Storm highlights need for emergency home health care planning

With a major snowstorm in the forecast, Todd Rose’s home health care agency set its emergency plan in motion, making a prioritized list of patients to visit in case resources became limited.

But two days after the snow hit, with power outages across the state and long lines outside the few gas stations in the area with power, Rose’s firm and other home health care agencies faced a problem they’d never contemplated: Visiting nurses and home health aides were struggling to get to their clients’ homes because they couldn’t get gas in their cars.

“Nobody thought about the gas situation,” said Rose, the president and CEO of Vernon-based Visiting Nurses & Health Services, which serves about 1,000 patients in 26 towns.

The problem improved as the week went on and gas stations regained power. But in its wake, some who work in home health care say the experience should be a reminder of the needs of a growing number of state residents who get medical or long-term care at home, and the need to adapt emergency preparedness plans to match.

Technology increasingly allows people with chronic or acute medical needs to receive their care at home, and the state is expanding efforts to move residents out of nursing homes, with a broader goal of significantly increasing home and community-based services and reducing the reliance on nursing homes.

But that can mean that when a disaster strikes, the services people rely on–delivered meals, aides to help them bathe or dress, visiting nurses to administer medications or help with devices–can be harder to get at home. If their needs can’t be met by shelters, people who aren’t acutely sick might have few options but to go to a hospital emergency room, particularly if they rely on oxygen or devices that use electricity.

Whenever there’s a power outage or major storm, including in the aftermath of last month’s Nor’easter, “they do end up in the hospital,” Connecticut Hospital Association spokeswoman Patty Charvat said. Hospitals have also delayed discharging patients until the power is restored where they live.

Dr. Margaret Rathier, medical director of home-based primary care at VA Connecticut in Newington, said phone outages made it difficult to reach patients to determine what they needed. Those who were home alone without heat were told to go to shelters, but some found that their local shelters wouldn’t take people on oxygen. While some shelters accept people on oxygen, Rathier said those that don’t might be concerned about the flammability of oxygen, or about whether the person knows how to take care of himself and can change out the oxygen tanks, or about being responsible for someone who is sick.

Another client got sent home from a shelter for being incontinent, she said.

“It’s kind of hard to find help for them,” said Rathier, who is also a professor of geriatrics at the University of Connecticut Center on Aging.

Some of the VA’s patients were placed in nursing homes, because it was the only alternative.

A place to go in Danbury

There were more options for people in the Danbury area.

Long before the storm hit, Matthew Cassavechia had been worried what people with functional needs–those who rely on oxygen, wheelchairs, or are bedridden or frail–would do in a disaster. It didn’t seem to make much sense to have them stay on a cot in a regular shelter, or spend prolonged periods surrounded by many people, including children, said Cassavechia, director of emergency medical services at Danbury Hospital.

When it became clear that the power outages wouldn’t end quickly, Cassavechia and others worked to set up a functional needs shelter. Western Connecticut State University relocated classes and basketball practices to make room for the shelter in one of its gyms. Danbury Hospital provided hospital beds that had been in storage and the state provided special needs cots. The American Red Cross and local delis provided food.

The shelter had a registered nurse on hand at all times; those who showed up included the Danbury High School nurses and nurses who are part of the Medical Reserve Corps. Paramedics from the hospital and nursing students also helped out.

The shelter rules allowed people to come with one aide or family member, and many of those who came were on oxygen. In all, 20 people used the shelter, coming from Newtown, Brookfield, Danbury, Newtown, Ridgefield and New Fairfield.

Without the functional needs shelter, Cassavechia said, they would either be at home or in the hospital. “And neither one of those choices are appropriate,” he said. “We essentially decompressed the hospital, which was overflowing, and we’ve gotten people out of harm’s way that were basically at their homes with no heat and no electricity.”

With power to the area restored, the last person left Monday and officials closed the shelter.

Rathier said one solution for the future could be to have regional shelters that can take people who are somewhat medically compromised. “Because it’s not fair to tie up the emergency rooms in that kind of situation,” she said.

Cassavechia said he’s gotten calls from other communities interested in the model.

“I think this is something clearly we need to look into because these people are some of the most vulnerable people in the community and they cannot be left behind,” he said.

Bringing in neighbors

The state requires home health agencies to develop 24-hour emergency plans for each patient, and the Department of Public Health includes home health agencies in its preparedness planning, spokesman William Gerrish said. During emergencies, many use family members as back up plans, prioritizing patients who don’t have families for visits.

In this storm, one of the challenges home care agencies faced was reaching clients with phone lines out.

At Rose’s agency, staff would try to call clients, but with phone lines down, many couldn’t be reached, and staff went to their homes. Many weren’t there, having gone to a shelter or to stay with relatives.

“That’s good, though,” Rose said. “That’s better than the alternative.”

Then there was the gasoline problem.

At Interim HealthCare, a nurse ran out of gas while looking for a station to fill up and her car got towed, CEO Ann Olson said. Another called in to say she couldn’t make her other patient visits and was going home. The agency, which covers all of Hartford County, managed to reroute other nurses who were in other towns and reached patients who had working phones to see if they could wait.

“You have to prioritize the cases so no one was put in jeopardy, but it just made it very difficult,” Olson said.

Deborah Hoyt, president and CEO of the Connecticut Association for Home Care & Hospice, said some home care workers went to municipal shelters and found their clients. Some ended up helping other people in the shelter with medical needs too, she said.

“These shelters are not a medical model,” she said, adding that home health care agencies should play a larger role in emergency planning.

Dianne Stone, director of the Newington Senior and Disabled Center, worked overnights at the town’s shelter, where as many as 100 people spent the night and hundreds more came for meals. She praised the operation, noting that many people stepped up and created such a sense of community that at least one resident stayed for the company after her power went back on.

But there were also challenges. Some people who came weren’t sick and didn’t need a hospital, but Stone said she wasn’t sure the shelter was the safest place for them. Some people in the shelter had dementia and tried to walk out at night; those working realized they needed to station someone at the door. At one point, the shelter staff tried to find a home health aide to help lift a person, but wasn’t able to get one.

“We really felt out of our league with some of the people coming in there,” Stone said.

Cots posed a problem for some people, who chose to go home to sleep. She said it became clear that a person who can live independently at home might not be as equipped for a shelter, possibly struggling to get to a bathroom that’s further away than it is at home.

But Stone said she wasn’t aware of anyone turned away for medical reasons, and said she heard from people at other shelters that were also able to accommodate people with fairly serious care needs.

In the future, Stone said, personal emergency plans should take into account long-term shelter issues. People who have trouble sleeping in cots could have a piece of foam on hand to bring to a shelter if necessary, she said.

And as more people with medical needs live at home, Stone said the community will need to be part of the solution. In Newington, several people came in with other people and, when asked for information, told the shelter staff that they knew little about the person, but had just checked on him or her and found that they were cold.

“That happened quite a few times,” she said.