For The Elderly In Nursing Homes, Climate Change Poses Graver Risks
When Hurricane Irma roared across South Florida in September 2017, winds cut off power to the elderly residents at the Rehabilitation Center at Hollywood Hills, leaving them in suffocating heat for more than three days.
As rooms in the 152-bed facility heated up, residents began having trouble breathing. Their temperatures soared. Fourteen people died, including Pedro Franco’s parents.
“It didn’t have to be that way,” said Franco, who sued the facility for negligence. "It was 100 percent avoidable.”
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For emergency planners and elder care experts, the deaths were a tragic reminder of the grave risks faced by seniors during natural disasters. A new report from the nonprofit news service Climate Central paints another grim picture for South Florida seniors facing rising seas. Of five coastal states that rank highest among retirees, Climate Central found South Florida has the most number of nursing homes and assisted living facilities at risk for future flooding. Broward County had the second highest in Florida, just behind Pinellas County.
It’s an outlook that could worsen problems already plaguing care for the elderly in the U.S., experts say.
“The story of the disaster effects on the elderly is like a magnification of all the things that we are already doing wrong for the care for the elderly in this country,” said Vincanne Adams, a medical anthropologist at the University of California, San Francisco who studies the effects of disaster on the elderly. “Disasters magnify the problems you already have.”
For its study, Climate Central used flooding maps to analyze the risk of future flooding to licensed nursing homes and assisted living facilities in Florida, North and South Carolina, New Jersey and Texas. Analysts selected the states because they rank among the top 10 destinations for retirees.
In Broward County, they found facilities with 244 beds could face frequent flooding in less than a decade. By 2050, the number jumped to 400 in facilities that could face chronic or frequent flooding. Another 200 would face occasional flooding.
Hollywood’s deputy Fire Chief Analdy Garcia, who witnessed the Hollywood Hills tragedy, said he worries about rescue efforts if water, not heat, triggers evacuations.
“Unless we have the ability to show up and pick up, the evacuation will be stalled,” he said.
Evacuating residents who may be frail or suffer from dementia or Alzheimer's can also make rescues more difficult, he said.
"You have to take a few seconds and reassure every resident,” he said. “You have to place yourself in a situation in which you might be scared, afraid or unknown.”
Hurricanes Can Be A Guide
Adams and other experts say hurricanes provide a good measure of what to expect in future flooding.
As Hurricane Irma barreled down on Florida, the storm’s boundaries were forecast to extend to both coasts. Flooding from storm surge was expected to reach up to 15 feet on the Gulf Coast, from Cape Sable to Captiva, and up to five feet from North Miami Beach to the Keys.
Evacuations were ordered for 6.5 million residents, leaving inland hotels booked and highways clogged. Assisted living facilities and nursing homes are supposed to have agreements with other facilities to provide shelter, since residents of those facilities are not supposed to be housed in public shelters. But Irma showed how disasters can quickly upend plans.
“This one nursing home ended up in a ... place that wasn’t equipped,” said Lindsay Peterson, a University of South Florida researcher who worked with Brown University to study the toll Irma took on seniors across Florida.
“They had some residents with dementia and very high needs just like sardines on the floor,” she said. “They were having problems with incontinence and staff trying to change them right there in this situation where they're surrounded by other people, having to walk on people to get to them, trying to hastily set up a sheet or something around them so their privacy was protected. There were just some really horrendous situations.”
The Centers For Disease Control and Prevention tallied Irma’s death toll in Florida at 123 people, including the 14 who died at the Hollywood Hills facility. But Peterson and the Brown team found the number of elderly deaths was likely five times higher after they examined deaths just after the storm and compared them to 2015 deaths.
That’s because many elderly deaths after a storm often get attributed to other causes, which Peterson and Adams say should instead be blamed on the storm.
“Elderly people are dying anyway of different things. And so they get recorded as deaths that aren't attributed to the disaster, or to Irma or Katrina,” Adams said.
Disaster experts call it 'masking,' she said.
“The same has been true for COVID,” she said. “Early on, a lot of the deaths from COVID weren't being recorded as deaths because they weren't testing them for it.”
Varying regulations, depending on which jurisdiction a facility comes under, can also complicate emergency plans for elderly facilities. Nursing homes that receive federally-managed Medicare dollars have to abide federal guidelines for plans. Those plans are updated and inspected yearly and often go into greater detail, Peterson said.
Florida regulates assisted living facilities that take state-managed Medicaid dollars and also requires emergency plans, she said. But those plans are overseen by local emergency managers, which can lead to uneven levels of protection, she said.
“I remember going to one planning meeting where the emergency manager came to speak,” Peterson said. “And this person was saying, 'I'm the emergency manager, but I also wear three or four different hats.' So he said 'be forewarned that probably maybe a day before the hurricane hits, I'm not going to be answering my phone anymore because I'm going to be over on this other desk, doing this other job.'"
The toll on staff also has to be factored in, she said.
"[Staff] don't get any sleep for days and days. And here they are trying to provide care for people who need feeding and hydration and they need their medications regularly," Peterson said. “And here the staff members are sleep deprived and terrified themselves.”
'The Water Won't Go Away'
Before Hurricane Andrew struck South Florida nearly 30 years ago, Ralph Marrinson said he had to evacuate 76 frail and elderly residents to a Lauderdale Lakes middle school. Marrinson owns five elderly facilities in Broward and three in South Carolina.
“Nothing occurred, fortunately. So we were able to come back and reoccupy the buildings, but the back and so forth,” took a toll, he said.
The Climate Central study predicts two of Marrinson’s facilities in Wilton Manors will experience occasional flooding by 2050.
He worries that while Broward County and other South Florida cities are working to address flooding with higher sea walls, bigger storm drains, pumps and other improvements, it may not be enough.
“Everything will be affected by it. And it's not going to go away,” he said. “The water won't go away. So what we have to plan for is those conditions, which are totally different than any other type of disaster that we've had.”
After focusing on strengthening its building to code to prevent more vulnerable buildings from going up, Broward County is now shifting to existing structures, said Jennifer Jurado, the county’s resilience chief.
“A lot of our efforts to date have been more focused on how do you embed resilience design standards in new development and redevelopment,” she said. “Once you've established how you're going to reinvest, though, what do we do with the existing or the remaining landscape and what's the exposure?”
A countywide plan now being drafted will look at critical facilities, including those that care for the elderly.
“Then you have to say, 'OK, well, now let's see how much can be mitigated,'" she said. “Where it can't be, then we need to have a different conversation."
Despite his alarm over future projections, Marrinson — who is about the same age as many of his residents — says he plans to retire to Ocean Reef, in North Key Largo.
“That’s about as close to the ocean as you can get,” he said.
He says he's confident fixes will be found.
“This will be solved,” he said, echoing the complicated optimism that underscores much of the effort to address more dire climate change risks that are still decades away.
For the elderly, that will require much more nuanced and better planning than past disasters have revealed, Adams said.
“We're facing this huge cataclysm of a crash of crises that are all happening at once. Multiple disasters. We've got the aging population [and] very inadequate resources for taking care of them. And that’s crashing into environmental change and climate change,” she said. “Florida is probably the test case for how we should and shouldn't do things for the rest of the country.”