My heart goes out to all who have been impacted by Hurricane Ian. In the face of such fury and destruction, I pause in admiration of those who have showed up to provide services that will bring back a sense of normalcy to communities forever altered by Mother Nature. These include first responders, disaster response volunteers, mutual aid groups from across the country and the world. They also include government employees at all levels, local, state and federal.
What is most amazing about this response is that it can be taken for granted. The fact is, we show up for each other. From the human-interest stories about individuals rescuing stranded people and animals, to the organized staging of materiel prior to the hurricane’s landfall, followed by cadre after cadre of trained professionals and volunteers; in times of trouble, humans help one another.
Vulnerability of Aging Adults
Florida is second only to California in being home to millions of Americans 65 and older. Both states are prone to natural disasters. Neither state is adequately prepared to assist this cohort of citizens to recover from disaster. And so, as aging adults, we need to think through our own specific disaster preparedness and make sure we are advocating for ourselves on a community-wide level.
Phases of a Disaster
Disasters have different phases:
1. Pre-disaster planning
2. Event search and rescue
3. Immediate post-disaster search and rescue
4. Immediate post-disaster recovery
5. Recovery and restoration
7. Long-term recovery and rebuilding
These phases vary in length of time dependent on the nature of the disaster (i.e., fire, earthquake, flood, hurricane), and the degree of severity.
These criteria help to determine who and how many kinds of response are needed. A 3-alarm fire requires multiple engines, rescue unit, and may include additional personnel and will take some time to bring under control. Recovery will consist of rebuilding, possibly rehousing, and filing of insurance claims. A Category 4 hurricane will require response from multiple agencies, probably will need state and federal disaster declarations, and could take weeks, months, or even years for full recovery.
Responding to Aging Adult Issues in a Disaster
We are all familiar with the common and expected response from 9-1-1. This system works really well with managing immediate emergency (non-disaster) response in urban areas, and while it takes more time, also in rural areas.
However, it is quickly overwhelmed when a disaster strikes, as the priority for first responder’s is different. And, if there are failures in communication (cell towers are down) or longer-term deployment of personnel and material is required (weeks/months), responding to more typical calls for helping with falls or transporting folks to the hospital from skilled nursing facilities may not be within the capacity of the system to handle.
Specific Issues That Need to Be Addressed in a Disaster
Here are some issues to consider in making sure the needs of aging adults are addressed in community disaster planning:
It is one thing to lose a home to a disaster. It is another to work through the maze of paperwork required to make a claim in order to rebuild. If you are not a home owner you may not have to fill out insurance forms, but finding housing may be even more challenging.
Issues of affordability are paramount, but so is availability. Folks in Florida no longer can look for housing just around the corner. For many, housing may only be found hundreds of miles away. This disrupts every level of community including social, medical, spiritual, and economic. Where will you go if you can’t go home?
Healthcare Continuum Interruptions
For older adults with chronic conditions that require treatment such as those with COPD or kidney disease, interruptions of care can be life threatening. This is also true for folks who are reliant on medications that need to be refrigerated or are delivered rather than purchased directly from a pharmacy.
When a disaster interrupts power and deliveries, folks need additional assistance and specialized care that goes beyond what Red Cross shelters are equipped to provide. In order to receive needed treatment, families may need to be separated from each other, adding to the psychologic burden that comes from having survived a disaster.
In recent years, we have seen how communities have been impacted when major hospitals are off line, care professionals are unable to get to work or find themselves without housing. This has a ripple effect across the care continuum as well as the economic hit that results from loss of income.
Many Medicare beneficiaries are reliant on having medications mailed to them. The company tells you this is for your convenience; however, it really just puts more money in their pockets. When there is no longer a place to receive a delivery, or you need to communicate a new address, the disaster makes this convenience a barrier that may be impossible to overcome. Having a plan for where you can get your medications is essential, as is having a supply of your meds always on hand. Sharing your health information with a trusted individual outside of your geographic area is a good idea in case your records can’t be accessed and your providers are unable to provide care.
Infrastructure (Transportation, Power, Communication)
We take being able to get where we want, buy what we need, and talk with people we love pretty much for granted. When any of these cornerstones of modern life are impacted, our lives quickly fall apart. Even though many of us grew up without technology, our memories are short.
The initial shock of not having electricity may be short-lived if the power is turned on within a couple of hours. But going without lights, refrigeration, chargers, and TV, radio, or iPads for days is unbearable.
When we are forced to detour from our favorite routes, many of us (myself included) become resentful and wonder why things are taking so long! After a disaster, familiar routes may no longer be available, and the familiar landscape may forever be changed.
Evacuation frequently results in people being separated. If you can’t talk with folks, the level of anxiety rises exponentially. I think the hardest of all is not being able to talk with someone, either by phone, text, or in person, and waiting to find out if they are all right.
Infrastructure is dependent on government and private sector cooperating and combining resources. When governments and private sector companies are impacted by a disaster, the return to normal is delayed. When individuals within government and private industry prey on people during and after a disaster, trust in the whole is lost. The consequences of this loss of trust impact the safety of people when faced with future disasters.
The whole point of insurance is to be an available resource when bad things happen. The fact that most of us purchase insurance because we are required to and do so at the lowest premium possible reflects two things that seem to be common to all humans. First is the belief that “it is never going to happen to me.” and second is, “I want to pay as little as possible!”
Insurance is about managing risk, but few of us have the imagination and the bank account to fully cover all our vulnerabilities. The result in disasters such as Ian is that while claims will be made and paid out, it will be insufficient to make a person whole because folks were under-insured or not insured at all.
Short-term solutions for providing food can be managed, but re-establishing networks for delivery of meals to housebound adults is another story. Agencies that provide these services rarely have access to FEMA registration information and sharing of relocation information is often restricted due to well-intentioned but bothersome identity-protection regulations.
Disruptions in food delivery to grocery stores can go on for days, and even months. For volunteer food insufficiency programs, the infrastructure that existed prior to the disaster no longer exists, and may or may not become re-established, leaving many hungry. If you live in an assisted living facility or continuing care residence that provides your meals, you will need to find alternative food sources.
Many disaster response programs rely on meals ready to eat (MREs) for folks who don’t have power to refrigerate or cook. These meals may not be appropriate for aging adults with specific nutritional limitations or needs.
The ultimate disaster for many aging adults is not the event itself, but the long-term consequences of loss. This is not just about shelter, but about the community relationships that sustain so many. If you live in an assisted living facility or continuing care community and your residence is condemned, you may end up being housed someplace that you have little or no say in choosing.
For those with dementia or other cognitive impairment, finding placement that will meet your needs is not just challenging, it may be impossible. If you are the primary caregiver of someone with dementia or similar memory and behavior challenges, you may find yourself without access to respite or needing to find help when the pool of helpers is also impacted by the disaster.
Separation from a pet is often as hard on the animal as it is on the animal’s “owner” It is important to have an evacuation plan for your animal(s) so that you will know they are being cared for and you can be reunited when things calm down. Pets cannot be taken to Red Cross shelters.
Recovery is a long-term process with many twists and turns. I remember one woman being interviewed in the early days after a hurricane. She said, “I am trying to be brave. I am grateful that my family is safe and we are together.”
This is typically what we are given as a model of recovery. Bravery and gratitude will only get you so far, just like thoughts and prayers don’t ease an empty belly or restore trust. The actual experience of recovery is very different.
In the days and weeks immediately after the event, much effort is spent in just filling out forms, learning to sleep on a cot, and making sense of a world that is no longer predictable or one you are in control of.
In the next stage of recovery, which may be temporary, attempting to find a routine that doesn’t exhaust you and resembles something you used to have, takes up your efforts. This is a period when disappointment often appears, as you learn that your insurance doesn’t cover what you thought it did, and you don’t qualify for programs even though you feel you are deserving. What is often hardest, is being on the receiving end of someone who blames you for what has happened or finding that friends and family may not be there for you
Then there is a period of predictability and hope surges. You become an expert at filling out government forms, you have developed patience in waiting on the phone for the next available operator, and you are touched and surprised by the generosity and kindness of strangers. This is when you commit to giving back and vow to never put yourself in this position again.
If you are lucky, the nightmares and panic attacks decrease in intensity and frequency. You are able to find a rhythm and get into a routine that feels almost normal. Maybe you start to rebuild. Maybe you give up. But, without question, you now understand that your life will never be the same.
Time passes, and then almost without warning, the anniversary of the disaster arrives. If you are one of fortunate ones, you will have succeeded in adapting to a changed world and gotten on with your life. If you are less fortunate, you may find yourself continuing to struggle with the loss and not yet able to reclaim predictability or feel secure.
Coming Together for the Long-Term
The future is time-limited for aging adults. Starting over when you are in your 60s or 70s, even with unlimited resources, is stressful. If you are hobbled by limited income, are socially or culturally marginalized, have chronic health conditions and experience food or housing insufficiency, the challenge is even greater.
As I said at the beginning, people come together in times of disaster. As aging adults, we need to use this fact and raise awareness around our special needs. We are being given a preview of where the gaps in services lie, and of how aging adults are going to manage as the days and weeks unfold in the aftermath of Hurricane Ian. We must use this information to keep all of us safe and improve care for aging adults in a disaster.
2 responses to “A Perfect Storm”
Mary, this is a superbly well thought-out overlay of the implications of being an older person — atop of all “the usual,” horrific ramifications of a huge natural disaster. Your blog combines your lifetime of thinking about “us” (elders), “times” projecting our unique situation, limitations and needs onto something like Hurricane Ian occurring.
Here in Southern Oregon we (usually) face “only” two potential disasters: wildfires and (someday – with a 30% chance in the next 50 years), a GIGANTIC Cascadia fault earthquake.) As two elders, we have ALREADY lived through (2020) half our our town burning to the ground, with us not knowing for many agonizing days about our immediate neighborhood and home. As a result we now are “over-insured,” including having 30 days of food and water on hand, a folding porta-potty in our storage shed, having a “grab-bag” of all our key documents ready to go, our car always FULLof gas /— plus we bought optional Earthquake insurance (“just in case”), and as well as expensively added numerous metal “earthquake clips” to better tie our home to its foundation. We also bought a gas-mains shutoff “key” which hangs on a hook near our back door.
SO, thank you for likely bringing “someone else’s” (Florida’s) disaster and its implications HOME to your readers. Bravo.
Yes, this is very thoughtful and informative and not a little scary. Just yesterday I said (yet again) that I was very grateful to live in a state that escapes most natural disasters (a couple of horrible I’ve storms excepted). My heart breaks for all those in FL (and elsewhere), especially for those who may lack financial, emotional and health-related resources to deal with these crises.