Disaster Planning
in Residential
Care Settings
Niurqui Imbert-Mariano
Alzheimer's Association New
York City Chapter
http://www.alz.org/nyc/
646.744.2920
Nmariano@alznyc.org
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Dementia and Disasters
People with dementia
are particularly
vulnerable to
physical/emotional
trauma related to the
chaotic situations
around disasters both
large and small scale
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Hurricane Katrina
• Nearly half the deaths were of people aged 75
or older
• 141 People are still registered as missing
• 5,500 – 6,000 residents were displaced and
evacuated as a result of Hurricane Katrina
• First hurricane-related deaths occurred the
day before Katrina struck when three residents
died while being evacuated to Baton Rouge.
• Majority of the bodies found after the storm
were discovered near nursing homes or
hospitals
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Tornadoes
• Every state is at some level
of tornado risk
• Approximately 910
tornadoes occur in the U.S.
each year
• Safety pre-cautions
recommended during a
tornado are difficult or
impossible for the frail
elderly.
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Disaster Prone States
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Fire Safety
• 2300 nursing home fires are reported each year
• 1 in 7 nursing homes will have a fire in the
coming year
• In the last 25 years at least 500 residents have
died as a result of a nursing home fire.
• Large kitchen and laundry operations put longterm care facilities at a greater risk for fires
• Cognitive and physical impairments make
evacuation difficult during a fire
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Other Disasters May Include
• Earthquake
• Power Outage
• Flood
• Chemical Spill
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Local Stats
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Reactions may include:
• Limited ability to
understand what is
happening or being
communicated with
them
• Forget what they have
been told
• Decreased ability to
negotiate new
surroundings
• Varied reactions
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Catastrophic Reactions:
Occurs when a situation overloads the mental ability of the
person to react rationally.
May result in exaggerated response such as striking out,
yelling, making unreasonable accusations, or becoming
agitated and emotional.
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Be prepared for residents to…
• Hide
• Fight
• Pacing
• Refuse to leave
• WANDER
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Dementia and Wandering
It is estimated that in the United States, at least one long term
care facility resident will wander away and die each week if
wandering behavior is not seriously addressed.
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Dementia and Wandering
Aimless or purposeful motor
activity that causes a social
problem such as getting lost,
leaving a safe environment or
intruding in inappropriate
places.
Wandering can occur on foot,
in a car or on public
transportation
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Dementia and Wandering
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•
Confusion
•
Inability to recognize familiar
people, places or objects
•
Fear arising from
misinterpretation of sights and
sounds
•
Looking for an object
Wandering Behavior
 4-26% of nursing home
patients wander
 Up to 67% of
community residing
patients wander
 If not located within 24
hours up to 50% risk
serious injury or death
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What we know about wandering
 95% of people are found within 1.5 miles
 The majority of people wander on foot
 When wandering in a car, will go until they get stopped
or run out of gas
 Cannot always prevent the triggers that may cause
wandering
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The Urban Wanderer
 25% fatality rate if not found within 24
hours. Rate higher in hot or cold,
rainy climates
 The majority of people are found in structures (35%) or
along roads (36%)
 80% of those reported missing survive uninjured, 14%
survive but are injured and 6% result in a fatality
 Due to ease of travel along roads the distance that people
wander grows: 25% found within .2 miles, 50% within .7
miles, 75% within 2 miles and 95% within 7.8 miles
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Disasters: Working with the Individual
• Respond to the emotion
that the person is
experiencing
• Be patient
• Be calm
• Be thorough
• Remember that each
person is an individual
and may react differently
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Facility Wide Disaster Concerns
• Insufficient Plans
– Unclear responsibilities
– Lack of resources
– Unreliable transportation
• Distracted Caregivers
• Unprepared or confused
residents
• Additional crises during
relocation
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Recommendations
Within the facility:
• Identify most vulnerable residents
• Identify staff members with close
relation to those residents
• Identify words, objects, etc that
bring comfort to each resident
• Incorporate into disaster plan
• Train staff on disaster plan
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Recommendations
Work with local emergency
response
• Develop facility plan
• Familiarity with facility
• Assistance from trained
professionals
• Community registry?
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Recommendations
In the event of an evacuation:
• Work in conjunction with emergency
responders
• Remember that everyone MUST be
accounted for
• Remember to bring medications,
medical papers, etc
• May want to bring a pillow, photo or
other familiar object
• If the person is a MedicAlert + Safe
Return member, notify the service
regarding the events and the person’s
whereabouts.
• Be prepared to deal with wandering!
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Recommendations
Other things to keep in mind:
• Catastrophic reactions may
require additional staff
• Emergency receiving
facility/respite
• Transportation plans
• Contacting families
• Medical records
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Case Study #1
Ms. Jones
•
•
•
•
84 y/o
Widowed
Raised 3 kids- 1 lives in area
Loves cooking and assisting with
cleaning
Facility fire alarms are going off- staff suspects that the fire began in the
kitchen. Fire is contained but there is a lot of smoke and all residents
must evacuate. When firefighters knock at Ms Jones door she thanks
them for coming and is insistent that they help her change her lightbulb.
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Case Study #2
Garden Village of Valley Park
• Assisted living facility
• 15 residents in lower level
dementia unit
• Wide range of functional levels
and levels of cognition.
At 5:30 a.m. police come to facility and notify staff that all residents must
be evacuated to to a chemical spill in the area. As detailed in your
facilities emergency plan, a bus will be coming to transport residents to a
nearby school for temporary shelter.
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1.800.272.3900
www.alz.org
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