Rising above Katrina's floods.

Last year's deadly hurricane season tested the entire GulfCoast, especially in Louisiana. Hurricane Katrina devastated the southeastern Louisiana coast and nearly destroyed New Orleans. Three weeks later, Katrina's ornery sister Rita roared up the Gulf of Mexico to revisit parts of New Orleans before turning her wicked eye to the state's southwestern coast. For Louisianans, hurricanes are familiar weather events that usually involve a three- to four-day inconvenience. But the hurricanes of 2005 have not only left their mark in devastation, they have blown away any illusions of a quick return to normalcy. The members of the Louisiana Assisted Living Association (LALA) are contemplating the lessons learned from Katrina and Rita and are revising their old emergency protocols accordingly.

Founded in 1999 to unite Louisiana's assisted living providers, LALA represents nearly 80% of the state's licensed assisted living capacity and serves as the industry's primary lobbying group. With an additional focus on education, association-sponsored seminars on topics such as emergency preparedness helped the assisted living sector resolve several evacuation and relocation issues before the first hurricane hit. In fact, last spring a meeting was held on disaster planning at which a representative from the Florida Department of Elder Affairs spoke to attendees about that state's experience in 2004 dealing with four hurricanes that hit back to back to back to back. Hearing about the logistics in caring for residents during that particular crisis caused jaws to drop around the room. As we listened, little did we know that we would soon be facing our own monumental challenges.

Fortunately, the spring symposium held a matchmaking session for northern and southern providers so they could establish predetermined relocation destinations for each other's residents before an evacuation order. These alliances proved invaluable a few months later.

The best evacuation approach, of course, is to encourage residents to leave with their families, if possible. However, because Katrina intensified very rapidly, that was not possible for residents who didn't have family nearby.

The Experience

With Katrina's winds and rain pummeling the southeastern Louisiana coast, many residents were evacuated to facilities in the southwest. Within weeks, the host communities fell under their own evacuation order as Rita intensified. Consequently, Katrina evacuees had to be re-evacuated along with the permanent residents, creating additional transportation problems. In one case, a school bus and a National Guard bus were needed for the new evacuations.

Because of the magnitude of the disaster and the large number of displaced assisted living and nursing home residents, it was a challenge finding housing for all those in need within the state. Housing arrangements were made with facilities in Texas and Arkansas, and providers across the country called and sent e-mails offering accommodations for the hurricane victims. Meanwhile, providers in northern Louisiana manned phones to locate rental properties for displaced staff members, as well as beds, mattresses, and furniture for residents. Everyone was scrambling to make use of any space available.

The Aftermath

The storms have passed but the challenges continue. New Orleans AL providers represent approximately 40% of the state's licensed AL capacity. Today, assisted living communities in the New Orleans area that escaped extensive damage have rooms available. The problem is staffing. LALA posts job openings on its Web site, but until the city reestablishes permanent housing, the severe shortage of direct-care staff will continue. Added to this is the task of emotional recovery. Some caregivers couldn't even locate their own family members for days or weeks, on top of which was the stress of not knowing if they had a job or a home to return to, or what their future holds. In sum, until providers can rebuild staff and get them into work, many communities are accepting only independent living residents.

For the first two weeks post-Katrina, the LALA phones rang 24/7. Association staff fielded calls from around the country from families trying to locate their loved ones. Meanwhile, we were trying to track down providers to get an update on their status. Because we did not have copies of their evacuation plans, we did not know where all our members had evacuated. We were unaware, for instance, that some providers had arrangements with hotels and resorts that were out of harm's way. Having that information readily available would have helped us answer questions on the whereabouts of residents and staff more quickly and efficiently.

Phone systems were so badly damaged that is was difficult to make outside calls. Cell towers were blown down, making cell phones worthless, and satellite phones were in short supply. In the end, e-mail was the primary method of communication with those members that were still operational. Executives from various state assisted living organizations also pitched in to help us get things done, and I worked closely with the executive director of the Florida Assisted Living Affiliation, who made many necessary calls for us.

Problems to Resolve

The crisis brought many emergency preparedness problems to the surface--problems that need to be addressed. For example, in Louisiana, assisted living staff are prohibited from assisting cognitively impaired residents with their meds. For residents with dementia, the law requires that family members handle medication responsibilities or that they contract with a third-party provider for that service. This regulation needs to be reexamined because, as evidenced by our recent hurricane experiences, family and third-party providers do not evacuate with the residents. Along with the regulatory problems, other medication issues need to be considered in disaster plans. Usually, only a 30-day supply of meds is kept on hand. What do you do when you can't contact or even locate a pharmacist for an extended period of time? How do you obtain pharmacy records when the pharmacy is destroyed?

After securing the safety of their residents, facilities need to take steps to minimize the risks to their organizations. Nature doesn't always allow time to pack up every important record for an extended time. Insurance papers, medical records, licenses, floor plans, bank records, tax records, and ownership papers are among the many vital documents that need to be protected and readily accessible following a disaster. I would suggest keeping copies of records at alternate sites so they can be accessed if the originals become lost or destroyed.

LALA recommends that facilities protect themselves from the start by detailing their disaster plans in the resident contract. Let families know in advance how the facility handles emergency situations that might displace a resident for an extended period of time. Have an attorney review this addition to the contract. Then, the resident or responsible party should sign off and acknowledge these provisions.

Conclusion

Louisianans are accustomed to riding out hurricanes without a hitch. That complacency was forever dispelled last summer. Our members were heroic in their endeavors. But they, too, suffered. Nearly everyone in the storms' paths suffered a loss of one kind or another. Administrators, staff, and the residents who call our buildings home felt loss, too. In February, LALA will present educational seminars on stress management and grief to help our LALA members cope with the way things are now and help them move ahead with their lives.

Seeing the devastation and being overwhelmed with the challenges of aiding those in need and reestablishing our network of communities was my most challenging professional experience. But it was also the most moving, as I witnessed the triumph of the human spirit and what can be accomplished when people work together.

Lisa Comeaux is President of the Louisiana Assisted Living Association. For more information, call [phone] or visit www.laassisted.org. To send your comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].