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By Thomas Goldsmith

In the anticipated path of a hurricane, the decision on whether to evacuate North Carolina residents in long-term care becomes a tough one based on a stack of different factors.

What might seem like an easy call — of course you want to get people out of harm’s way, right? — gets more complicated given the health of the residents, the location of a center and the logistics of transporting residents, staff and copious supplies and equipment. The question was taking on stark immediacy Tuesday with the imminent arrival of Hurricane Florence, a Category 4 storm.

“It’s hugely stressful,” Jeff Horton, executive director of the North Carolina Senior Living Association, said about moving in the face of a storm. “It’s stressful on you and me. Imagine someone who’s got chronic health issues and possibly dementia.”

With the storm slowly churning its way toward the North Carolina coast Tuesday, state and local officials did not have hard numbers on how many nursing homes and assisted living centers were being evacuated. County officials had ordered partial or mandatory evacuations of residents in Bertie, Brunswick, Currituck, Dare, Hyde, New Hanover County and Onslow counties, according to the state Department of Public Safety.

Hurricane Florence’s position late Tuesday evening keeps it on track to come ashore in North Carolina later this week. Photo courtesy: National Hurricane Service

“In North Carolina, when to evacuate starts with a local decision because local officials know their communities and their people best,” Ford Porter, a spokesman for Gov. Roy Cooper, said in a statement to press Tuesday.

Evacuating is a big deal and health care facilities of all sizes are slow to make the call. The leaders of the Outer Banks Hospital, squarely in a high-risk zone, have decided to stay. Whereas one small hospital Down East – Bladen County Hospital – did start to evacuate, according to James Bullard, the emergency coordinator for the Cape Fear Valley Health System, of which Bladen is a part.

“It’s only about 11 patients,” he said. “Between today and tomorrow, we hope to have those transported out.”

Balancing risk

Academic research carried out after the devastation of Hurricane Katrina in 2005 showed that death rates increase among assisted living residents who are evacuated during disasters. A review of 10 such studies found the risk of death at 60 days was less than one percent for nursing home residents who sheltered in place, but more than 15 percent for those who were evacuated.

“Evacuation seems to have a negative effect on the survival of nursing home residents independent of the effect of the disaster,” said the authors of the 2017 survey in the Journal of the American Medical Directors Association.

Early this week, the state Division of Health Service Regulation supplied facilities with a list of items needed for residents who remain at an assisted living facility during a storm. These include extra water supply, food that doesn’t have to be cooked, flashlights and batteries, a weather radio, means of transportation if the decision changes, backup power sources and a dry spot to store medical records and medicine.

A decision to move assisted living residents requires a waiver from the state Department of Health and Human Services because residents’ situations will vary from those spelled out in regulations and statutes.

“Typically just to evacuate residents requires several days change of clothes, the medication cart, care plans, medical equipment like oxygen concentrators,” Horton said. “It’s a big deal. It’s a major undertaking.”

Nursing homes, which provide more medically intensive care, must notify state and federal regulators of an evacuation, but don’t have to get preapproval.

“Think about access”

If the decision is to stay, administrators have to give careful thought not only to the storm’s immediate effect, but also to what comes next.

“The biggest issue is flooding,” Horton said. “You have to think about access to and from the facility. If all the roads coming in to the facility are flooded and you’re on dry ground, can an ambulance get there?”

Family care homes (FCHs), for six or fewer people, and adult care homes (ACHs) provide 24/7 supervision for people who are less critically ill and who don’t receive nursing care. In specified cases, these residential centers can take in community members who need shelter.

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“In general, licensed ACHs and FCHs should not shelter individuals from the community,” Megan Lamphere, chief of the state Division of Health Service Regulation, Adult Care Licensure Section, said in an email to facility operators.

If shelter for non-residents is approved, the center has to be designated by the local emergency management plan and to send DHHS a waiver request with a floor plan that indicates where the non-residents will stay.

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...