by WECAN DO · 2006 — AARP’s commitment to better protecting older persons in disasters. caregiver/overview/Just_in_Case030706_links.pdf or at aginginstride/.

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WE CAN DO BETTER:LESSONS LEARNED FOR PROTECTING OLDER PERSONS IN DISASTERS ByMary Jo Gibson With Michele Hayunga The AARP Public Policy Institute, formed in 1985, is part of the Policy and Strategy Group at AARP. One of the missions of the Institute is to foster research and analysis on public policy issues of importance to mid-life and older Americans. This public ationrepresents part of thateffort. The views expressed herein are for information, debate, and discussion, and do not necessarily represent official policies of A ARP. © 2006, AARP. Reprinting with permission only. AARP, 601 E Street, NW, Washington, DC 20049

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2Lessons Learned forProtecting Older Persons in Disasters ACKNOWLEDGMENTS Many individuals have made significant contributions to this report. First, we wish to thank Michele Hayunga, who reported the proceedings of the AARP conference held on December 1, 2005. That conference was spearheaded by Dalmer Hoskins, managing director of policy at AARP. Others who played key roles in organizing the conference were Elizabeth Clemmer, associate director of AARP’s Public Policy Institute (PPI), Lisa Stand and Molly Long of Office of Policy Integration (OPI), and many members of the PPI Independent Living and Long-Term Care Team, especially Andrew Kochera and Sheel Pandya. Shirley Ross and Tyaisha Williams of PPI and Gwen Craig of the OPI provided logistical support. Critical guidance in organizing the conference was also provided by Hilary Styron of the National Organization on Disability. Julie Cohn, AARP regional director, and Bentley Lipscomb, AARP Florida state director, chaired panels, and Lucy Theilheimer, director of AARP Strategic Planning, led the stimulating and lively participant discussions that occurred throughout the day. Last but far from least, we thank Dr. Georges Benjamin, the keynote speaker and the executive director of the American Public Health Association, the 12 con- ference panelists from diverse organizations, and more than 100 participants who shared their expertise and resources. Ari Houser of AARP’s PPI played a central role in developing the three questions used in the Harris Interactive survey of persons age 50 and older, which was conducted in November, 2005, under the leadership of Diana Gravitch. Shelly-Ann Sinclair of PPI provided valuable editorial assistance.Special thanks are also due to the host of individuals who reviewed the report and provid- ed valuable insights and suggestions, including the conference panelists, and many AARP staff. These staff include Ilene Henshaw and Susan Weinstock of AARP’s State Affairs Department, Mimi Castaldi of AARP’s District of Columbia Office, Bentley Lipscomb of AARP’s Florida State Office, Patti DeMichele of AARP’s Louisiana State Office, Jo Reed and Rhonda Richards of AARP’s Federal Affairs Department, Lisa Stand of OPI, Lee Rucker of PPI, Brewster Thackeray of the Office of Social Impact, and Robin Talbert of the AARP Foundation. Finally, AARP Creative designed the report. Mary Jo Gibson

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TABLE OF CONTENTS 3Lessons Learned forProtecting Older Persons in Disasters Foreword 4I Executive Summary 5II Introduction 11III Special Risks Faced by Older Persons in Disasters 17IV The Emergency Management System and Older Americans 21V Principles for Preparedness 25VI Lessons Learned and Promising Practices for Protecting Older Persons in Disasters 29Improving Planning and Communications 30Highlights from the AARP Conference 30Other Promising Practices and Lessons Learned 34Identifying Who Will Need Help and What Kind of Help: Registries, Tracking, and Medications 40Highlights from the AARP Conference 41Other Promising Practices and Lessons Learned 46Evacuating Older Persons in the Community and Nursing Homes: Transportation and Sheltering 48Highlights from the AARP Conference 49Other Promising Practices and Lessons Learned 54VII Concluding Remarks 59VIII Appendix 61Conference Agenda 62Discussion at the AARP Conference 64Biographies of Panelists 70Older Persons and Evacuation: Who Needs Help? A Survey of Americans Age 50 or Older 72Glossary of Emergency Preparedness Terms 73Selected Resources 75Endnotes 76

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4Lessons Learned forProtecting Older Persons in Disasters FOREWORD The searing images of older persons affected by hurricanes Katrina and Rita in the Gulf Coastregion in September 2005 sparked the writing of this report and the conference upon which it is based. Along with the millions of other Americans watching the news during that month and even as we go to press, we at AARP are convinced that our nation can surely do better in protect- ing older persons in disasters. In search of lessons to help prevent what happened in the Gulf Coast from ever happening again, John Rother asked the Public Policy Institute to bring together a diverse group of national leaders and state and local representatives “who have been there.” This report condenses the key lessons learned from that intense day of discussions in December 2005. In addition, Mary Jo Gibson of AARP’s Public Policy Institute integrated diverse sources from an extensive literature review to identify the special vulnerabilities of older persons during disasters andto provide concrete examples of promising practices and helpful resources. We hope that this report and its recommendations help to spark action at federal, state, and local levels of government to better protect older persons and persons with disabilities during disasters. We also hope that it helps to further dialogue and partnerships among key networks that have so much to learn from one another: the aging community, the disability community, and the emergency preparedness and disaster relief communities. Elizabeth Clemmer Associate Director, AARP Public Policy Institute

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INTRODUCTIONAn estimated 1,330 people, many of whom were elderly, were killed as a result of Hurricane Katrina. The vast majority of fatalities were in the New Orleans metropolitan area, with substan- tial numbers in Mississippi as well. In Louisiana, roughly 71 percent of the victims were older than age 60, and 47 percent of those were over age 75. Most of these victims died in their homes and communities; at least 68—some of whom were allegedly abandoned by their caretakers—were found in nursing homes. As of February 17, 2006, 2,096 people from the Gulf Coast were still reported missing. 1For the older people who survived, the emergency response problems often resulted in inappropriate displacements, deterioration in health and functioning, or other harms, even though these are more difficult to quantify. This report and the conference on which it is based were sparked by those events and signal AARP’s commitment to better protecting older persons in disasters. Older persons are likely to be disproportionately vulnerable during disasters because they are more likely to have chronic illnesses; functional limitations; and sensory, physical, and cognitive disabilities than are those of younger ages. In addition, they often take multiple medications, rely on formal or informal caregivers for assistance, and, especially at advanced ages, experience gen- eral “frailty.” Other factors that increase older persons’ vulnerability in emergencies and disasters include living alone and in isolated rural areas. On December 1, 2005, AARP convened a diverse group of government officials at federal, state, and local levels; emergency preparedness and response experts; relief organizations; and aging and disability advocates to identify lessons learned and share promising practices in protecting older persons in disasters. The goal of the conference was to bring the right stakeholders together to explore workable strategies for the future to better protect older persons in both the communi- ty and nursing homes. All of the panelists and most of the participants were “people who have been there.” PURPOSE AND METHODS This report presents highlights from the AARP conference, an extensive literature review, and data from a short survey of persons ages 50 and older conducted by Harris Interactive on behalf of AARP in November 2005. The intent of the report is to provide suggestions and links to prac- tical tools and resources that will be helpful to policy makers at federal, state, and local levels; nongovernmental organizations; and older persons, family caregivers, and persons with disabili- ties. While the vulnerabilities of older persons in disasters overlap with those of other vulnerable populations, including younger persons with disabilities, older persons also face special health and other risks with advancing age. The report addresses the following issues as they relate to older persons in the community and in nursing homes: (1) planning and communications; (2) identifying who will need help and what6Lessons Learned forProtecting Older Persons in Disasters

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kind of help, including registries, tracking, and medications; and (3) evacuating older persons, including transportation and “special needs” shelters. These topics span two phases of disaster events—preparedness and response. The recovery phase of disasters, while critically important and currently under public scrutiny in the aftermath of hurricanes Katrina and Rita in the Gulf Coast, is beyond the scope of this report. CONFERENCE HIGHLIGHTS AND OTHER LESSONS LEARNED Planning and Communications Older persons and persons with disabilities, whose needs may overlap, face special risks duringdisasters. Government emergency planning documents or processes at any level—federal, state, or local—rarely mention the needs of vulnerable older persons. Among the recommendations made at the conference and in the literature are: Establish clear lines of authority among federal, local, and state governments as well as withprivate sector entities, including nursing homes, with regard to emergency management, especially evacuations of older persons. Engage in integrated/coordinated planning that begins at the neighborhood/facility and com- munity levels but reaches to the state, regional, or even national level. Develop strong relation- ships and partnerships before disaster strikes. Provide public information on emergency preparedness to older persons and persons with dis- abilities that is appropriate to their needs and in accessible formats. As part of these focused education efforts, include information about the need to evacuate if an order to evacuate is given and what can happen if one does not do so.Explore the psychological as well as other barriers to heeding orders to evacuate, and ways to overcome them. Educate older persons and others to have emergency supplies ready to “shelter in place” for three to six days without power or being able to go out for food, water, or medicines, and to make a personal plan to meet their “special needs,” such as temporary back-up power for home dialysis. Train emergency management personnel in the needs of older persons and train aging network personnel in emergency management procedures. Practice plans regularly and include older persons and persons with disabilities in emergency drills and training exercises. Make better use of aging and disability experts in planning for and responding to disasters, including making better use of “aging network” resources and expertise. Ensure that the federal Interagency Coordinating Council on Emergency Preparedness and Individuals with Disabilities also addresses the needs of vulnerable older persons who do not have disabilities.7Lessons Learned forProtecting Older Persons in Disasters

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Create a team that mirrors the management structure of the federal National Response Plan to support the needs of older persons and persons with disabilities. One component of this team would be a permanent, designated liaison who would report directly to the principal federal officer (PFO). Provide more funding to the U.S. Administration on Aging (AoA) to develop and implement its emergency management responsibilities on behalf of older persons. Use a combination of methods for public emergency notifications in alternative formats, such as both audible and visual cues to reach populations with sensory and cognitive disabilities, and develop close working relationships with the media to publicize the availability of hotlines in alternative formats. Have at least three backup communication plans and test at least one of them regularly. Identifying Who Needs Help and What Kind of Help A key finding from the Harris Interactive survey is that about 13 million persons age 50 or olderin the U.S. say they will need help to evacuate, and about half of these individuals will require help from someone outside of their household. This proportion increases with advancing age. Among the recommendations made at the conference and in the literature: Make identifying, registering, and tracking older persons who cannot evacuate on their own a high priority in local communities. Have aging services staff work with clients to develop individualized emergency plans and coor- dinate this work with local emergency management personnel and those responsible for “special needs” registries. Encourage voluntary use of “special needs” registries. Pay special attention to the needs of persons with dementia and take advantage of special pro- grams, such as the Alzheimer’s Association Safe Return Program. Use special tools being developed to quickly assess the needs of frail older adults who have been evacuated to settings in the community. When preparing for disasters in nursing homes, ensure that residents and their medical infor- mation, including medications, can be identified during and after evacuation. Move toward a national electronic health record that protects individual privacy, learning from experiences of the U.S. Department of Veterans Affairs, which has a consolidated records sys- tem that uses bar codes and captures medical history, medications, and the like. In the interim, encourage individuals to write down their medications, including dosage, aller- gies, and conditions, on an index card and keep it with them at all times. Encourage consumers to take advantage of their local pharmacy’s computer tracking system by filling out a medication profile that lists all current medications, and to take a waterproof bag with their current medications, even if the bottle is empty, if they have to evacuate. Invest in better technology to track individuals during emergencies, such as using “smartcard” chips, while protecting individuals’ privacy and confidentiality. 8Lessons Learned forProtecting Older Persons in Disasters

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Evacuating Older Persons: How and to Where? The lack of specific evacuation plans for older persons in the community and in nursing homes is a major problem. Among the key practical issues are how to transport older persons and persons with disabilities safely and provide accessible shelters that are appropriately equipped and staffed to meet essential needs.Among the recommendations made at the conference and in the literature: Plan at the community level to provide accessible transportation for persons with mobility limi- tations or low vision or for others unable to transport themselves.Provide a notification hotline or other mechanism to alert hospitals, nursing homes, and other residential facilities to begin early evacuations, and contact previously identified older persons and persons with disabilities in the community who will take longer to evacuate. Identify older persons and persons with disabilities who will need emergency transportation. Include plans for transporting emergency supplies and appropriate labeling of medications when evacuating nursing home residents. Coordinate plans with transportation vendors for nursing homes residents with other facilities and community groups to avoid having too many providers relying upon too few vendors. Plan for transportation for long-term care facility staff as well as truck rentals to get water, food, and medical supplies to facilities. Require long-term care facilities, under federal and state licensing standards, to have well- developed, feasible, and practiced emergency plans for residents that are on file with the state; these plans should include evacuating residents, transporting medical records and properly labeled medications and supplies, and providing for care outside the facility. Plan for evacuating the families of long-term care facility staff and providing for their care. Adopt “special needs” shelter legislation at the state level that provides for appropriate registra- tion, transportation, staffing, and discharge policies. In addition, “special needs” shelter poli- cies should provide for coordination with community-based aging and disability organizations. Address barriers to the accessibility of public shelters by persons with disabilities, and the cre- dentialing of health personnel so they can gain access to shelters and other evacuation sites. Provide for a sufficient number of shelters that have backup generators to power life-sustaining medical devices. 9Lessons Learned forProtecting Older Persons in Disasters

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