Calls for Better Evacuation Plans for the Infirm

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Thousands of residents from nursing homes and other long-term care institutions were displaced by Sandy, and hundreds still remain in temporary housing.

As state panels prepare final recommendations for improving disaster preparedness, advocates and experts point to a series of failures in evacuating and housing some of society’s most vulnerable citizens.

“Although most people ultimately did okay, there was a tremendous amount of confusion," said Dr. Irwin Redlener, head of the National Disaster Preparedness Center at Columbia University. 

"There were a lot of lessons to be learned after Sandy," he said of evacuation and relocation efforts. “But I was surprised we hadn’t already learned how to do this more effectively.”

Gov. Andrew Cuomo appointed Redlener to co-lead a panel to improve New York's emergency response efforts. A preliminary report was released last month, and he said final recommendations will be published soon.

When Sandy was approaching, Cuomo administration officials, together with those in New York City, initially decided that people in long-term care residences in the city's storm-prone areas should "shelter in place," rather than relocate to other facilities -- despite a general evacuation order for those areas. The risk to residents, many of whom are elderly, mentally ill or physically disabled, was deemed greater from moving than from staying put.

Only New York City made this calculus. Authorities decided to evacuate residential institutions in the vulnerable areas of New Jersey and Nassau and Suffolk counties.

After flooding caused greater damage than anticipated and it became apparent facilities were unable to operate, the city and state evacuated residents to a range of places. Some went to comparable facilities inland, which led to temporary crowding. Others went to group shelters and other settings.

"We had contracts with a number of other homes to relocate residents, but they were all in the same situation we were,” said Michael Friedman, administrator for Belle Harbor Manor, an adult home for 160 relatively independent mentally ill and physically disabled residents in the Rockaways. “The evacuation plans are for individual places. They don’t work well for mass evacuations, if everyone’s hit all at once.”

Dr. Thomas Farley, the city's Health commissioner, echoed the sentiment during a recent City Council hearing.

“There wasn’t a great delay in finding beds for hospital [patients]. There was enough spare capacity in the system,” he said. “But it was much more work and difficulty in finding beds for chronic care facilities. The nursing home industry tends to run much closer to 100-percent capacity.”

Belle Harbor Manor residents were transferred multiple times before returning to their renovated facility last week. They spent three weeks with hundreds of other evacuees at the Park Slope Armory, and then were moved to the Kings Hotel in East New York for another three weeks, before being settled into Milestone, a privately managed residence for the mentally ill on the grounds of Creedmoor, a state psychiatric facility in northern Queens. They stayed there for a little more than two months.

The weakness of existing regional evacuation efforts has been highlighted in reports going back many years. In 2006, following Hurricane Katrina, the state Assembly's Committee on Corporations, Authorities, and Commissions studied New York’s plans for a similar event. The report found the evacuation plans residential institutions submit to the state often aren’t detailed enough – and, even if they were better, the state is not equipped for numerous homes evacuating at once.

Former Assemblyman Richard Brodsky, the Committee chairman at the time, said despite the critique, he was never able to persuade state officials to change anything.

“There’s no real political energy behind prevention," he said. “In the age of television and electronic media, it turns out that there’s much more political sex appeal standing in command and control centers issuing orders, than there is spending the time, months and years before disasters, investing in things.”

Joseph Donchess, executive director of the Louisiana Nursing Home Association, had been helping facilities develop emergency prepared plans in the hurricane-prone Gulf Coast for 20 years, when Hurricane Andrew hit in 1992, causing destruction throughout the region. Since then, Louisiana, Florida and neighboring states have set higher standards for facilities' evacuation plans, requiring them to be more detailed and have more backup options, and state authorities have monitored these plans more aggressively.

“Our Health Department will check to see if, ‘Well, this nursing home is planning to go to this place, and another home is going to that place,’ and they’ll find the duplication," Donchess said, and make sure the duplications are eliminated. He said the resilience of the evacuation plans was put to the test in 2008, when Hurricane Gustav forced 93 nursing homes with 8,000 residents to evacuate. “Fortunately, our plans worked. We got all 8,000 people into either other nursing homes or adequate housing.”

New York's post-Sandy recommendations are expected soon from the governor's panels, and then it will be up to state officials and legislators to revise and enforce regulations.

“People give lipservice when we actually need details," Redlener said. “You would think, for example, if you were running a nursing home in an area that needs to be evacuated, you wouldn’t need to be told about bringing medical records and all the information that needs to be transported with residents.”

Redlener said he hopes the commissions he and others are leading will produce tangible improvements.

“There’s still a lot of work to be done,” he said. “And that will involve more intense scrutiny of the planning process throughout the state, more verification that the plans are actually workable. All this is now on the table.”