Several days after Hurricane Irma wreaked havoc across Florida, nine residents from one of its nursing homes died.
The deaths were not caused by flooding, high winds or a building collapse, but by room temperatures that went from hot to oppressive and finally to fatal after a transformer powering their cooling system failed. The first question that came to my mind was, "How could this have happened?"
The tragic events at the nursing home
The tragedy came to light following multiple calls to fire rescue crews from The Rehabilitation Center at Hollywood Hills during the early morning hours of Sept. 13. The first, at about 3 a.m., involved a patient in cardiac arrest. The second emergency call an hour later prompted fire officials to call the State Department of Children and Families to report their concern. At about 5 a.m., a third call came in. At that point, the hospital staff at Memorial Regional Hospital across the street had decided to check the facility themselves, and as one report described it, "What they found was an oven." The facility was evacuated immediately. Rescue units moved residents out while hospital workers established a command center and triaged patients. They checked the facility room by room, discovering three patients already deceased and nearly 40 others with breathing issues. Most were treated for dehydration, respiratory distress and heat-related problems. Some patients had temperatures of almost 106 degrees, and four expired soon after arriving at a hospital. Authorities learned later that another patient had died at the center that morning and was moved directly to a funeral home and not counted initially. To date, nine patients ranging in age from 71 to 99, have died, including 93-year-old Carlos Canal, who passed away Sept. 19. The medical examiner is investigating their deaths; a criminal homicide investigation is under way; new admission processing has been halted; and the nursing home is temporarily closed.
Nursing home situation leaves many questions, few answers
Calling the situation "unfathomable," Gov. Rick Scott vowed to "aggressively demand answers," and hold accountable anyone not acting in patients' best interests. Sen. Bill Nelson called it, "an emerging scandal of gargantuan proportions," saying it was "inexcusable" that no one called 911 as residents sweltered in their rooms.
The Florida Department of Health said that "at no time" did the nursing home "report that conditions had become dangerous or that the health and safety of their patients was at risk," according to reports.
These tragic deaths raise many disturbing questions for family members, healthcare consumers, concerned citizens and nurses. As cries for answers from bereaved families and the public began, Florida state officials, utility company executives and nursing home administrators started pointing fingers and playing the blame game. The center's administration said they prepared "diligently" for the hurricane, and after the storm staff worked to get needed government help, but to little avail. They reported calling the utility company when warm air began coming through vents, but the promised equipment was never received. Portable fans were purchased for each patient room; patients were dressed in as little clothing as possible and moved to hallways near cooling units. Staff used ice to cool them; provided cold drinks; and checked temperatures every shift. But was it was enough? As nurses, we want to know what policies were in place regarding patient checks. Were extra emergency steps taken to ensure safety during and after the hurricane? How were staffing numbers and mix; were they increased based on changing patient conditions? How aggressively was outside assistance sought? Were follow-up calls to officials timely? Were extra physicians, supervisors and administrators called in? When room temperatures began to become unbearable, were rescue plans made? and why wasn't 911 called to evacuate patients? With a hospital so close by could patients have been moved there sooner? Was the facility generator in good working condition pre-storm, and did the portable generators used post-storm emit noxious fumes causing the medical examiner to delay determining final causes of death?
After asking these valid questions, how can nurses take action? 1. Nurse leaders can meet with their teams to review disaster plans, looking at what happened in this tragedy to determine how they might better prepare themselves to safeguard their patients. Meetings could include open discussion and assessment of the completeness of disaster preparedness plans; consideration of possible scenarios not included; and creation of back-up plans. 2. Staff nurses can educate themselves on the quality of oversight and review of nursing homes by state and federal agencies, and what needed changes they may see. 3. Nurses also should expect questions from patients' families and be prepared to share information regarding their disaster plans and any corrective actions they've put in place so a situation like this one never arises in their facility.
There have been no official accusations of any deliberate act causing the tragedy. Whether conditions that resulted in the deaths were unwittingly allowed to continue is a separate question that investigators, lawyers and judges will be answering. But nurses can use this tragic event to look at any possible ethical issues that could have contributed to things ending the way they did, looking honestly at their own and their colleagues' ability to report any unethical behaviors or practices they're aware of without fear of reprisal, retribution or even ostracism.
Let's ensure it never happens again
The governor announced new rules requiring nursing facilities to have generators and fuel that can "maintain comfortable temperatures" for at least four days after a power failure. Facilities have 60 days to comply. He also instructed the state's Agency for Health Care Administration and the Florida Department of Children and Families to work with law enforcement officials to determine whether staff did enough. Safety check systems have been stepped up. Firefighters have helped relocate many elderly residents from centers without power. Facilities statewide have devised new patient cooling methods, and are working with utility companies to restore power much faster. Heartbreaking tragedies, particularly ones involving the frail elderly, whose children worry about their vulnerability and helplessness in emergency situations, can spur us to action -- take stock of our readiness and make needed changes. And in the wake of these storms, there's a lot to learn.
Courses Related to 'Care of Seniors'
60081: Protecting Seniors in Disasters (1 contact hr) Major disasters affect everyone, but the senior population is particularly vulnerable to their devastating effects. Of the about 1,200 people who died in Hurricane Katrina in 2005, 74% were older than age 60, and 50% of those were older than age 75. Those who survived experienced stressful and sometimes inappropriate displacement and often a significant decline in health and functioning. Similar disproportionate deaths among seniors have been documented in other natural disasters. This module will inform nurses about how they can help protect the health and lives of older Americans when they are faced with disaster. 60050: Stopping Abuse and Neglect in Nursing Homes (1 contact hr) By 2060, 98 million Americans will be age 65 or older. The future increase in the aging population suggests that more elderly and disabled people will stay in a nursing home at some point in their lives, making it all the more important for nursing homes to be safe places for residents. Congressional investigators found that one in three U.S. nursing homes was cited for an abuse violation, and abuse in 256 nursing homes across the country was so serious that it put elderly lives in jeopardy or actually resulted in death. Factors contributing to abuse and ways to identify, respond to and prevent abuse are discussed. 60080: Clearing Up the Confusion About Delirium (1 contact hr) Delirium is a medical condition manifested as a disturbance in consciousness and cognition that occurs for a short time. Delirium occurs in around 50% of hospitalized patients 65 years or older and costs more than $164 billion per year in hospital and medical costs. An estimated 30% to 40% of delirium cases among hospitalized patients are preventable. Among community-dwelling elderly and those in long-term care, cases of delirium may accompany a number of medical conditions. The risk rises with age and accompanying dementia. Primary care providers should be aware of a relatively high risk of delirium among patients in long-term care, those over the age of 85 and those with dementia. Among older hospitalized patients, delirium is a common complication adding to length of stay and increasing cost of care. As in many other healthcare situations, nurses are frontline observers who can recognize beginning signs of delirium and initiate care.
