Nursing Homes Face Dilemma

By MARY FOSTER

NEW ORLEANS – The first victims of Hurricane Katrina never felt the raging winds, never saw the floodwaters. They were two elderly nursing-home residents who died on a school bus that took three hours to load and five hours to travel from New Orleans to Baton Rouge.

A third resident of the Ferncrest Manor Living Center died later at a hospital, and 21 others were treated for dehydration after riding buses that officials said were not air-conditioned, lacked water and had no certified nurses aboard. Authorities blamed the deaths on the stresses of the evacuation.

The tragedy illustrates the dilemma facing nursing home operators: Hurricanes can kill, but evacuating frail and elderly people can prove deadly, too.

“You’re damned if you do, damned if you don’t,” said Steve Yancovich, administrator of MeadowCrest Living Center in Jefferson Parish. “It took us 3 1/2 hours to load one bus, and we used three buses. That’s very stressful on people who are frail and it’s exhausting for your staff.”

The question of how to weigh those risks is at the center of a trial now under way, involving a different nursing home.

Mabel and Sal Mangano, the husband-and-wife owners of St. Rita’s Nursing Home in St. Bernard Parish, just outside New Orleans, are charged with negligent homicide in the deaths of 35 patients who drowned – some of their in their beds – after the Manganos decided not to evacuate. The case was expected to go to the jury as early as Friday.

Prosecutors said the Manganos should have heeded warnings and cleared out before the huge storm roared ashore. The defense maintained the Manganos had safely taken shelter in the sturdy brick nursing home for 20 years, and if levees had not broken they would have remained safe. The defense also noted that neither state nor local governments announced a mandatory evacuation.

Moreover, an expert in internal medicine and public health testified for the defense that loading such patients onto buses would have taken hours and endangered their lives.

“If you evacuate, somebody is going to die,” Dr. Brobson Lutz told the jury. “You’re dealing with a frail, elderly population.”

The plight of the elderly during and after Katrina has focused new attention on guidelines governing the evacuation of nursing home patients, and renewed debate over the risks of moving the infirm.

The number who died during or after the Katrina evacuation is difficult to count, since deaths were scattered across several states. By some estimates, nursing home residents accounted for almost 10 percent of the more than 1,400 deaths in Louisiana. As many as 55 of the deaths occurred during or immediately after evacuation.

Only 21 of the 57 nursing homes considered at risk during Katrina evacuated, authorities said. The rest chose to spare fragile residents a traumatic, possibly fatal trip.

Some of those who stayed suffered, too. At St. Rita’s, water reached the roof of the one-story building. At the Lafon Nursing Home of the Holy Family in New Orleans, 22 people died in the heat wave that came after the storm. Authorities are still investigating that home.

Louisiana officials hope they are now better prepared. New regulations require nursing homes to have emergency transportation and a safe location out of the projected strike area if a mandatory evacuation is announced.

“We have had every nursing home submit their emergency plans, including evacuation plans, and they have all been reviewed,” said Dr. Jimmy Guidry, medical director of the Louisiana Department of Health & Hospitals.

Joseph Donchess, executive director of the Louisiana Nursing Home Association, said the group backs most of the regulations but worries some residents could be evacuated unnecessarily.

“You could be spending a lot of time on the road if we have a busy hurricane season,” Donchess said. “There are a lot of storms that look like they’re headed to Louisiana then veer off.”

But “until everyone knows the levees are safe and they’re comfortable with them, nursing homes will evacuate if a hurricane comes anywhere near them.”

Under the new rules, the governor’s state-of-emergency declaration 72 hours before tropical storm-force winds hit Louisiana triggers a mandatory evacuation of nursing homes in the path of the storm. The idea is to move nursing home residents out before the highways become completely jammed.

Evacuation standards vary in hurricane-prone states, but strong storms in recent years have prompted many to rethink rules governing nursing homes.

In Florida, regulations only require nursing homes to file a disaster plan saying when they would evacuate, said Ed Towey, spokesman for the Florida Health Care Association. The decision of precisely when to leave is usually up to the homes, though state health authorities can order an evacuation in certain situations.

The Alabama Hospital Association has tried to come up with some guidelines, spokeswoman Rosemary Blackmon said, but individual health care providers still make the final call.

In Texas, officials once thought the trauma of evacuating was enough to justify keeping patients in place, but that changed after Katrina, said Jack Colley, director of the Division of Emergency Management.

“Evacuate everyone out of the kill zone,” he said. “Where they stay, they die. We make if very blunt.”