In 1963, an electrical fire at the Golden Age Nursing Home in Ohio killed 65 residents. Some were restrained in their beds, and the facility had no evacuation plan.
After Hurricane Katrina in 2005, the owner of the St. Rita’s Nursing Home near New Orleans decided to forgo evacuation. A wall of water killed 35 residents.
More recently, a power outage caused by Hurricane Irma left the the Rehabilitation Center at Hollywood Hills in Florida without air conditioning for several days. Eleven residents died.
How prepared would similar facilities in Hawaii be if disaster struck?
The level of protection for Hawaii’s kupuna in nursing and care homes varies.
Almost all of the larger skilled nursing facilities in the state, as well as more than 110 other health facilities, have access to emergency services through the Healthcare Association of Hawaii Emergency Services Coalition.
HAH is a nonprofit organization that represents Hawaii’s major health care providers and is federally funded through a Hospital Preparedness Program grant. It has an administrative team of three and access to volunteer physicians, public health personnel and other support staff.
All of the facilities have backup power generators in case of outages, said Christopher Crabtree, director of the HAH Emergency Services Coalition.
Participation in the coalition is voluntary and comes with the agreement that in a disaster, facilities are willing to send employees to where help is most needed and share their resources.
Some of these employees make up the Kalawao Rescue Team, the coalition’s disaster medical assistance team of more than 100 health professionals who can be dispatched to member facilities in the event of a disaster or power outage.
Member facilities can also have their disaster plans reviewed and approved by the coalition. Those plans include evacuation and shelter-in-place procedures.
In addition, HAH recommends protocols for chemical threats, explosions and epidemics.
“A centralized health care association is important, because it ensures that we are all on the same page,” Crabtree said.
“The only problems that we have are with the ‘mom and pop’ nursing homes,” he said. “I just don’t have the resources to support that number, and that’s unfortunate, I wish we could.”
The coalition would need an additional half-million dollars to hire two employees and provide the communications equipment needed to serve smaller care homes, often referred to as Type-1 facilities, Crabtree said.
Type-1 facilities are often operated in residential areas by families with basic levels of nursing certification.
Care homes that house five or fewer residents can choose to be represented by the Alliance of Residential Care Administrators. More than 190 have done so and pay a yearly membership fee of $150 for liability insurance, in-service training and a budget for a lobbyist representing Type-1 facility interests.
But in emergencies, ARCA doesn’t have the resources to support the care homes outside of its ability to deploy ARCA volunteers, according to Lilia Fajotina, vice president of ARCA.
Because ARCA’s entire budget is comprised of membership fees, the organization doesn’t have an office where it could store emergency provisions for Type-1 facilities. Instead, ARCA administrative officers meet monthly at Aiea Public Library.
Type-1 facility operators like Ema Arelliano, who has run an adult residential care home in Kaimuki for more than 20 years, said that on night shifts when only one person is on duty, family members who also work at the home and live nearby could be called to come help in an emergency.
Home Away From Home serves four senior residents.
“We have a care home and a family home nearby, so help is never far way,” said Arelliano, whose facility is registered with ARCA.
When it comes to evacuation plans, the standards that small facilities have to meet also differ.
Larger skilled nursing facilities, those wth six or more patients or residents, are required to comply with federal guidelines outlined by the Centers for Medicare and Medicaid Services for disaster preparedness, which include the mandate that they must be reviewed and updated regularly.
Edna Abad runs a small senior care home in Pearl City with her husband, where they care for just three residents.
“The last time we updated our plan was three years ago after a tsunami warning,” Abad said. “If it’s between life and death, we’ll just get in the car and go.”
Smaller care homes and facilities — which collectively house more than 1,500 of Hawaii’s kupuna — are required to follow the more lenient state guidelines.
“The smaller (care homes and community foster homes) don’t have federal oversight,” said Janice Okubo, communications director for the state Department of Health.
The state guidelines don’t require care home operators to update their plans, and the guidelines themselves have not been updated since they were created in 2006.
For most Type-1 facilities, disaster preparedness consists of an evacuation plan and monthly fire drills.
In comparison, a recent rule for facilities that follow the federal guidelines requires all Medicare facilities to participate in two conference-level disaster preparedness drills a year with HAH’s Emergency Services Coalition.
Some people believe that communities should be more intricately involved in the emergency preparation process for small senior care homes in residential areas.
“Right now, the key people are the neighborhood boards, they’re the ones feeling the pulse of their neighborhoods,” said Ray Tsuchiyama, former deputy director of the National Disaster Preparedness Training Center.
“Communities like Makaha, Hawaii Kai, Waimanalo, Hauula are in the forefront already, they are the ones leading in disaster preparedness because they realize they’d be cut off from the rest of the island,” Tsuchiyama said.
Hawaii Kai Strong is a community organization that holds events meant to help residents with disaster preparedness. Topics covered include family disaster plans and the logistics of building a 14-day supply kit, using information supplied by Hawaii Emergency Management.
Some members of the group also go through a Community Emergency Response Training program, taught by HEM and comprised of three days of training in disaster preparedness, search and rescue, and practice exercises.
“When we do have any kind of disaster, we can assist — we can’t replace (first responders) but we can help,” said Matthew Glei, volunteer facilitator for Hawaii Kai Strong.
One of the biggest challenges facing care homes and assisted living facilities in the state is having sufficient staffing, said state long-term care ombudsman John McDermott.
“The one thing that is difficult to plan for is, what if your staff doesn’t show up?” McDermott said. “For our nursing homes, because the (federal funding) is not that great, staffing can be pretty tight and if the disaster was in the late evening, when there is a really small staff — then there are challenges.”
McDermott said that when Hurricane Iniki struck in 1992, he was working at Hale Nani Rehabilitation and Nursing Center in Honolulu. Not enough employees made it to work, he said, which made it a struggle for the few employees who reported for work to transport patients to safety.
“Our nursing homes are all in residential areas, and it would be nice if neighbors felt a sense of responsibility to go over to the nursing homes and help,” said McDermott.