Hospital helps chronically ill prepare for disaster

CMs make sure eligible patients sign up for shelters

As hurricane season approaches each year, case managers in North Broward Hospital District's disease state management programs work with their patients to make sure they will be safe if a storm hits the area, causing flooding and power outages.

Patients without insurance and some Medicaid patients are eligible for the Ft. Lauderdale, FL-based hospital system's chronic illness program for patients with diabetes, asthma, hypertension, congestive heart failure, HIV-AIDS, breast cancer, and high-risk pregnancies. The program is part of the North Broward Hospital District, a health care system that includes five acute-care facilities and 11 primary care sites.

Case managers, located in the health system's primary care clinics, work with patients to help them understand and learn to manage their disease. They work on medication adherence, remind them of follow-up doctor appointments, and educate them on tests and procedures, such as eye examinations for diabetics.

"One of the goals of our case management program is to keep our patients healthy and help them avoid hospitalization or trips to the emergency room. As part of the program, we help them be prepared for a hurricane so they can stay healthy in the event of flooding or power outages," says Lori Kessler, BSW, MHSA, district manager for the disease state management programs.

Many of the elderly, unfunded, and underserved patients in South Florida live in trailer parks, which are particularly vulnerable in bad weather. "As we approach hurricane season, the case managers find out where their patients live and determine if there is an evacuation plan and if there is a shelter in the area," Kessler says.

They make sure that patients in low-lying or otherwise vulnerable areas are registered either with American Red Cross or medical shelters in the area. The case managers concentrate on the patients who live closest to the ocean in areas where there is a higher risk of flooding. If the patients are medically fragile, or need oxygen, the case managers make sure they are registered for a medical shelter where they can go during a storm. They provide their patients with the telephone number and location of the shelter and encourage them to go there before the storm.

"We encourage them to keep enough medications so that they can take care of themselves when they are out of the home. The shelters have a full medical team to ensure the patient's safety and well-being during the storm," she says.

The case managers make sure that all of their patients who qualify for a medical shelter or a Red Cross shelter are signed up with the shelter. If patients elect to remain in their own homes, case managers make sure they have enough food, water, and medication to last a week. They educate patients on items they should stock up on, such as batteries, bottled water, and enough food to last a couple of weeks.

"We try to be sensitive to what the patients can afford. We give them lists of foods that they can relate to and urge them to stock up on those," she says.

For instance, since Latin and Caribbean diets typically include beans and rice, the case managers would recommend that these patients buy canned beans and packages of pre-cooked rice, rather than things such as peanut butter or granola bars.

The nurses remind all of their patients to keep enough of their medication in stock in case they are homebound following a storm. They educate them on the necessity for good hydration and diet during a flood or power outages.

After the storm subsides and the health centers reopen, the case managers get in touch with their patients to make sure they are OK and to assess whether any urgent medical issues have come up during that stressful time, Kessler says.

(For more information, contact Lori Kessler, BSW, MHSA, district manager for disease state management programs, North Broward Hospital District; e-mail: LKessler@nbhd.org.)