Caring for the Ages

Six Months Later: Lessons Learned from the Tragedy of 9/11

Emergency Preparedness in LTC Facilities in New York City

by Ann D. Gross, MA

“If I’ve lived long enough to see this happen in our country, then I’ve lived too long.”

--Comment by World War II veteran on 9/11/01

If you talk with administrators and other senior managers at long-term care facilities in New York City, many will tell you they consider the tragedy of September 11, 2001 a wakeup call. For those whose “To Do” lists before 9/11/01 included “Work on emergency planning” somewhere down at the bottom, everything has changed. In New York, in particular, based on their experiences during that terrible day and its aftermath, many long-term care administrators and others responsible for seniors (and/or persons with disabilities who might face similar challenges as do seniors) have created emergency preparedness plans, specifically in the event of another terrorist attack.

New York City’s five boroughs are home to some 1.3 million seniors, and the 85-and-over cohort is the fastest growing segment of New York City’s population. According to federal sources, there were some 6,300 seniors living around the area of the World Trade Center’s Twin Towers, and nearly 19,000 older adults living within a three-block radius.

“We always had an emergency preparedness plan in place,” said John Zeiss, Vice President, Operations, Isabella Geriatric Center. a 705-bed facility in Northern Manhattan, currently with 695 residents. He explained that JCAHO compliance requires that a facility have such a plan in place, along with two emergency drills per year. Among those drills that Isabella holds are drills that are based on what could actually happen.

“We try to make our drills realistic,” says Mr. Zeiss. “It’s not likely we’ll face a tidal wave or a severe earthquake, but we could have a bad accident outside our facility or a gas explosion, and of course always water and power outages. So the most recent drill that residents and staff were subject to was a realistic simulation of a bad accident outside Isabella Geriatrics Center’s facility.

In addition, since 9/11, Isabella, along with many other long-term care facilities, have heightened their existing security measures for people entering and leaving the residence. If someone arrives and says they have an appointment, the person is not allowed in unless the person they say they’re meeting with has been contacted and gives the “OK.”

“While no system is 100% perfect, our residents know we are working harder to protect them, and it helps them feel more secure,” said Mr. Zeiss. “And that’s important for their well being.”

Regarding threats of bioterrorism, Mr. Zeiss said that the Isabella Geriatric Center Safety Committee, comprised of members from Administration, Risk management, Security, Housekeeping, Infection control, Medicine and Nursing, meet at least monthly, and have discussed plans to cope with such an attack. Sometimes, the first line of defense is just common sense in trying to keep a sense of calm.

“To begin with, we train our staff to try to react appropriately, and not to panic, and we all agree that saving lives and saving residents from danger is the No. 1 priority. In the case of the anthrax scare, we didn’t want to make a big deal about it with the residents, feeling that it would do more harm than good.

But Mr. Zeiss and other senior managers made sure the Center’s pharmacy was stocked with the drugs of choice during the anthrax scare, which were doxycycline and Cipro. And they made certain that all staff members and residents got flu shots.

“We provided gloves and masks to our mailroom workers and anyone else who handled mail. We told them it was fine to wear the gloves and masks if they chose to do so,” added Mr. Zeiss.

But after the anthrax scare in New York had subsided, the staff went back to not using gloves for the mail.

“We’re also in close touch with our post office regularly, to find out if they know of any recent threats, or anything we should worry about,” he adds. “And our foodservice distributors work closely with us, and they have their own set of stringent checks to keep the food supply safe. All the packages we buy are sealed,” added Mr. Zeiss.

“Equally important,” says Mr. Zeiss, is having links to the community. We are next to the George Washington High School, and we work together on a great deal of emergency planning. We always ensure that between us we have an open line to the Fire Department, to the Office of Emergency Management, and to the Office of Emergency Management Services. They know that we have supplies and can offer medical attention; so it’s a wonderful partnership,” he adds.

Fredda Vladeck, CSW, Director of the Aging in Place Initiative, United Hospital Fund in New York, is a strong advocate for a community-based, cooperative effort for emergency preparedness. Ms. Vladeck, a nationally recognized expert in services for the aging, notes that entire apartment buildings, housing complexes and neighborhoods have become “naturally occurring retirement communities, “ or “norms,” and notes that there are now some 400,000 people in New York City -- or one out of every three seniors, living in one of these communities. The Aging in Place Initiative, which is a collaboration between the United Hospital Fund and the United Way of New York City, identifies unmet social and health care needs of older New Yorkers and helps to coordinate services in the neighborhoods where they live.

Regarding emergency preparedness for facilities in New York, Ms. Vladeck is adamant. “There needs to be a community-wide response to planning,” Ms. Vladeck said. “This means that we all work together, beginning on the Community Board level, which is the logical place to start.

“We all have a need to be connected in a way that we never felt the need for before the tragedy of September 11,” said Ms. Vladeck. “And I think we all need to respond together to this wake-up call.

“We need to pool the resources of the Norms, of the local senior centers, of nurses and social workers, and pharmacists, pharmacies, doctors, and restaurants,” she said. We need the resources of the Aging Network and of the local school systems. In New York we have seen that, at the time of a disaster, we need the resources of the entire community.”

Ms. Vladeck cautions that we also need to be creative in planning for emergencies, and not just base our planning on the “most recent experience. We need to be careful about planning only to remedy the last disaster. Instead, we need to plan for whatever might happen,” she adds.

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SIDEBAR: (550 words)

How to Prepare For an Emergency at Your Facility

On Monday, February 11, five months to the day after the terrorist attack on New York City, Senator Larry Craig (R, Idaho), a member of the United States Senate Special Committee on Aging, held a field hearing in Manhattan on emergency preparedness for seniors and people with disabilities in New York City. Among those who were invited to testify (including Senator Hillary Rodham Clinton, who offered a statement for the record as she was unable to be there in person), was Igal Jellinek, Executive Director of Council of Senior Centers and Services (CSCS) of New York City. CSCS, a nonprofit organization founded in 1979, represents some 265 senior service organizations, ranging from individual community-based senior centers to nursing homes and other long-term care facilities, to large, multi-purpose citywide organizations.

Among the emergency preparedness suggestions that Mr. Jellinek offered on behalf of the Council of Senior Centers and Services, based on interviews with CSCS members, many apply to long-term care facilities. Included were the following suggestions:

· Offsite data storage. Make sure your staff backs up all its essential computer files -- at least on a weekly or biweekly basis, and keep a copy of the disk or CD in two different places; the Administrator and Executive Director, respectively, can take disks home, as long as the information is stored offsite.

· Restaurants as community resources. Ensure that there is a team of restaurants identified in your neighborhood as willing/able to provide emergency food to a pooled resource.

· Neighbors helping neighbors. Maintain a bank of names of volunteers, both of neighbors helping neighbors, and of people in local institutions who would like to volunteer to help others in the community, including those at your facility, should an emergency arise.

· Secure photo identification. Work with your local law enforcement and community planning services to create a secure system of photo identification for professional healthcare and senior service workers that will enable them to get through to your facility in an emergency.

· Physical plant risk assessment. Ensure that each facility has done a risk-assessment audit of its hardware, software, insurance coverage, and physical plant.

· Transportation. Work with your local officials to develop a city-wide, statewide and nationwide emergency transportation plan; each community needs a contingency plan for moving people, (including those in wheelchairs), emergency supplies, and medication.

· Pharmacy services. Develop a network of emergency pharmaceutical services that includes the means both to fill medications and get them to those who need them, as well as get them to community-based seniors as well.

· Prepare, upgrade communications systems at your facility. Upgrade communications systems (including trunks of phone lines and emergency response systems), and develop “redundancy” communications plans, including instructions on use of emergency communications products and tools with backup.

· Staff training. Teach your staff to remain flexible in terms of implementing your emergency preparedness plan, making sure to adapt to the nature and site of the disaster/emergency.

· Continuous communications. Communicate with your clients and staff immediately and as continuously as possible; ensure that people do not feel isolated or abandoned.

· Empathy for your staff’s needs. Understand that your staff may feel a need to offer help and to be helped; offer group discussion sessions, and, if possible, allow staff release time for volunteering.

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Additional sidebar, if appropriate/applicable

Emergency Financial Assistance: Answering the Needs of Seniors in the Communities Hardest Hit by the World Trade Center Attacks (415 words)

In the wake of the tragedy of September 11, the Council of Senior Centers and Services of New York City, found that several of its members needed emergency financial assistance on a short-term basis. Enter Atlantic Philanthropies, which provided $50,000 of emergency funds for CSCS to distribute to members in immediate need. Following were the seven recipients and the way they used the awards:

· The Caring Community at 20 Washington Square North in Manhattan, to reimburse them for food and water provided to seniors in the community between September 11 and 21, 2001, and to provide crisis training and workshops for staff to help them work more effectively with older people in the community.

· The Chinese-American Planning Council, Project “Open Door,” at 115 Chrystie Street in Manhattan, to purchase Chinese/English language radios, emergency food packages, and battery-operated flashlights and alarm clocks, all for seniors in the agency’s lower Manhattan catchment area.

· Community Food Resource Center, 39 Broadway, for additional social work and outreach workers to support existing staff, as well as support for friendly visitors to older people in the vicinity surrounding Ground Zero, and to purchase cell phones as well as pay for charges related to cell phones for staff in the wake of constant service interruptions of land line telephones in the area.

· The Educational Alliance, 197 East Broadway, to fund one staff member for a three-month period to provide intensive counseling, workshops and other assistance related to September 11.

· Hamilton-Madison House, City Hall Senior Center, 100 Gold Street, for newspaper advertisements announcing the 100 Gold Street senior center opening (replacing the center closed in the aftermath of September 11). In addition, the grant went to cover the cost of additional staff time in assisting the American Red Cross in translating materials for mental health workshops to be conducted in Chinese, and to provide additional meals at the Gold Street senior center, as a result of increased attendance at the new facilities of seniors who wanted to be with others.

· The United Jewish Council of the East Side, at 235 East Broadway, to provide direct counseling services for seniors and families affected by the World Trade Center tragedy and its aftermath.

· And to VISIONS, at 500 Greenwich Street, to support an emergency mobility fund to provide transportation for older people who are blind or visually impaired and unable to use public transportation or Access-a-Ride due to service interruptions in the wake of the September 11 tragedy.

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