Special-needs patients need care during disasters

FL agency pays employees who assist at shelters

While Floridians are relieved to be over the 2004 hurricane season and able to focus on the ongoing cleanup, other parts of the country have been dealing with snow and ice storms, and flooding that disrupt transportation and the ability of people, including home health agency staff members, to perform daily duties as normal. One benefit of the unusual hurricane activity in Florida is the visible reminder to all home health  agencies to make sure their emergency preparedness plans cover opportunities to help during an emergency.

In Stuart, FL, the Visiting Nurse Association (VNA) of Florida not only prepares its own patients for evacuation and care during an emergency, but the agency also actively participates in the special-needs shelter operated by the county in which the agency is located.

"We have provided staffing for the special-needs shelter for 15 years," says Elizabeth Simmons, RN, BSN, director of professional services for the VNA. "We believe that it is part of our service to the community to make sure the county has enough help to provide the shelter," she explains.

VNA employees volunteer to work at the shelter based upon their own family situation, Simmons explains. "The employees who volunteer are paid for their time by VNA." Other shelter staff members are county health department workers who are required to work, she says.

During Hurricane Frances, Simmons and a social worker from VNA volunteered to work at the shelter. "It was a terrific experience, and I’m proud that my agency participates in a community project like the shelter," she says. Every community should have plans for a special-needs shelter, Simmons suggests. No matter who is involved in the setup and management of the shelter, there are lessons that can be learned from the Stuart shelter, she says:

Staff appropriately.

"We worked continuously for five days, taking shifts to rest at night," Simmons explains. "We worked in teams of two nurses and two lifeguards/emergency medical technicians," she says. Be prepared for patients with physical limitations, Simmons continues. "The lifeguards were a big help because they were able to help with lifting patients, and we had some immobile patients in the shelter," she adds. The health department also had a physician at the shelter throughout the storm.

Designate one organization as shelter manager.

Although VNA of Florida has made a commitment to provide staff for the shelter, staff members also understand that the shelter manager is designated by the county health department and that during the emergency, VNA staff members at the shelter report to the shelter manager, says Simmons. "The health department has the resources and the personnel necessary to set up the shelters, but volunteer nurses and staff members are important additions to the health department staff," she says. While the shelter is successful because of a team approach, it is important that one person be in charge, Simmons adds.

Make sure patients know what to bring.

The shelter in Stuart housed almost 300 patients for the five-day period.

"Patients are instructed to bring three days of food, water, and medication as well as their own caregiver, but some patients were dropped off with nothing," she admits. Hurricane Frances was unusual because the storm stalled over the east coast of Florida and the shelter was occupied for five rather than the typical three days.

"Luckily, the shelter was located in an elementary school so shelter employees were able to improvise with food in the cafeteria, and other shelter residents shared what they had when the storm stalled and would not leave the area," says Simmons.

Clearly define who can be accepted by the shelter.

Home health agencies in the area registered patients for the special-needs shelter if the patient had no way to evacuate the area or no family member with whom he or she could safely stay, she points out.

"To qualify for the shelter, a patient either needed electricity, which is provided by generator in the shelter, or had a special care issue such as a Foley catheter or wound care." Although some dialysis patients were at the shelter, they could not be dialyzed, Simmons adds.

"We did refuse one tracheotomy patient who needed to be suctioned every hour because we did not have the staff to assign to one patient. He was sent to the local hospital," she explains.

Be prepared for oxygen patients.

"Over 60 of our shelter patients were using oxygen," Simmons adds. While nurses are familiar with the use of oxygen tanks, they were all grateful to staff members from a local durable medical equipment company who volunteered to stay at the shelter to help with the oxygen equipment, she says.

"I don’t think they got more than a few hours of sleep throughout the entire five days. They even brought extra tubing, equipment, and tanks that they used for all oxygen patients — not just their own patients," Simmons explains. "They were able to handle problems with tanks, nebulizers, and concentrators that we would not have known how to correct," she adds.

After the hurricane had passed through the area, VNA nurses who could drive into Stuart came to the shelter to relieve nurses who had been there for the five days, Simmons notes.

"VNA nurses made visits to our patients who were at the shelter, and they also gave those of us who had been working during the emergency a chance to check on our homes and get some rest," she says.

At the agency office, laptops powered by a generator enabled staff members to check schedules and find patient information. "Because power had been out for so long in areas where our nurses live, we had a number of power strips set up to enable staff members to charge their cell phones and PDAs," Simmons continues.

Nurses made phone calls to check on patients still in their homes. "Many of patients needed us to deliver water, ice, and other essential items more than anything else," she says.

The state of Florida requires home health agencies to develop an individual emergency plan for each patient with the input of the patient and the patient’s family. The purpose is to make sure patients and their caregivers know what the patient will do and where the patient will go in the case of an evacuation order or the threat of a hurricane, Simmons explains.

"Patients are usually reluctant to talk about emergency plans when there is no threat of an emergency, but I think our experience with multiple hurricanes in one season will make it easier for us to discuss plans in the future," she adds.

For more information about participation or establishment of a community-based special-needs shelter, contact:

  • Elizabeth Simmons, RN, BSN, Director, Professional Services, VNA of Florida, 2400 S.E. Monterrey Road, Stuart, FL 34996. Phone: (772) 286-1844. E-mail: beth.simmons@vnaflorida.org.