Sunday, December 7, 2008

Hospice Care in the Aftermath of Hurricane Ike

It was only 3 short months ago that Hurricane Ike devastated the Texas Gulf coastline creating havoc in the Galveston and Houston areas. I had a chance to share some emails with Deborah Perryman, LMSW (Executive Director) and Beverly McCormick, RN, BSN, CHPN, (Community Outreach Education Liaison/Admission Nurse) with Hospice Care Team, a not-for profit hospice that serves the areas hit by Hurricane Ike. Here are some of the excerpts from those emails demonstrating some of the adverse conditions during and after the hurricane. For another Pallimed post on natural disasters and hospice check out the post on the Iowa Floods.
(Note: some details regarding patient stories has been changed to protect patient privacy)

How do you deal with your own needs and losses along with our patients?

McCormick: We have offered each other lots of support, designated a special room where anyone could meet with bereavement person or SW or each other. We've cried a lot at different times, we try to help each other as needed. Now further out, our executive director encouraged trying to take time for ourselves and have fun. We even planned some events just for staff.

We are all clear with boundaries, we do not share our losses with our patients, they have enough to deal with. We can support each other, and can make general comments but focus on patients and families at this trying time. ( That is as always ).

Since many patient couldn't return, our census was greatly impacted which affected staffing, and sadly we had to make some layoffs.

Perryman: It was hard dealing with my own needs and loses because there were so many people hurting. I changed the route coming to the office because the National Guard and Disaster Relief groups made me cry. When we found real food, lunch was provided to the staff which consisted of chili, hot dogs and chips. What a feast! The staff cheered when we received mail for the first time after the hurricane. When the office reopened, there was no power but we decided to meet anyway as patients/families were calling with needs. About 15 minutes after our chaplain prayed, the lights came on. Boy did we cheer then. Driving around town everyday brought new challenges and new waves of emotions. That was certainly a life altering experience.

The staff met every morning to share information ( where to get water, ice, food; stores opened; where to get gas, etc), hugs, tears and accounting for patients/families. Staff was encouraged to take time for themselves. I was finally sent home on Thursday after exhaustion took over. The staff at HCT is awesome and handled the Hurricane like the professionals that they are. Kudos to the staff!!!!!

Can you share some challenging events your hospice staff have encountered?

Perryman: One of the biggest challenges was the cell phones. FEMA and others took over the cell towers prior to the storm on Friday and it was difficult to impossible to get cell phone coverage. My home land line remained intact throughout ALL of the storm and after the storm. One of the hospices in our alliance provided an emergency number just hours before Ike hit. It was a blessing as the patients, families, and staff could stay in touch. Between my home line and cell phone, we were able to remain in communication with everyone.

Another big challenge was that people wanted to return home right now!! There were curfews, gas shortages, no food in stores, many (like me) still had no power. Some employees slept in the office as there was power and air conditioning!! One nurse had to go out during the curfew
to make a visit as the patient was transported home at the family's request to get him settled and order meds.

McCormick: I talked with a patient from a trailer in the woods to try and get access to oxygen refills and refill medications just so he could return home. Nursing facilities were totally stretched going to places with halls for rooms and their sack of personal belongs, traveling with staff who had to leave their families etc. A church sent volunteers to help with care. One nursing home was so damaged, it is closing, the other doesn't want to reopen without UTMB hospital to send patients. So many people are so uprooted.

Were your emergency /disaster plans helpful?

Perryman: Yes. HCT practiced the emergency plan for Rita and it was okay. Since then there had been some drills and were able to work out a few hitches. The biggest challenge with the emergency/disaster plan was that every time we began a phase of the plan, the path of Hurricane Ike came closer and closer to Galveston County. It was a challenge staying one step ahead of the storm! Thankfully, all of our patients were accounted for and provisions made to meeting their needs.

McCormick: We do have a good emergency plan in place and it worked. We triage our patients on admit and weekly; they have hurricane info in their patient handbook. We send two weeks meds, supplies, obtain oxygen and give names of hospices in locations they evacuate to.

Any particularly difficult clinical situations that you would care to share?

I admitted a patient the Thursday after the hurricane and their friends graciously took in three families on evacuation including this dying patient who in fact died only a few days later. I readmitted a patient last week who had been followed at home by Houston hospice, now living in a rented condo in Galveston. Her husband was home trying to save belongings before their house was cut down as most are up to four feet through the sheet rock down to wood. He lost most of his belongings plus knowing he'll lose his wife of 50 years soon as well. Fortunately they are blessed with adult children who help.

I went to admit a patient and it was almost impossible to get into the house. There was a chair at the bottom of the front door to the trailer about 10 feet below, fortunately, there was a way to get in the back door, no AC, caregiver a young mother with an infant. Tough times.

I met with a man at small community hospital who hadn't evacuated in Galveston, but got so sick with no power, water, etc, he had finally gone there (to the hospital). He wants to return to home, but has no caregiver and so we'll see what we can do. He said he had hoped to be washed out to sea with the Hurricane as his doctor told him he was a goner! (I doubt that, but that was his interpretation and why he accepted home hospice when discharged).

Our chaplains and social workers are giving much support; and volunteers, if not affected, have been helping as well, one is giving out food from a church and offering support.

We've all been working hard. Lots of things are hard as very few live in their homes.

Perryman: The most difficult was trying to staff crisis care around curfews. We were very limited in mobility due to no power, NO GAS, damage in neighborhoods. Staff was able to meet everyone's needs by being creative and resourceful during and after the hurricane.

HCT was able to keep a core team (RN, social worker, and chaplain) within miles of our service area.

Three months later, it is amazing where we are. Our Emergency Management, Bruce Clawson, in Texas City was awesome. He provided guidance and assurance prior to the storm. After Hurricane Ike, daily calls provided needed information and updates to meet the devastation
that was left behind. It was hard at times not to panic-- which is the right decision totally pack the office or leave it-- go or stay--and yet all of the choices made worked. We are very blessed and look forward to a break until next Hurricane Season.

Thanks to Ms. Perryman and Ms. McCormick for sharing this helpful insight. If you are making any donations to hospices this year in your local area, you might consider giving to some of the hospices in the areas hit by Hurricane Ike.
(Images via Wikipedia Commons)

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