Wednesday, June 25, 2008

Iowa Floods Affecting Hospice Care

By now the news about the 2008 Midwestern flood is no longer the lead story in the news cycle. The president has been to some of the affected areas, and the presidential candidates have stopped by as well. Disasters of this magnitude affect the health care in a community because your coronary plaque or impending stroke isn't going to wait for the flood water to recede. A good friend of mine David Wensel, DO is a hospice & palliative medicine physician for Hospice of North Iowa in Mason City, IA, and he was kind enough to answer some questions about how the floods affected hospice operations during a disaster.Pallimed: Please give us some background on Mason City and the Hospice of North Iowa.

Dr. Wensel: The Winnebago River cuts through the heart of Mason City and flood stage for it is above 15 feet because of the 15-foot levee built in 1961. The river crested at over 18 feet so the levee did not fail. The water went over it but it did flood many areas of Mason City and shut down the city water treatment plant. About 140 homes have been condemend in a city with a population of about 30,000. Hospice of North Iowa serves 16 counties and has an inpatient unit with 6 occupied beds at the time of the initial flooding.

Pallimed: What is the most significant way the floods impacted home hospice care in Mason City?

Dr. Wensel: Many of our team members were unable to get to patients' homes due to road closings. The greatest impact to our inpatient unit was the lack of water. There was no direct impact to the buildings or offices of Hospice of North Iowa, however many of the staff could not come into the office due to road closings.

Pallimed: Can you share how some of the emergency planning went into effect?

Dr. Wensel: Our emergency planning went into effect as soon as we knew the river was going over the levee and we would lose water (from the water treatment plant). Our plan was to ensure that the patents and families at our inpatient unit would have appropriate care and if needed to be transferred to a facility that could care for them. We were able to continue providing care for our patents and families without interruption.

Pallimed: How did hospice agencies deal with staff who needed to look after their own concerns as well as for the patients and families?

Dr. Wensel: Several of our staff members did get flooded and we provided them with the time and support they needed to first care for their families. Once that was done, we asked our staff who was available to contact by phone or in person all the patients that were enrolled in hospice to ensure they were provided the care they needed. The police and fire department were available to help evacuate anyone who needed it.

Pallimed: Were there offers of support from other hospices locally, regionally or nationally?

Dr. Wensel: We did get offers of support from several of the hospice agencies in Iowa but the greatest help came from our hospital and parent organization. Hospice of North Iowa is owned by Trinity Health, the 4th largest Catholic Healthcare network in the US. Within 24 hours we had large amounts of water and several large trucks that could produce potable water. The CEO from Trinity arrived with a large donation from all the other hospitals within our system to help all the employees affected by flooding. It was truly amazing to see all the support and kindness offered by total strangers.

Pallimed
: How was the coordination with hospitals or nursing homes?

Dr. Wensel: Many of our hospice patients are living in nursing homes, so the hospital and our hospice offered support and water to the nursing homes during the entire time of the flooding. None of the local nursing homes were flooded but did need help with staffing and water. Our hospital, Mercy Medical Center-North Iowa had to postpone elective surgeries so that only the emergencies could be handled due to the lack of water.

I was called into the hospital to admit a patient who suffered an intracranial hemorrhage and was unable to drive there because the roads closed due to flooding. We had to work with the hospitalist service and the nurses, chaplains, and social workers already at the hospital to get the patient and family the support they needed.

Pallimed
: What are the important lessons learned from the flooding to share with other hospice agencies as they look at their own disaster planning?

Dr. Wensel: The greatest lesson learned is to plan for the worse case scenario. As a hospice think about if you lost half your staff, some of your patients had to be evacuated, and you had no safe water. You can never plan for every possible problem that might come up, but it would be very helpful to talk through different disaster plans with your staff. You never realize how wonderful it is to wash your hands, brush your teeth or take a bath until you can't. I had never thought about all the things we do to care for patents that require water.

Pallimed: Any other stories you care to share about the flood?

Dr. Wensel: As always the greatest stories are those of our staff and their commitment to caring for patients and families. Many of the sacrifices will never be known or made public. I can only say I was amazed how we rose to the occasion and accomplished the seemingly impossible. I am so proud to be one of the medical directors for Hospice of North Iowa, and thankful that I get the chance to work with the people here everyday.

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