergencies.
These alone are all good reasons for older adults, their families, and their caregivers to take a few simple steps to prepare for an emergency.
Note: although we are specifically identifying the needs of your aging parents here in this article, these preparedness measures—with a tweak here and there— are universal, so they are just as applicable for a kid in college, and for you as well.
HOW TO PLAN FOR A DISASTER
The first areas to consider are the basics of sustaining life: food, water, critical medications, and appropriate clothing.
Your aging parents should stock supplies now, so they have ready-to-eat food, water, and batteries for flashlights and radios during an emergency. They should also have an evacuation plan, a backup plan for when things go sideways and know in advance what to do with their pets.
In addition to a basic emergency supply kit, our aging parents need a personalized emergency plan, listing where they can go in an emergency, what they should bring with them (such as medications, eyeglasses, hearing aids and extra batteries, oxygen, or assistive technologies), how they will get there, and who they should call for help.
Those who use a communication, assistive, or mobility device need also to consider, how they will go about transporting this device with them if they need to evacuate. Similarly, if appropriate, the plan should include any food or supplies needed by a service animal.
Your parents should keep a list of their medications, doctors, and pharmacies in a waterproof bag. And, yes, it’s a good idea to also have a photo of that list stored somewhere in the cloud. But remember, it’s quite possible that there will be no Internet or mobile service available, at the time when you might need the information—so “old school” is still the best information management option. Experts also recommend including a photocopy of doctors’ prescriptions, to make it easier to get refills in another location. Your parents should also keep a backup list of emergency information, including contacts, medications, medical devices (including style and serial number), and doctors, in another location such as at a friend’s home.
People with pets should arrange to take them along during an evacuation or leave them in a safe place. Most shelters do not allow pets due to health, safety, and noise concerns. FEMA recommends that pet owners contact a local animal shelter or talk to a veterinarian to learn about emergency options for pets. But do it ahead of time. If you’re like me, you’ll want to take your pet with you in case of an evacuation, so you’ll need to find hotels that are pet friendly along your evacuation route. Websites like: Go Pet Friendly https://www.gopetfriendly.com/ , Pets Welcome www.petswelcome.com/ , and Bring Fido https://www.bringfido.com/ are a few good place to start your search.
YOU ARE YOUR OWN FIRST RESPONDER
Don’t rely solely on first responders and government agencies to help during and after a disaster. In a wide scale emergency, those systems—regardless of how well intentioned—often break down. So it’s all about personal responsibility. Like I tell my clients… Ultimately, you must be prepared to be your own first responder.
PIn the initial stages of a disaster, especially a powerful hurricane or other wide-scale event, people are typically on their own, at least for awhile. It takes time for emergency responders to organize and reach the scene of a disaster, even under the best circumstances.
Having lived through a direct hit of Hurricane Sandy, I learned a few lessons I could not have learned any other way. Virtually every system broke down.
Local hospices and many homecare agencies “lost” patients when they were evacuated by authorities, and since all communication lines were down, administrators and visiting nurses were left frantically searching amid the confusion.
Police departments, firehouses and ambulances were under water. Cell phone towers had blown down, and because critical power transformers were under water, those that did remain could not get power to them.
Fallen trees and storm debris blocked evacuation routes—preventing outside help from getting through. Intersections to major arteries were blocked off by local, county and state officials for weeks following the storm—which made getting around town a real challenge.
In an attempt to rescue residents of the barrier islands, when the tidal surge brought 8-foot seas into the town center, National Guard heavy equipment crushed the pre-World-War II water and sewer lines buried shallowly beneath the flooded streets, as they rolled over them. The result was an instant public health emergency, as raw sewage poured into the public water system. Plus, without functioning pumps, at the local sewer treatment stations, to keep the negative pressures in check, raw sewage backed up through toilets and flowed freely into area homes.
Many of those who thought they could tough out the storm, ended up stranded for weeks—without food, water, working toilets, medications or help—when their only evacuation routes were cut off by floodwaters, fallen trees, downed utility poles and exploding underground gas lines.
My colleagues in New Orleans, Houston and Florida tell me the same kind of horror stories.
So, with Murphy’s Law planted firmly in mind— when planning for disaster, you and your parents should assume that nothing works the way it should.
WHAT TO DO WHEN PLAN ‘B’ GOES TO HELL
Your parents might not be able to reach their doctors or pharmacies, receive home-delivered meals, or obtain their usual home health services during the initial days of a severe disaster, and possibly for some time after. Make a plan, and then a backup plan for when the first plan fails.
To keep planning from seeming overwhelming, experts recommend focusing on preparing for disasters that are most likely to occur in your area.
For example, if your parents are living in Florida they need to know how to prepare for a hurricane, while those with parents living in the Midwest and mountain states, should stock up for blizzards and floods. In California, people should prepare for earthquakes and wildfires, while those living near a chemical or nuclear plant or along a highway where hazardous materials are frequently transported, need to prepare for disasters in these settings. Those who live in or near major cities, should also keep plastic sheeting and duct tape, to seal out toxins from a dirty bomb or chemical attack.
Although the basic emergency items (such as food, water, and medicine) needed to prepare for most disasters are similar, certain situations require different responses.
For instance, older adults should know that responding to a toxic chemical attack would mean they have to move to a high floor to avoid gases that sink to the ground. On the other hand, they should be prepared to go to a centrally located room (preferably without windows or exterior doors) or a basement during a radiation emergency.
Rain gear and something warm is a must in almost every climate—even in subtropical Florida. There are more deaths as a result of hypothermia than from heat. In the winter, extra blankets are a must—a good alternative that can fit into a pocket or purse are those Mylar reflective blankets. They’re really compact and inexpensive enough (you can get them for under a buck), so get a whole bunch and keep them in your car, purse and prep kit.
In areas prone to extreme weather shifts—like the desert states—it’s important to pack extra clothing that can handle the swing in temperatures. And socks. One cannot have enough pairs of clean, dry socks.
Since emergency officials will typically notify people about what they should do in each of these events, it is crucial to include a battery-powered or hand-crank radio, in any disaster-preparedness kit. A hand crank radio is an essential piece of preparedness equipment, regardless of where you or your parents live. I found this one on Amazon for under $17 and it also has a cell phone charger and flashlight.
Many localities also have websites and brochures telling older adults and people with special needs how to prepare for an emergency. If your aging parent cannot complete all the preparation steps required — such as carrying a gallon bottle of water into the house — and you are at a distance, ask a friend or neighbor close to your parent to help them. Depending where your parents live, there may also be local volunteer groups able to assist with preparation. A good place to inquire is the area agency on aging for their county.
In particular, those with cognitive, mental, or physical disabilities are likely to need assistance from caregivers or others to take the necessary steps.
The U.S. Administration on Aging (AoA) says that, “although the exact nature of the emergency cannot be predicted, there are preparations that apply to almost any kind of disaster.”
AoA suggests that older adults and their families:
- develop a family communication plan so that the whereabouts and well-being of every family member is reported to a key person(s) during a disaster;
- plan how to keep informed of developments in the disaster situation by telephone, cell phone, computer, radio, television, or newspaper;
- identify a meeting place away from home that is reasonably familiar and convenient for all family members;
- maintain a supply of personal, health, and home supplies, including a two-week supply of prescription medications, enough ready-to-eat food and water to last three days, first-aid supplies, candles and matches or flashlights, a waterproof container for essential documents, and items needed by older adults and persons with disabilities; and
- prepare a to-go kit that is ready in case of quick departure and includes a flashlight, extra batteries, a battery-operated radio, a first-aid kit, contact lenses or eyeglasses, medications, copies of prescriptions, photo identification, copies of essential documents (birth certificate, marriage certificate, Social Security card, and Medicare, Medicaid and other insurance cards), and a small amount of cash (a maximum of $50).
- Because southern coastal communities are so prone to hurricanes, its recommends that older adults living in those areas pack a 30-day supply of medication and a two-week supply of special diet foods or supplements when a hurricane is expected. When a hurricane is approaching, many coastal states, such as Florida waive restrictions on obtaining more than a month’s worth of medicine at one time.
LONG TERM CARE FACILITIES
If your aging parent is in a nursing home, assisted living facility, or retirement community you should inquire about the facility’s disaster planning.
Questions to ask include:
What emergency plans are in place?
How does the facility define an emergency?
Are sufficient supplies and generators available?
When will an evacuation occur? How will it be carried out?
Who will notify me if my parent has been evacuated?
The National Citizens’ Coalition for Nursing Home Reform, an advocacy organization for nursing home residents, has published Emergency Preparedness: Questions Consumers Should Ask. The document—available as a PDF—lists additional questions to ask about a facility’s emergency plans.
Retirement communities, nursing homes, assisted living facilities, and other facilities for older adults should practice responding to an emergency and ensure that all residents know what to do in a disaster. If your parents’ facility or community does not have an emergency plan, maybe it’s time to start the ball rolling.
WHAT HAPPENS DURING A DISASTER?
Given there is some type of advance warning, the media and government agencies are usually able to warn residents in advance of certain kinds of disasters, such as hurricanes and ice storms.
To alert residents, some local governments provide email or cell phone messages or use a “reverse 9-1-1” system that automatically dials potentially impacted households, to notify them of a situation, such as flooding.
A service company known as Nixle allows government agencies to send messages to local residents via phone, email and web. Information is delivered almost instantly. Nixle serves government agencies and organizations in all 50 states. By June 1, 2017 over 8,100 government agencies and over 3,000,000 subscribers were registered to use the Nixle location based service. You can check here to see if they currently serve your community.
In places that are not served by reverse 9-1-1 or Nixle, residents must rely on television or radio news for updates on local disasters. Emergency officials tell people, through the news media, how to prepare for or respond to an event and whether it is best to “shelter in place” in their homes, go to a nearby shelter in a community center or other protected area, or evacuate the area.
You should urge your aging parents to listen to these instructions and follow the advice. Some older adults are naturally reluctant to leave possessions accumulated over a lifetime and go to a strange place. But, the danger of ignoring an evacuation order is too great.
We saw the devastating results for the elderly in Hurricane Rita and Katrina’s destruction of numerous Gulf Coast communities in 2005, Sandy in 2012, and more recently in Houston, Florida and South Carolina with Harvey and Irma. In each of these cases, more than 70 percent of those who died were elderly who refused to evacuate.
THE FIRST 72 HOURS
In the immediate hours and days after a disaster, emergency responders focus first on saving lives, evacuating people from dangerous areas, and ensuring that they have food, shelter, and water.
Understanding the chain of command will help an older adult feel less anxious. Local responders generally carry out these activities with assistance as necessary from state resources. Only in the case of a severe disaster does the state ask the federal government to step in and assist. Local responders are usually more effective than state or federal responders, in an emergency, because they know the area, the people, and the available services. They have been trained to take the best course of action to protect a community.
In a typical disaster, people return home and resume their regular lives as quickly as possible. But as we saw with the terrorist attacks of September 11, 2001, and huge, destructive hurricanes (1) not all disasters are over in a few days or weeks and (2) people with pre-existing chronic health conditions are vulnerable to adverse effects, if they do not receive their usual medical treatment during the disaster recovery phase.
WHAT YOU NEED TO KNOW ABOUT SHELTERS
Most people who cannot leave an area, prior to a disaster, go to a designated community shelter, usually operated by the American Red Cross or a community organization. These shelters are opened when a disaster affects a large number of people or is expected to last several days. In addition to basic shelter, these facilities offer meals, water, personal hygiene items, first aid, and information.
People who go to a shelter must bring their own bedding, medications, and other special-need items. Pets are not allowed in shelters. These are two very important considerations for your aging parents emergency plan.
Additionally, here are some other considerations specific to the elderly:
- Many older adults are overwhelmed by the crowding, noise, and lack of privacy in a general shelter.
- Older adults with arthritis might find it difficult to sleep on a cot or floor mattress.
- People with dementia may become agitated during a crisis, especially if they must leave their usual environment.
- Older adults, with chronic conditions, face health risks if they cannot obtain their medications, special diets, or needed medical assistance while in the shelter.
- Few localities have shelters just for older adults. However, some gerontologists—myself included— and preparedness specialists, recommend that communities should consider providing shelter for older adults in a familiar place, such as a local senior center. Does Yours?
Special Needs Shelters
Most states set up Special Needs Shelters, for medically dependent residents, in advance of an anticipated disaster, such as a hurricane. These shelters should be considered a last resort for people who cannot travel to friends or relatives outside the disaster area.
Special Needs Shelters are designed for very ill people who need medical assistance and have nowhere else to go. Evacuees at a Special Needs Shelter might have had a stroke, use a wheelchair, or require special medical equipment, such as intravenous devices, gastric tubes, or indwelling catheters.
People who go to Special Needs Shelters must bring their own medications, medical devices, bedding, and food, as well as a caregiver.
These shelters are generally in a school or other public building and are likely to offer few accessible bathrooms, no shower facilities, and no privacy.
Many of these shelters require people to register in advance. Some provide transportation to the shelter, but most do not.
Special Needs Shelters are typically staffed by medical personnel, social workers, and administrative staff.
Public health specialists are supposed to inspect the shelter to ensure that no communicable diseases or unsanitary conditions are present, but remember… they are going to have their hands full. So, don’t count on the system working according to plan.
Some states, such as Florida, have a discharge-planning program to ensure that Special Needs Shelter residents have a safe place to go to when they leave the shelter.
Long-term care facilities try to keep residents safe within the facility, whenever possible. Evacuation can exacerbate many health conditions for very frail people. During emergencies, the staff should be trained to pay special attention to people with disabilities or cognitive impairment.
Most are good about this. But as we saw in Florida and New Orleans, there are those who tragically abandon their patients. Remember, disasters affect everyone—including healthcare workers and their families. Many simply are unable to get to the facility, leaving those there, to cope with the limited resources and critical, rapidly changing conditions.
Generally, arrangements are made with other nursing homes to relocate residents, along with their medications, medical records, and wheelchairs. The facility should have plans to transport residents if necessary. But it is your responsibility, as the child of an aging parent, to care for your parent, and get them to safety.
Your parents facility should, at the very minimum, have an evacuation plan in place, to safeguard that they have adequate provisions and staff available during emergencies to ensure:
residents take their medications with them if they evacuate,
a central information source exists so families can find residents,
personal belongings are protected,
beds are available and transportation needs are met.
PLANNING FOR THE AFTERMATH– POST-DISASTER RECOVERY
Following a disaster, older adults can turn to aging services providers for assistance. The aging services network — which includes state and area agencies on aging, local service organizations, and Indian tribes and Native Alaskan organizations — helps restore meals, transportation, and other services as quickly as possible. These agencies can also help connect older adults to other services they may need, such as FEMA funds, housing or food stamps.
In many areas, an area agency on aging, senior center, or other facility that is familiar with a client, tries to locate the older adult to verify his or her condition. In Florida, which is considered a model state for disaster planning, the Department of Elder Affairs checks with local area agencies on aging, to determine whether they have checked on their clients and if they are able to meet those clients’ needs.
Although many areas offer food, water, and ice after an emergency, in a shopping center parking lot somewhere in a town, Florida goes one step further for its older adults. It sets up special food and water distribution centers in retirement communities. That way, the older adults do not have to stand in long lines, exposed to heat, cold, or unhealthy conditions. Emergency workers deliver supplies to homebound elders.
Medications in An Emergency
Interruptions in taking certain medications can exacerbate underlying chronic illnesses. For example, older adults who stop taking psychotropic and similar drugs, may experience behavioral changes and people with dementia, who do not take their medications, are likely to experience additional confusion and fear. Professionals trained to work with older adults should watch for confusion, that may result from withdrawal from medication, as well as dehydration, depression, relocation stress or injury.
Recovering from a disaster can be as difficult for an older adult, as surviving the disaster itself. This is especially true if the person has lost a home or possessions.
For a short period of time, most disaster victims will share the same emotions: disbelief, anxiety, depression, withdrawal, fear of darkness, and trouble sleeping. Older adults may be more sensitive to these feelings.
Here are a few things to keep in mind:
No one who experiences a disaster is untouched by it.
It is normal to feel anxious about your safety and that of your family.
Profound sadness, grief and anger are normal reactions to an abnormal event.
We each have different needs and ways of coping.
Encourage your aging parents to talk about their feelings — anger, sorrow, and other emotions — even though it might be difficult.
Maintain a normal household and daily routine, limiting demanding responsibilities for them.
Encourage your parents to Spend time with family and friends.
Participate in memorials, rituals, and use of symbols as a way to express feelings, and use existing support groups of family, friends, and religious institutions. Feeling that you can do something is very comforting.
DISASTER PREPAREDNESS RESOURCES
FOR CHILDREN OF AGING PARENTS AND THEIR FAMILIES
Below you’ll find a summary of some of the suggestions I made on Episode 26 of the show.
General Preparedness Information
Are You Ready? (a FEMA publication)
Disaster Preparedness Planning for Older Adults US Public Health
Items mentioned on the show:
Lightweight Travel Wheelchair Keep this near the front door or with the rest of the emergency supplies, so your parents can use it if they need to be evacuated. I suggest this even for those clients who do not have difficulty walking. Emergencies can have them standing for long periods of time and require them to walk very long distances… this can help.
Here’s a six pack of emergency whistles with lanyards that can be attached to an LED flashlight. I make sure my clients have something like this in every room in their home—just in case they need to call for help and can’t get out.
I forgot to mention these chemical light sticks on the show, but they are great! We used them during Hurricane Sandy when our power was out for three weeks. They last for 12 hours and are less than a dollar each. I now give them to all of my clients. I also suggest attaching a front door key to one and keeping it in the bedroom, just in case you need to toss it out to the police, so they can get in without having to break down the door.
Use this Key Lockbox to allow emergency personnel to quickly access your parent’s home in an emergency. The Police can keep the access code on file.
Another thing I failed to mention is this really cool water purification straw. My husband and I both carry one in our “Go Bags”, which we have with us at all times (a holdover from his days as a Public Health Doctor, when he had to be prepared at anytime to be deployed). You can literally use this water purification system to safely drink water from any source.. stream, pond, street puddle, etc… and it’s reusable. And Yes… if you know my husband, you know he’s already tested it.