Nursing Homes Need Novel Solutions to Deal with Hurricanes

By Robert A. Belflower, Ph.D.
Faculty Member, Emergency and Disaster Management

The U.S. population is aging, with an increasing number of seniors residing in nursing homes. An estimated 54 million Americans are 65 or older.

That number is expected to increase to 70 million by 2030. Also, an estimated 96% of the seniors residing in nursing homes have a physical or mental disability requiring daily monitoring, care, and assistance from nursing home staff.

Many seniors elect to retire in the southern U.S. states due to their temperate climate and lower cost of living. This area extends from the coastline of North and South Carolina, down to the Florida Keys, and along the Gulf Coast to Brownsville, Texas.

But this is the same region that is annually threatened by hurricanes from June 1 to November 30. So it is incumbent upon nursing homes in those areas especially to provide a safe and secure living environment for their residents, even during hurricanes.

Depending upon the severity of the situation, nursing homes might evacuate their residents to a safer location or elect to shelter them in place. Either way, qualified nursing home caregivers must tend to the needs of their elderly residents.

Staff Characteristics at Nursing Homes

Nursing home employees include a wide range of occupations and skill levels, including housekeeping, dietary, transportation, aides, LPNs, RNs, physical therapy, and administration. Some nursing homes may include additional occupational roles as well.

The staff covers the full gamut of worker characteristics: married, single, with/without children, young, elderly, live close to work, live far away, transportation issues, day care issues, financial issues, and motivational issues.

Nursing Home Staffing Challenges

Whether the nursing home evacuates or shelters-in-place, all of these characteristics may come into play and influence the quantity of the staff. For example, some nursing homes may choose to shelter-in-place during a storm, but some staff members might be single parents residing in areas subject to flooding. They would choose to evacuate their families to a safer location, and thus would not be available to work in the nursing home.

Conversely, the nursing home may opt to evacuate. Some of the staff may not have the financial resources for fuel, food and motels to accompany the evacuated residents. So they are not available to provide continuing care.

Even when the nursing home shelters-in-place and the staff appears to have no issues, flooded or blocked roads could prevent some staff members from reaching the nursing home. Again, those workers could not provide residential care.

Staffing Solutions to Survive Hurricanes

Louisiana was hard-hit by hurricanes in 2005. Katrina flooded the New Orleans metropolitan area and the north shore of Lake Pontchartrain. One month later, Rita came ashore near the mouth of the Sabine River with devastating effects from western Louisiana north to Shreveport.

Most of the state was threatened or directly affected by one or both of these hurricanes. Whether area nursing homes sheltered-in-place or evacuated, most of them experienced staffing shortages.

At the same time, many of Louisiana’s nursing homes developed similar solutions from the lessons learned during Katrina and Rita: Provide for the staff is how Louisiana nursing home administrators summed up the solution. Below are a few observations from nursing home administrators whose facilities were affected by hurricanes Katrina, Rita, Gustav, Isaac or Ike.

1. “You need staff to take care of the people. If you don’t evacuate your staff with you to the next shelter facility that you evacuate to, it’s unbearable for that group. That’s a tremendous amount of planning and inconvenience not only for the patient or resident, but for the staff too because they have family where they live. If they’re going to be evacuated for seven days, they worry about their family as much as they do the residents and rightfully so. They need resources, and if you bring them, that’s additional resources. You do this calculation, which would include the families of the staff. We may not forget about them, but it’s an additional burden.”

2. “We had a contract system in place to pay the employees a bonus incentive. The ownership here had put together beds, trailers, compact trailers and stuff and had them parked outside the facility so the staff would have a place to go and change just to get away. At [one facility] we have bunk bed space so they just go in there and they have their own room, their own TV.”

3. “[As the hurricane approached, some staff] had no cash. They couldn’t even go to an ATM and get money. So my company sent a plane to somewhere up north. They actually got down here, picked up our computers, flew them north, downloaded payroll, cashed everybody’s payroll checks at banks in the north, [and then] flew all that cash back down. I’m sitting here with armed guards in my nursing home here paying my staff in cash so they would have enough money to live on.”

4. “[The hurricane] really did affect us, impact us all, and some of our staff couldn’t come to work because of damage they had received. They were without fuel. Rather than our generator not having fuel, there were problems with staff being able to get fuel to come to work for that period of time as I recall. One of our owners lives in Shreveport, and had some kind of large container. I don’t know, a 100-150-gallon container. He would fill it up in Shreveport and come and dispense it to employees. You know, just enough to get home and get back tomorrow. That’s how some of the employees were able to work a regular schedule.”

Teaching Nursing Homes to Provide Qualified Staff

Almost all management and leadership courses teach executives how to take care of employees. It is an important step in assuring that the organization has qualified employees prepared to respond to all types of contingencies.

Louisiana’s nursing home administrators have taken that adage to heart and have implemented innovative solutions to provide qualified staff to their facilities during hurricanes. Such creative solutions help assure that Louisiana’s nursing home residents continue to receive quality care during hurricanes or other natural disasters.

About the Author

Robert A. Belflower, Ph.D., served on active duty in the U.S. Army for six years before joining Northrop Grumman Corporation for a 32-year career as a program manager. Most recently, he has four years’ experience in higher education as an administrator and faculty member. Decision-making during stress is his research interest. He was a coach at the U.S. Army’s Leaders Training Program that trained brigade and battalion commanders and their staffs during an intense seven-day simulated combat environment.

He was the deputy exercise director for a series of emergency management and consequence management exercises conducted for large school districts, military installations, foreign nations and the U.S. Northern Command. His doctoral dissertation examined the decisions made by nursing home administrators during the approach of a hurricane.