Protecting Our Most Vulnerable Citizens From Flood Risks

Coastal areas in the U.S. have experienced several hurricanes costing too many lives and billions in property damages. The impacts from these storms, sometimes miles inland from the coasts, have fallen hardest on vulnerable residents of nursing homes and assisted living facilities. In 2005, hundreds of nursing home residents drowned in Hurricane Katrina’s floodwaters. Sadly, even with the harsh lessons of Katrina, a lack of preparation by nursing homes was evident during the major hurricanes of 2017 and 2018. Through proper education, planning and investments, however, nursing homes and assisted living facilities can and should better protect their residents from storms and floods, including the effects of power failures.

About 1.5 million people live in U.S. nursing homes. And, more than 10 million Americans — mostly 65 or older — need long-term services and support to help them with daily activities. Of the 877 direct fatalities from Hurricanes Katrina and Rita, 12% were nursing facility residents. Almost half the adults living in nursing facilities reside in hurricane-prone Gulf and Atlantic Coast states.

A year after Hurricane Irma and the tragic nursing home deaths at the Hollywood Hills Rehabilitation Center, the US Senate Committee on Finance released “Sheltering in Danger, How Poor Emergency Planning and Response Put Nursing Home Residents at Risk During Hurricanes Harvey and Irma.” The Senate report stated:

“In addition to the people who died [at Hollywood Hills from hurricane impacts], more than 100 residents had to be evacuated, evaluated and appropriately treated, underscoring that the facility’s missteps put many more people at risk.”

“Hurricanes are not rare, unexpected events. They are a common occurrence that climate scientists expect will increase in frequency and intensity as ocean temperatures continue rising, along with more extreme drought and heat bringing the devastating force of hurricanes, destructive winds, catastrophic storm surges, and widespread flooding.”

Credit: CNN

Credit: The New York Times

A North Carolina firefighter holds on to two nursing home patients as a member of the “Cajun Navy” drives his truck during the evacuation of a nursing home due to rising flood waters. At the La Vita Bella assisted living facility in Texas, residents spent hours in waist-deep water waiting for help.

The Senate report recommended standard assessment of the risks of evacuating residents versus sheltering in place.

The decision to evacuate prior to a major weather event, barring a mandatory evacuation order, typically falls on administrators of a long-term care facility in consultation with emergency services agencies. A decision to shelter-in-place must be supported by the capability of the facility to function for the duration of the storm and days afterwards.

But, what does such a “capability” entail?  Is it just the presence of backup power or does it also include keeping initial flooding and secondary flood waters away from the building and backup generators? The Centers for Medicare & Medicaid Services and state regulatory agencies should ensure that long-term care facilities in or near federally-designated flood zones address flooding risks in their hazards assessments and include flood monitoring in their emergency plans.

As the Senate Report concluded, “if a decision is made to shelter-in-place, then preparations, facilities, staff, and procedures need to be robust enough to do so.”

The Florida Agency for Health Care Administration reports that just 88 of the state’s 683 nursing homes evacuated due to Hurricane Irma, while 635 of the 3,109 assisted living facilities evacuated. If most long-term care facilities don’t evacuate their patients, and most facilities have not invested in any flood risk assessments or defenses, there is substantial risk that patients could be injured or even drown in a flood event.

FEMA Flood Maps Don’t Tell the Whole Story

Mexico Beach Storm Surge Impacts

Hollywood Hills Rehabilitation Center

Most nursing homes and assisted living facilities likely know little about their risks of flooding other than their location relative to a FEMA-designated flood zone. But, there are serious problems with the accuracy and comprehensiveness of FEMA flood maps.  FEMA maps fail to include heavy rainfall flooding, a huge problem in the Houston area from Hurricane Harvey. Even after a storm has passed, secondary flooding effects can cause extreme damage, as was the case with Hurricane Florence in North Carolina.  In coastal areas, FEMA’s flood maps are typically less reliable than NOAA storm surge models or data from private companies such as Coastal Risk. In the case of storm surge damages at Mexico Beach, FL from Hurricane Michael, hundreds of homes in FEMA’s ‘500-year’ risk zone were completely demolished and hundreds of nursing home patients had to be evacuated.  

Nursing Homes and Assisted Living Facilities Need to Defend Against Flooding

Not every nursing home or assisted living facility has equal flood risk. However, for those long-term care properties with flood risks, the type of risk matters. Is the risk from a river or stream, heavy rainfall or hurricane storm surge? Does the force of surging waves become a factor? New technologies, like flood risk assessments from Coastal Risk’s, quickly and inexpensively assess the flood risks for any long-term care facility in the U.S. for all four types of flooding: river, heavy rainfall, storm surge and tides. With these new technologies, authorities can “triage” the flood safety of nursing homes and assisted living facilities including cost-effective investments in permanent or removable flood barrier systems well in advance of any storm or flood event.