Leaving everything behind: VOA chapter learns to operate across state lines.

When Jim LeBlanc, president of the Volunteers of America's Greater New Orleans affiliate, first heard about Hurricane Katrina heading toward the city, he thought he had things covered. This was, after all, another exercise in what's become an annual ritual: break out the disaster response plan and get to work preparing residents for evacuation.

"For the past three or four years during hurricane season we've had to evacuate people from our communities once or twice a year," LeBlanc said. "We know the drill: We hire several Greyhound buses, pack several days of clothing for each person and make hotel reservations. We know we'll be back in a few days after the storm's over."

Fast-forward nearly four weeks later. LeBlanc is in temporary offices in Baton Rouge. The 70-plus residents his staff evacuated are living at the Methodist Conference Center in Palestine, Texas. His former office and the housing and social support service communities that once served 40,000 mentally disabled, elderly, single parents and other needy persons each year were still underwater in New Orleans.

"We always assumed that even if we had to be out for [several days], we'd be able to come back," LeBlanc said. "The thought that many of our facilities would be under 8 to 10 feet of water for two weeks never occurred to us."

The experience taught him a lesson, LeBlanc said. "Every year before hurricane season starts, we'd pull out our disaster planning manual, review it and update it," he said. "But the one thing we never did was to say, 'What do we do if The Big One hits?'"

Hurricane Katrina has demonstrated how critical it is to have an evacuation plan for residents, no matter what type of facility you have or where it is located, according to Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging (AAHSA) in Washington, D.C. "Whether it's required or not, you should have one," he said. "People need to know your whereabouts. They need to know what happened to you if catastrophe strikes."

When it came to developing a disaster management plan, the Florida Health Care Association (FHCA) felt like experts, explained Lu-Marie Polivka-West, the association's senior director. Given the number of hurricanes the Tallahassee-based association deals with each year--including four during hurricane season in 2004--FHCA decided to rework its existing, comic book-thick manual and turn it into a formidable and useful guide for anyone who wants it, Polivka-West said.

During 2004, the association regularly gathered member administrators, nursing directors, risk managers, lawyers, and finance advisors for input on the most vital elements of a disaster management plan, according to Polivka-West. The resulting 151-page manual--available at www.fhca. org--is "probably three times bigger than what we had," she said. "Every time we had a hurricane, we learned something. We regrouped, shared the experiences and put the information into our plan."

The book includes procedures on how to prepare for virtually any disaster, including hurricanes, fires, floods, tornadoes, power outages, bomb scares, bioterrorism and malfunctioning heating or cooling systems. Although written to conform to Florida state requirements, chapters can be easily adjusted to accommodate other states' procedures, Polivka-West said.

Typical sections include pre-planning strategies, such as having a letter that can be quickly sent to family members, placement of identification wristbands on residents in case they are separated during evacuations, and updating of staff phone lists, staff and departmental roles and responsibilities during evacuations, and arranging transportation for the move.

Joe Doncbessis, executive director of the Louisiana Nursing Home Association in Baton Rouge, La., said his association developed "one of the best emergency preparedness plans in the country" after Hurricane Andrew hit Florida, Louisiana and the Bahamas in 1992 and caused $36 billion in damage [2005 dollars]--the most destructive hurricane in U.S. history until Katrina.

In general, the plan includes procedures on what to gather for the patient prior to an evacuation; contacting family members and giving them the option of picking up loved ones; having contracts with reliable bus services; and emergency routes out of town, Donchessis said.

It's also crucial to have a host site or sites waiting to accept your patients--something that can literally change overnight, Donchessis advised. "If you have an agreement with another nursing home, that home might have 80 residents one day and 95 the next," he said. "You have to constantly keep up with them to determine how you may have to adjust where your residents are going."

Still, there are some things that a disaster management plan can't handle, officials noted. One of those issues is the unpredictability of Mother Nature: a storm that seems relatively tame and "okay to ride out" can suddenly become life-threatening, Donchessis said.

Such is believed to be the case at St. Rita's Nursing Home in Chalmette, La., where the bodies of 34 persons--most of them elderly--were found after Katrina hit. According to Louisiana State Attorney General Charles Foti, the facility's owners refused to evacuate because they believed they could "ride out the storm" as they had during other such events.

Foti said deaths might have been avoided if St. Rita's staff had stuck to its established evacuation plan. St. Rita's owners, Salvador and Mabel Mangano, have been charged with 34 counts of negligent homicide and face up to 170 years in state prison, according to Foti.

Some of St. Rita's 34 dead still need to be identified, according to Foti. Two of the bodies could be family members or people who took refuge there, but the majority were residents, he said.

"We feel we have proven negligence," Foti said during a press conference." [The Manganos] did not follow the standard of care that a reasonable person would follow in a similar circumstance."

But the Manganos' attorney, Jim Cobb of Emmett, Cobb, Waits & Kessenich, said that he believes the Manganos' refusal to move was justified. "This facility had weathered every single storm for 20 years without a drop of water," Cobb told CNN.

Cobb said his clients are not criminals. If anything, he contended, they should be considered heroes for the fact they "saved 52 lives" after the water began to flood the facility. "To indict them for a crime under that set of circumstances is, in my view, out of bounds by the attorney general," Cobb said on CNN.

About the only thing people can agree on is that St. Rita's had an emergency response plan or disaster management plan--something required of all licensed Medicaid nursing homes in the state, according to Bob Johannessen, communications director at the Louisiana Department of Health and Hospitals in Baton Rouge.

The details of those plans remain a mystery, Johannessen said. "Those are kept on file at the local Office of Emergency Preparedness, which at this point is in the same condition as the facility--under water," he said.

According to Donchessis, the "look what happened last year" scenario might have also played a major role in the tragedy at St. Rita's. He noted that when facilities were evacuated in September, 2004 in response to Hurricane Ivan, the evacuation buses ended up stuck in a 12-to-14-hour traffic jam. Residents from several nursing homes died before they could get to safety/Given that situation, recent history tells us it might be safer to shelter in place than risk going through traffic," Donchessis said.

A similar situation from late September further emphasized Donchessis' point. On Sept. 22, some 24 residents of Brighton Gardens of Bellaire, an assisted living facility near Houston, were killed on a jammed Dallas highway when their bus caught fire. The seniors were being evacuated in advance of Hurricane Rita, which was expected to hit the Houston area by that weekend, according to Paul Williams, media relations person at the Assisted Living Federation of America (ALFA) in Fairfax, Va.

Another factor is that the extent of the danger can vary from storm-to-storm--meaning that safety precautions that worked for one hurricane might not be as effective during the next, according to Polivka-West. During evacuations for Hurricane Charley in August, 2004, the association's disaster plan called for use of ambulances at the nursing homes. But that could not be followed because all the hospitals had to be evacuated and they had priority, Polivka-West said.

"Even with the best-laid plans, it depends on the extensiveness of the event as to whether or how you can follow your plans," she said. "Still, we didn't lose anybody last year in four hurricanes, so we must have gotten it right."

LeBlanc said that he thought he and his staff had gotten it right when they made a three-day reservation at a Houston hotel as they planned their evacuation from New Orleans. But when Hurricane Katrina's aftermath turned into an extended ordeal, the group of 70-plus consumers and 46 staff members had a major problem. "We couldn't stay longer, because the hotel had already sold the rooms," he said. "We eventually found another hotel for a few more days, then rented, sight unseen, a slew of apartments in a Houston complex. We figured we had to do something for these folks."

When those apartments turned out to be uninhabitable--"they were maggot-filled," LeBlanc said--the group took refuge at the Houston Convention Center. A short while later they heard about the Methodist Conference Center in Palestine. "We landed in heaven that night," LeBlanc said. "I count my blessings every day that we landed where we did. We kept running into people with great spirits and great hearts."

Emergency response plans also require a high level of cooperation by all involved, according to Minnix.

For example, despite having several hundred members who are willing to take in displaced residents, brokering needs with resources has proven difficult because of different approaches by the Federal Emergency Management Agency (FEMA) and AAHSA, Minnix said. "We have different rescue strategies," he said. "FEMA puts people on airplanes, sends them to different cities and gives them debit cards. Our strategy has been to find out what the need is in the local situation and then help people find a place to live. I have members who are totally willing to go to New Orleans and get people. That's an entirely different strategy from putting people on an airplane and sending them to another city."

Disaster response plans are also only as good as the team that tries to implement them, according to Marc Morial, president and chief executive officer of the National Urban League in New York City. "There's a certain component of disaster response that requires battlefield-type decision making, because there are always unforeseen circumstances," said Morial, who endured his share of hurricanes and other natural disasters during eight years as New Orleans' mayor. "That's why you bring experts together in a command center to deal with it."

Expect a lot of clean-up duty after the response plan is implemented and the crisis has passed, according to Charles Gould, president and chief executive officer of the Volunteers of America at its national headquarters in Alexandria, Va.

For example, the association is still trying to locate clients and staff members who evacuated to different parts of the country as they fled Katrina, Gould said. "We're trying to find them to make sure their needs are being met. But people got scattered so far," he said. "Not all of them were evacuated. Some people just got in their cars and went to families in other areas. They may not be in the same situation as some people, but we're still anxious to know where they are."