News & Awards



May 23, 2007

By Victor Hull

ST. PETE BEACH -- On the verge of another hurricane season, transportation problems threaten to disrupt nursing home evacuation plans in Florida and other storm-prone states.

Lack of transportation proved fatal when Hurricane Katrina slammed the northern Gulf Coast in 2005, and caused problems for Florida during Hurricane Charley a year earlier. Despite those vivid lessons, many nursing home administrators and disaster planners say facility residents remain vulnerable because no solution has been found to guarantee rides when storms force evacuations.

The problem may even be worse, because the federal government has asserted claim over hundreds of private charter buses for emergency use. The claim leaves fewer buses available for nursing homes to use, participants at a national "Nursing Home Hurricane Summit" this week said.

"We call it our Achilles heel," said LuMarie Polivka-West, the conference moderator and a policy expert for the Florida Health Care Association, a state organization representing long-term care facilities.

Representatives from Louisiana, Alabama, Georgia and other states agreed. They also cited communicating after a disaster, when cell phones and land lines typically fail, and deciding when to call for evacuations as other major hurricane challenges facing nursing homes.

 The conference was sponsored by the Florida Health Care Association and a national nonprofit, The John A. Hartford Foundation, which is paying for a study on ways to improve nursing homes' disaster preparedness.

A similar meeting last year led to the development of a new computer program designed to help facilities with emergency planning. The program is scheduled to be finished by year's end.

One potential solution to the transportation problem, suggested by representatives from the private bus industry, calls for nursing homes to buy old buses retired from metropolitan transit authorities, such New York's, Atlanta's or Chicago's.

Relatively cheap to buy, the buses could be maintained and driven for a fee by private bus companies, said Robert A. Watkins, vice president of Consolidated Safety Services Inc., a transportation quality assurance firm, who pitched the idea at the conference.

The biggest advantage: assurance the rides would be available when needed. In contrast, when Hurricane Charley made a quick turn toward Southwest Florida in 2004, many nursing homes had trouble evacuating because several had contracted for service with the same bus companies, which could not meet the demand.

Others had counted on using ambulances, but those vehicles were unavailable because hospitals needed them.

"It's a common-sense solution to a very big problem," Watkins said, adding that the buses typically cost $2,000 or less each and estimated annual maintenance is less than $1,000.

Too many details remain for the idea to help much this year, including who would pay for the buses. Watkins said nursing homes could pay private bus companies to maintain their vehicles, or lease them to the firms on the condition that they be available on call.

Nursing home industry representatives argue that it makes more sense for the government to buy a fleet of used metro buses and make them available for emergency use.

"I think it's a viable consideration for FEMA," said Polivka-West, referring to the Federal Emergency Management Agency. "We think this should be a national response, instead of an individual (nursing home) facility response."

The nursing home industry has expressed resentment toward the federal government, which last year signed contracts with private companies for the right to use 1,500 buses in an emergency. In addition, nursing home representatives said FEMA has reserved the right to take control of other buses if needed.

"We didn't have (access to) enough buses in the first place," said Janice Zalen, a director with the American Health Care Association, a national organization of long-term care facilities.

Reliable transportation is critical for the life-and-death decision of deciding when and if to evacuate nursing homes, whose residents often have serious health problems that, in years past, would have been handled in hospitals.

Because a move can be deadly for these older, frail residents, facilities do not want to evacuate unless absolutely necessary. Delaying an evacuation decision requires that the ride be available and that it be equipped for people with medical needs -- including air conditioning.

Charlotte, Manatee and Sarasota counties alone have approximately 6,000 nursing home beds in 45 facilities. The region's 91 assisted living facilities, which also house residents with some medical needs, have nearly 6,300 beds.

The Hartford Foundation's Amy Berman noted that of 1,330 people who died from Hurricane Katrina, 71 percent were over age 60 and almost half were over 75.

Officials have resorted to using military transport and other unconventional resources. One of the worst tragedies occurred in 2005, when 23 assisted-living home residents in Texas died in a bus that burned during an evacuation before Hurricane Rita. The bus had an expired registration and was pressed into service during the evacuation, according to testimony at a National Transportation Safety Board hearing.

Even when enough buses are available when needed, when a storm threatens, drivers do not always show up.

Joseph Donchess, executive director of the Louisiana Nursing Home Association, said he has been assured by state and federal officials that enough buses will be available if needed this year. But he expressed skepticism, given that his pleas for state police to help escort nursing home evacuees through pre-storm traffic jams have been rejected.

Officials from Alabama and Mississippi said they are also concerned about getting nursing home evacuees through traffic as coastal residents flee.

Ken Presley, vice president of the United Motorcoach Association, said there are 35,000 to 38,000 large buses nationwide. The issue is getting them where they are needed in an emergency.

Because they are so expensive -- more than $400,000 -- operators can't just let them sit. Ideally, they're booked nearly 80 percent of the time. Idling them for emergency use does not make business sense, Presley said.

Nursing homes, on the other hand, do not want to pay for them in the absence of a storm. They want them available on 24- or 48-hour notice.

Operators "can't afford to do that based on a 'might call,'" Presley said. "Long-term care facilities are going to have to spend some money to make it work."

Watkins, whose firm helps ensure the safety of buses used to transport the military for the Department of Defense, agreed. He said facilities are going to have to look out for themselves, rather than waiting for the government or someone else to solve the problem.

"Everybody looks to a huge solution from the sky," Watkins said. "It's not forthcoming."

Tom Kelly, CEO of the Village on the Isle retirement community in Venice, has come up with his own solution. He's arranged to use buses from area churches, providing for 90 seats for residents in an evacuation.

"There should be some government-private collaboration," he said.