The aftermath of Hurricane Irma has sparked many conversations about senior health and disaster preparation, and whether skilled nursing facilities should be prioritized when it comes to restoration of power and recovery efforts.
In fact, Florida Gov. Rick Scott has already taken steps to implement emergency rules relating to additional protections for the elderly in light of the tragedy at The Rehabilitation Center at Hollywood Hills, where 12 residents died after Hurricane Irma knocked out power and the air-conditioning system.
We at Plaza Health Network agree that there needs to be some changes in the way skilled nursing facilities prepare and are prioritized during times of natural disaster. Skilled nursing facilities are operationally different today than they were 20, or even 15 years ago.
Today, we provide a higher level of skilled care to more complex, non-ambulatory patients — patients who may depend on ventilators, oxygen or dialysis.As a result, evacuating a skilled nursing facility is more than just challenging. They must harden their structures to protect from water intrusion and other damage because evacuation is simply not an option for these delicate patients.
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Only 20 out of about 600 skilled nursing facilities in Florida do not already have one or more generators.
In fact, a proposed local Miami ordinance will require that nursing and assisted living facilities “be equipped with properly functioning generators with adequate fuel capable of continuous use to power essentials, including but not limited to, elevators, lights, emergency alarms and air-conditioning in the corridors of the facility.” It is recommended that even those that do have generators find a way to increase their fuel capacity so that they may maintain power to essential equipment. We believe that using portable air-conditioning units in common areas that can be hooked up to generators to prevent heat-related ailments is also an appropriate alternative.
Proper staffing is also essential for skilled nursing facility disaster preparation. Before, during and after Hurricane Irma, Plaza Health Network implemented a Team A/Team B strategy which ensured 24-hour staff coverage at all of our Plaza Health locations in an effort to provide constant medical, rehab services and personal care to patients. Team A stayed at the skilled nursing facilities through the duration of the storm and Team B came in to relieve them after the storm had passed.
This level of continuous care is a policy that all hospitals adhere to though it is not currently required of skilled nursing facilities. It should be. Adhering to this level of preparation and staffing resulted in seamless, continuous delivery of care to even our most critical patients.
Post-storm care is important which is why these facilities need to ensure that all patients remain hydrated and monitored at least every two hours, especially if there is minimum or no air conditioning after a power outage.
If we are to ask skilled nursing facilities to adopt these hospital best practices for staffing during times of natural disaster, then skilled nursing facilities should also be categorized as top priority when it comes to restoration of power and recovery efforts. With more complex patients in our care that may be unable to evacuate, it is crucial – lifesaving even – that we be designated as “critical facilities”, immediately after hospitals, in restoration efforts. Local Miami commissioners are now being asked to consider a resolution that directs city managers to work with FPL to establish a policy prioritizing senior housing, skilled nursing homes and assisted living facilities so that they do not have to endure long power outages that could be life threatening.
Overall, we need to ensure that skilled nursing facilities are recognized as more than just “nursing homes.” We are providing sub-acute care to patients as they transition from the hospital setting. It is imperative that special consideration be given to the vulnerable, frail seniors in specialized rehabilitation and skilled nursing facilities. Their lives, and health, depend on it.
Elaine Bloom is a former Florida State Representative who is now president and CEO of Plaza Health Network, South Florida's largest network of skilled nursing and rehabilitation facilities.