When disaster strikes, U.S. isn't always "Uncle Sugar." (View from Washington) (Column)

With a sound that some eyewitnesses describe as a "herd of locomotives," an earthquake struck southern California at 4:31 AM on Monday, January 17. One of the largest nursing homes in the area, the 750-bed Jewish Home for the Aging of Greater Los Angeles, has a campus only a half-mile from the epicenter of the quake. Michael Turner, director of public affairs for the home, describes how cables tested at 12,000 pounds were snapped like strings and how foot-long anchor bolts were pulled from concrete by the force of the tremor. Fortunately, casualties on-site consisted of a single patient suffering a broken hip.

On the other side of the continent, a different type of disaster occurred during southern New Jersey metropolitan area. Two weather systems collided over the city, causing a freak ice storm that tore down power lines, smashed roofs, and made all major roads impassable. More homes and businesses lost electric power from the ice storm than from the earthquake and, in the end, there was a larger death toll from the freeze.

In early February, Congress passed the largest domestic disaster relief bill in the history of the United States. Over $8 billion has been committed by the federal government to help recovery from the destruction caused by the January earthquake. The Jewish Home for the Aging will be one of the beneficiaries of this bill, receiving approximately 70 percent of the cost for repairing major damage in a grant from the Federal Emergency Management Agency, or FEMA. The nursing homes of greater Philadelphia, in contrast, will not receive any federal compensation for the disastrous ice storm.

This underscores one premise for federal disaster services: They are generally not applicable in situations where it is believed that local support services -- public utilities, streets maintenance, etc. -- will be able to restore order reasonably soon, as was the case in Philadelphia. But there are other limitations, as well, of which nursing homes should be aware.

The basic structure for national emergency management, including the creation of the Federal Emergency Management Agency, follows a blueprint laid out by a special task force of the National Governors Association (NGA) in 1979. The NGA Emergency Preparedness Project sought to end the confusion of dozens of federal agencies having a piece of the disaster pie, while keeping basic control of emergency services in the hands of state government. The result is a system in which the federal government acts only at the request of a state governor, and in which the basic unit of disaster response is the county emergency management team.

According to Veron Wingert, a former deputy director of the NGA Emergency Preparedness Project who now works at FEMA, the original concept of emergency management services divides all disaster-related activities into four phases: long-term mitigation of the impact of potential disasters; short-term preparedness for an emerging crisis; immediate response to the crisis; and long-term recovery from the disaster. Public-private partnerships are active throughout the process, but particularly during the long-term mitigation and recovery phases.

The experience of the Jewish Home for the Aging in Los Angeles shows the FEMA concept in action. Like most businesses in southern California, the home has no earthquake insurance because rates and deductibles are too costly. On the other hand, the home had developed a prearranged step-by-step plan for responding to an earthquake. The plan began with all available staff participating in an immediate inspection of the entire facility, to identify injuries, respond to the fears of the residents, and locate any structures in danger of collapsing. On January 17, according to Michael Turner, the inspection was complete within 20 minutes so that administrators knew exactly what problems needed to be corrected.

The most pressing physical concerns after the earthquake were the loss of electricity, gas for heating and cooking, and water, and the inability of the Monday morning day shift to reach the facility through debris-clogged streets. Although water mains and gas lines on the nursing home campus were intact, there were so many breaks elsewhere in the city that normal toilet and kitchen operations could not be restored for four days due to lack of water pressure. Again, advance planning made the difference, with staff quickly installing plastic basins in the non-functioning toilets and supplying the residents with balanced cold meals. Nurses handed out flashlights and those administrators who could reach the home volunteered as clinical aides.

The residents of the Jewish Home for the Aging, with an average age of 90, came through the disaster better than any planning had anticipated. "We've been through a lot in our lives," was their general response. Employees, however, were very hard hit by the disaster. One LVN lost a husband and son in the collapse of the Northfield Apartment complex. Many others lost their homes and all of their possessions.

Responding to the needs of employees often is neglected in disaster planning, but the Jewish Home for the Aging made a positive commitment to use its own resources rather than wait for FEMA to help. The nursing home psychologists and social work staff were placed at the disposal of the employees, while daycare services, small emergency loans, and emergency overnight shelter were made available by the Jewish Home for the Aging to the 650 nursing home personnel. Staff members created a fund for the LVN who lost most of her family, while the Jewish Federation offered $1,500 interest-free loans to the employees, co-signed by the nursing home.

Recovery from the disaster is going to take many months. The greatest damage suffered by the Jewish Home for the Aging has been in the mechanical penthouses, where the air conditioning units were destroyed. Quick response by FEMA in providing approximately two-thirds of the cost of repair is helping nursing homes throughout southern California get a quick start on tackling the most obvious problems, such as this. In the end, however, effective development efforts make the difference in how quickly the remaining 30 percent of repair costs can be obtained.

For some types of emergencies, FEMA can offer nursing homes help in preparing for the onset of a crisis. Emergency communication systems, for example, can be provided that will link the home with the county emergency management team. These systems are useful in a radiological or weather-related crisis. There is no advance warning, however, for an earthquake, and the case of the Jewish Home for the Aging illustrates that planning for emergency use of a nursing home's own resources is the best way to limit the impact of a disaster on the home's residents and operations.