The North Bay Fires & Older Adults

Believe it or not, I am passionate about things besides just Birkenstocks.  I am passionate about advocating for the rights of older adults.  It is my life’s work to help older adults manage their health, keep as active as possible, and remain safely in their homes.

Lack of appropriate senior housing has been on ongoing issue for years.  There was a housing crunch in California before the fires and now there is a cataclysmic housing crisis after the fires.  It is all over the news, from the local SFgate.com article, “Santa Rosa housing scarce before the fire — what now?”, to the national piece on CNN.com  “They survived the California fires. Now, the crisis is finding housing”.  What is not discussed in these articles is that the lack of housing for the geriatric population, who require caregiver assistance, has become a calamity after the fires. 

According to KTVU, at least 5,700 structures were damaged in the North Bay Fires.

Click Picture to watch video from KTVU

Of the structures that were damaged or destroyed, many were extended care facilities that housed dependent older adults.   The California Department of Social Services has created a document listing the damage to all registered facilities.  It is astonishing how many facilities were affected.  In addition to extended care facilities, scores of seniors who were living in their homes, with part time caregiver assistance during the day, lost their homes in the fires too.  Moreover, caregivers of seniors had their homes burn down as well.  The magnitude of the devastation is far reaching.  You don’t hear about this in the news, but those who work in the health care field are well aware of situation.  

All these displaced older adults who no longer have caregiver help, whether in a facility or at home, now needed a bed in an a extended care facility because there was nowhere else for them to go.  Their need for hands on assistance simply could not be met in a shelter.  Sadly, due to the pre-fire housing crisis, there were a shortage of beds from which to choose.

The “global” Birkenstock shortage seems like a silly little problem when you take into consideration the lack of bed availability in extended care facilities, in California, for our most vulnerable older adult population.  Through my work, I know for a fact, that finding a bed at an extended care facility for someone with custodial or skilled needs was next to impossible before the North Bay Fires.  Now, two weeks after the fires began, there are simply NO BEDS available in the local Bay Area for our geriatric population. 

Those who need a higher level of care are being placed in facilities in the Central Valley or North of Sacramento.  Far from their homes.  Far from their loved ones.  Soon those beds on the outskirts of the Bay Area will be filled and it will become even more difficult to help California’s most at-risk older adults.

I understand that The North Bay Wildfires are a catastrophe for thousands of people. 

Map from Cal Fire on 10/20/17 showing containment of each fire which began 10/9/17

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FEMA and the Red Cross have come to help those displaced by the fires.  However, the older adult population are a specialized group whose needs cannot be met in emergency shelters.  Such stories are not being shared in the media and seniors are not getting the extra help they need during this crisis.  In fact, the media has more stories about displaced pets after this disaster than the impact of the disasters on this care dependent group of the population.  But, I hear their stories first hand and they are heart breaking.

The geriatric population and their ongoing need for assistance (health, welfare, financial) have been ignored for far too long.  Their needs and their problems are swept under the rug by many politicians.  It is time that Local, State and Federal agencies recognize that the lack of bed availability in Residential Care Facilities for the Elderly (RCFE) has been an ongoing problem and is now approaching a catastrophe of its own.  

Before the fires, RCFEs would pick and choose who they would accept to their facility.  I could tell you horrifying, unjust, and unethical stories about this, but then this blog would become a novel.  I am surprised that there is not a law against such practices.  If you have a bed, you need to take the first person who requests it.  Plain and simple.  First come, first served.   The RCFEs are getting paid after all.  Thousands of dollars a month when that bed is filled.  So do your job, RCFEs, and help those that need assistance!

How can we help our most vulnerable population now and when the next catastrophe hits.  The next wildfire?  The next hurricane?  The next big earthquake?  Create protocols, create laws, create guidelines that require RCFEs to make beds readily available to anyone who has a need.  Whatever is in place now is not working.  I am on the front lines and I am telling you that the current placement process DOES NOT WORK. The more needs one has, the less likely an RCFE will accept that person.

The needs that older adults have revolve around managing their Activities of Daily Living (ADLs) and their Instrumental Activities of Daily Living (IADLs).   Activities of Daily Living include tasks like eating, bathing, dressing, toileting, transferring (walking) and continence.  Instrumental Activities of Daily Living involve functions like managing finances, managing transportation, shopping and meal preparation, housecleaning and home maintenance, managing communication and managing medications.  Difficulties with ADLs and IADLs often correspond with how much help, supervision, and hands-on care an older person needs.

After the fires, emergency shelters ended up being overwhelmed with older adults whose care needs could not be met.  While emergency shelters may be useful for able bodied individuals, they are not safe for our older adults that cannot independently manage their own ADLs/IADLs.  Untrained volunteers cannot safely and properly handle the needs of someone with dementia, advanced Parkinson’s Disease, or ALS.

For example, think about the older adults with memory loss that were evacuated or lost their homes during the fires.  How can untrained volunteers in shelters handle behavioral issues associated with dementia?  With any level of memory loss, anything outside of a normal routine can cause extreme anxiety, agitation, or increased confusion.   Heck, such an event causes anxiety and agitation on individuals without memory loss.  What protocols have FEMA or the Red Cross put in place to deal with individuals with memory loss who have been affected by catastrophic events?  I recommend that they reach out to the Alzheimer’s Association and figure out a plan ASAP.

Alzheimer's Association has info on planning for an emergency

Many seniors who were evacuated arrived at evacuation facilities with their assistive devices.  Canes, walkers, and wheelchairs are wonderful equipment to keep older adults mobile and active.  However, most of the emergency shelters, like churches, schools, or auditoriums could not meet the needs of multiple individuals with adaptive equipment.  Some shelters did not have wheelchair accessible bathrooms. Thus, one catastrophe lead to another crisis. How does the American with Disability Act (ADA) come into play during an catastrophic event?

From what I have learned over the last 2 weeks, there are no guidelines in place to aid older adults, that require hands on assistance, in the event of an emergency.  Federal, State, and Local aid is more useful for able bodied individuals.  Something needs to be done about this so that everyone’s needs, including the geriatric population, are met.

Birkenstock has different footbeds and widths for their shoes. Something to meet everyone’s needs.  There needs to be Federal, State, and Local protocols in place to meet individual needs at various levels on the continuum of care.  While there is some level of emergency preparedness in place for able bodied people, there is no such protocol for high risk individuals with specialized needs.  

Perhaps this means having dependent older adults register with the local fire department.  This way, if there is an unforeseen emergency, like a fast moving wildfire, emergency responders can better help those most vulnerable.  The vast majority of older adults do not utilize smart phones and never had the option to receive the emergency text alert from Nixle.  Others are hearing impaired and could not hear the first responders telling them to evacuate.  There are so many different needs within our older adult population.  All issues need to be taken into consideration when creating better guidelines so that no one is left behind.

Take a look at what happened to the residents at a senior living complex in Santa Rosa.

Photo from the Press Democrat

Over 40 residents were allegedly left abandoned by staff in this facility as flames rapidly approached.  This is appalling on so many levels.  I pray that the Federal government and the State’s Ombudsman office investigates how and why this happened!!!  Who will be fined for such neglect?!

My hope is that FEMA, the Red Cross and other emergency agencies can learn from these glaring mistakes.  Perhaps they can glean some best practice techniques from the staff at the Kaiser Permanente facility in Santa Rosa.  

Kaiser staff tirelessly, efficiently, and safely evacuated all their patients and staff from their Santa Rosa facility at 330am IN THE MORNING to their hospital in San Rafael.   Flames made it up to the property line at the hospital in Santa Rosa and yet, every single patient and staff member made it out safely.  No one was left behind!!  Many of the staff helped with the evacuations even though their own homes had been lost to fire.  Later that same morning, Sutter in Santa Rosa had to evacuate their hospital as well.

Photo from the Mercury News. Kaiser Santa Rosa in background.

Kaiser and Sutter, two separate health care organizations, worked TOGETHER to ensure that all patients’ needs were met.  They set up a joint reunification hotline to help family members reunite with loved ones that were evacuated.  They shared resources to help expedite the placement process of so many dependent elders.  Maybe our politicians can learn how to work together, like Kaiser and Sutter, to ensure that no older adult is put at-risk during the next catastrophic event.

You already have local sites identified as evacuation centers in each County.  I suggest that our Federal, State, and Local agencies create a unique evacuation site for older adults who are dependent on others for ADL/IADLs assistance.  A location where trained volunteers can meet the needs of older adults, but where evacuees do not require hospital level of care. 

This way, you keep the hospitals free to handle real emergent medical needs.  Finding beds to relocate evacuated older adults with special care needs can be facilitated from such an evacuation site.  People should not have to go to the hospital for placement.  Sending someone to the hospital for placement is a poor use of resources.

However, with the current catastrophe, hospitals are where many older adults ended up because most evacuation sites could not meet the ADL/IADL needs of certain evacuees.  Part of the reason so many seniors were evacuated to hospitals is because of the pre-fire bed shortage in California. 

When the media talks about the housing crisis in California, let’s not forget about the bed shortage in extended care facilities.  When we talk about rebuilding together, let’s include rebuilding those extended care facilities too.   

The “global” Birkenstock shortage pales in comparison to the shortage of beds available for the older adult population in Northern California.  Let’s all work together to ensure that older adults have their care needs met in a safe environment.  One catastrophe is creating another catastrophe and we can no longer ignore it.