My sister survived the pandemic in a nursing home. How will she fare in a climate disaster?
After this year’s natural disasters, I worry more about climate emergency preparedness at my sister’s nursing home than COVID-19.
My fears about nursing home virus outbreaks have receded, given widespread resident vaccination and mandates for health care workers.
But I anxiously monitor rain forecasts, concerned about damage to my sister’s facility from extreme weather. I have no idea what her facility’s evacuation plan is and neither does she. Late summer's Hurricane Ida ushered in tornadoes and flash flooding in the northeast, drowning 11 people in New York City basement apartments.
Rain thrashed my windows and puddles swelled into small rivers around my building. I imagined storm surge flooding my sister’s nursing home in Rockaway, New York. Her coastal facility escaped unharmed. This time.
Strengthening disaster planning
As the pandemic revealed cracks in our public health infrastructure, climate change has exposed vulnerabilities in the emergency preparedness of hospitals and long-term care facilities. While preparing for the next pandemic, we must also strengthen environmental disaster planning for health care institutions facing more frequent and severe hurricanes, droughts, heat waves, wildfires and floods.
Climate funding must bolster the emergency preparedness of health care facilities to protect our most vulnerable citizens and the availability of medical care for everyone. Inaction has already cost us poorer health, lost lives and taxpayer dollars.
A report from the National Resources Defense Council estimates the health care costs of climate change and fossil fuel production to be more than $820 billion per year.
Research shows that hurricanes, for example, might cause immediate increases in mortality and injury, worsening chronic illnesses, higher transmission of infectious disease and rising rates of mental illness. Taxpayers cover exorbitant, climate-related health costs through Medicare and Medicaid.
Hurricane Ida’s convergence with a COVID-19 surge left Louisiana hospitals juggling multiple disasters – a grim preview of our future if we fail to update and enforce health care facilities’ emergency plans. Seven nursing homes lost operating licenses after evacuating 843 residents to a crowded warehouse.
Frail people lay on mattresses without food or clean clothes, some wearing only soiled diapers, as trash piled and water entered the building. Twenty-six residents died, with five classified as storm-related deaths and investigations ongoing.
Wildfires also threaten health care facilities. A recent investigation found wildfire a “significant hazard” to 35% of California nursing facilities. And 78% had violated fire safety and emergency standards with little follow-up.
A federal audit recommended more inspections and staff safety training, but the state health department disagreed and cited insufficient resources for increased oversight.
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Disrupted care has severe health consequences for nursing residents with complex medical needs, including dementia, compromised immune systems, cardiac and respiratory issues.
A recent study found nursing home deaths rose 25% after power outages during 2017’s Hurricane Irma. Growing numbers of younger nursing home residents with disabilities like my sister also face cascading health risks of natural disasters.
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Most stressed families don’t ponder climate change prior to a relative’s admission to a hospital or nursing home. I didn’t. Little could I have imagined how consequential the location of my sister’s facility may prove one day.
Climate change and long-term care
Climate change barely crossed my mind last fall when coordinating my sister’s admission. I imagined an idyllic setting and hoped to escort her to the nearby boardwalk when lockdown ended. With limited time to research facilities, I scrolled past Google results that mentioned “Sandy” to information about COVID-19 deaths, Medicare star ratings, bariatric accommodations, staff and family members’ reviews.
After this summer’s record rainfalls, I researched the devastation Hurricane Sandy wreaked on nursing facilities clustered in the Rockaways before my sister lived there. Then, more than 4,000 nursing home and 1,500 adult home residents in New York City awaited evacuation for up to three days in the cold and dark.
Many long-term care residents endured weeks to months of displacement while facilities underwent repairs and families struggled to locate them.
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Gaps in the emergency preparedness of our health care facilities highlight critical connections among our physical, social and care infrastructure. Reducing fossil fuel emissions, investing in clean and renewable energy, and strengthening the power grid will also reduce health care costs and poor outcomes and alleviate growing health inequity.
Serious efforts to fortify the climate resilience of our medical infrastructure must invest in preventative mitigation rather than reward post-disaster response. Profit-driven health care systems won’t implement comprehensive safety plans without external regulation and sufficient funding for enforcement from state health departments. One route for leveraging government pressure is linking disaster planning to Medicare and Medicaid payments to health care facilities, much like the Hospital-Acquired Condition Reduction Program, which reduces Medicare payments to the worst-ranking hospitals on hospital-acquired conditions such as infections.
Closing facilities that fail emergency preparation isn’t a solution. Growing demand for limited long-term care requires upgrading structures to withstand more severe weather and better evacuation planning to ensure continuity of care. We have a responsibility to maintain safe permanent housing for nursing home residents and the supportive social networks they have cultivated in their facilities.
Residents in my sister’s facility have borne multiple adversities and COVID-19, as I learn during visits from a cheerful woman with diabetes who endured a recent leg amputation and COVID infection twice. Eighteen people in this 120-bed facility died of COVID, with seven presumed to have died from the virus.
What chaos will these survivors face with accelerating climate change?
I shudder at how a climate disaster would tear apart my sister’s world. With her serious mental illness and mobility issues, the trauma could be catastrophic. I have nightmares of her struggling to flee her room filled with her paintings of beach sunsets and wooded scenes she cannot traverse in her wheelchair. Would she receive her medications? When would she return? How would I find her?
We cannot fail nursing residents on climate change as we have with our lack of emergency preparedness during the pandemic. Nor can we claim being caught off guard at recurring climate disasters. If we continue on the path of inertia, we’ve chosen to sacrifice our most vulnerable citizens, including my sister.
Stacy Torres, a member of USA TODAY's Board of Contributors, is an assistant professor of sociology in the Department of Social and Behavioral Sciences at University of California, San Francisco.
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This article originally appeared on USA TODAY: First COVID, then climate change: Nursing homes aren't prepared
