ARCHIVED: Theme 5: Building a Global Framework to Address the Needs and Contributions of Older People in Emergencies – Evacuation

43. Hurricane Katrina demonstrated that evacuation of large urban centres can be problematic and that older people may be at particular risk. They may be isolated and housebound; fail to heed warnings; and/or be reluctant to leave their homes. Other seniors may be frail and have illnesses which could compromise their health during evacuations, should they not receive continuing care. In addition, many older people live in regions and communities without an emergency plan in place and with little or no capacity for emergency response. The challenges of evacuation go beyond the actual movement of older people: for example, in many jurisdictions there is no system or capacity to locate older people who are unable to evacuate on their own.

Considerations

44. It is important that communities, including older people themselves, are provided with adequate information about what to do during an evacuation and what resources are available. At the same time, this information needs to be backed up by workable evacuation plans and systems.

45. There are significant differences between developing evacuation scenarios for emergencies and developing scenarios for disasters: in emergencies, there is usually a reliance on responders to evacuate people whereas in disasters, people are often required to mobilize and evacuate themselves.

46. Many factors contribute to a good evacuation plan. These include identifying those who are vulnerable (including those who cannot or will not self-identify); addressing the particular needs of the frail elderly and those with special needs; ensuring access to reliable information to facilitate triage, to ensure continuity of health services, and to assist family tracing and unification; and establishing strong linkages among care providers, service providers and governments to ensure seamless access to essential services.

47. Home and special care facilities present special challenges for the evacuation of older people in emergencies and disasters. For these facilities it is especially important to have good emergency response plans in place that adhere to consistent national standards and guidelines that are tested and evaluated.

48. Priorities for Action

1. Develop a systematic approach to evacuations at the national and community levels that is built on the matching of older people's needs with flexible and appropriate evacuation arrangements and facilities. This approach must be formalized within comprehensive, integrated plans linking emergency management and health care services and assistance.
2. Engage seniors directly in education and training initiatives associated with evacuation plans to strengthen their capacity to ensure appropriate levels of self-care and mutual support during evacuations.
3. Predicate evacuation procedures on community-based systems that identify vulnerable seniors and where they are located.
4. Develop special plans involving the use of multiple types of vehicles including ambulances with stretchers, buses, trucks, and other private vehicles to attend to the special evacuation needs of the frail elderly.
5. Encourage the practice of triaged or staggered approaches to managing evacuations wherever appropriate and practical.

Evacuation of the Sutherland Hills Rest Home in Kelowna During the Okanagan Mountain Fire

The staff of Sutherland Hills, working in concert with IHA (Interior Health Authority) personnel, had the daunting task of moving the rest home residents. [ … ] It is important to remember that only about one quarter of the residents of Sutherland Hills were cognitively intact whereas the majority had mild to severe dementias.

With a limited number of ambulances (three), an important consideration was evaluating which residents were too sick or frail to manage a bus trip and should be transported by ambulance. By departure time, large ash was falling around Sutherland Hills and the smell of smoke was in the air. Ambulances, wheelchair access buses and trucks were used to move residents, their beds, mobility aids, and minimal possessions and supplies from Kelowna to Vernon. Interviewees reported that a trip that ordinarily takes a little over 30 minutes, on this occasion took several hours as traffic carrying other evacuees moved out of town at a snail's pace. Arriving in Vernon, a community 47 km north-east of Kelowna, residents, staff and beds were taken to the two identified care facilities (Gateby House and Noric House) and moved into makeshift wards set up in dining rooms and other open areas. The evacuees remained there for nearly a week. [ … ]

After the event, staff identified a significant problem in evacuating elderly clients. When the evacuation notice was given, many family members were naturally very concerned about their family members at Sutherland Hills. Some families took their frail family members home without realizing what was involved in caring for them. One resident fell during her sojourn with her family and broke her hip; for this person, the fracture has become a more vivid memory than the forest fire. With hindsight, staff reported that they would caution against families taking on such responsibilities without the training, physical environment, and mobility aids that support residents in the facility.

Source:  Cox, Robin. Older persons in emergency and disaster situations: A case study of British Columbia's Firestorm 2003. [Vancouver, BC?], 2006. (Unpublished).

Theme 6: Special Needs Shelters and Long-Term Accommodation

49. Emergency shelters are often required to care for frail or ill individuals. This can lead to complex demands on service providers, especially when older evacuees have specialized needs such as bedding, nutrition, and medications. Further, these needs are sometimes overlooked: for example, there is frequently the assumption that the needs of older people will be met by family members and older people are often "hidden" within the total shelter population. In addition, there can be particular challenges associated with obtaining medical histories from evacuees who are cognitively impaired, placing them at even greater risk of having their special care needs overlooked.

Considerations

50. There are a number of definitional issues that need to be addressed, particularly around the question of what constitutes a "special needs" as opposed to a public shelter. For example, at what point is it necessary to single out particular age-related or clinical health needs and under what circumstances?

51. Shelters reflect the social, cultural, and economic circumstances of a region including the infrastructure of roads, water, and sewerage, and the size, profile and distribution of the population. Thus, individual communities must remain flexible and willing to adopt different approaches to the provision of shelters.

52. In addition, no single model of shelter can address all seniors' needs: the type of shelter available can have a significant impact on people's mental and physical health. For example, those housed in smaller shelters tend to demonstrate more positive post-disaster effects. Further, issues such as gender, maintaining family units, addressing special care needs, and the admissibility of pets are all issues that need to be considered. Promising community-based models of shelters are emerging that focus on small neighbourhood groupings as well as the use of other institutions as temporary shelter facilities in certain circumstances.

53. Policy guidelines around the operations of shelters are not common yet are important, especially where multiple jurisdictions are involved. Such guidelines or frameworks need to address issues of governance and roles and responsibilities, kinds and levels of care to be provided, standards and guidelines, and accountabilities.

54. Communities should strengthen efforts to incorporate the building of "smart" emergency preparedness technology into public buildings and facilities. For example, seniors' housing units should be equipped with emergency generators (as should certain food and gas/petrol suppliers within communities).

55. Priorities for Action

1. Articulate the key features and characteristics of special needs shelters and identify and/or develop, and encourage the use of standardized instruments such as screening tools to assess and monitor levels of care required/provided.
2. Ensure that special needs shelters are able to address the diversity of living circumstances and needs of older people including the capacity to accommodate diverse relationships, special caregiving responsibilities, and other circumstances and arrangements that might otherwise act as barriers to their mobility and relocation.
3. Develop guidelines that allow other care facilities in the vicinity to accommodate special needs "visitors" who require shelter in circumstances where special needs shelters are not available.
4. Develop special measures that identify and draw on all of the resources within communities to provide a surge capacity within shelters in emergency situations, including the use of specially trained volunteers.

The Great Hanshin-Awaji Earthquake: After the Shock

Of 6,533 victims killed in the collapse of buildings and other damages caused by the Great Hanshin-Awaji Earthquake, 53% were over 60 years of age. Of the 930 who died of secondary effects between January and June, 90% were elderly people over 60 years of age. The average age of those who [died] during this period was 69.2 years.

In the aftermath of the earthquake, many older people weakened from the harsh living conditions and loss of caregivers. For the elderly with medical conditions and disabilities, life in emergency shelters was extremely harsh. Inadequate heating and poor nutrition contributed to high rates of dehydration, diarrhoea, muscle and joint-related symptoms, hypertension, pneumonia, and other ailments. Many who had been receiving health support within their homes found themselves without their caregivers and means to keeping up with their treatment and self-care. Those taken to hospitals were frequently returned to shelters because of shortages of in-patient beds.

An important programme that came from the Great Hanshin-Awaji Earthquake was the formation of the Health Advisors System. This was part of the broader nursing care provision system in the Hyogo prefecture but targeted persons and other people with special needs. The Health Advisors System included not only outreach services to the elderly and at-risk individuals to ensure continuity of health care and social welfare support, but also the formation of community activities to reduce older people's isolation. Resident social meetings, health consultation meetings, tea parties and memorial day services were important in helping older people re-establish networks of mutual support and assistance while enhancing their overall quality of life and place in community.

Source: Hutton, D. Older People in Emergencies: A Framing Document for Policy and Program Development. Draft Version 3 prepared for the World Health Organization. 2006.

Theme 7: Resiliency, Recovery and Restoring Livelihoods after a Disaster

56. Vulnerability and resiliency are not mutually exclusive: the special needs of older people often exist alongside extensive skills and unique experiences. The ability to maintain self-sufficiency and autonomy-through work, intergenerational supports, and/or social pension schemes-contributes substantially to the capacity of older people to cope with and recover from crisis. However, while older people-and particularly those in developing countries-remain economically active, aid assessments often overlook this reality.

Considerations

57. Emergency and disaster situations often involve significant trauma for older people. They may suffer a significant loss in family, friends, networks, often accompanied by a corresponding change or loss in their role and status in their community. They may also experience a loss of income, home and property. For many, these losses can be devastating and compromise their resiliency and health. For others, the experience of previous trauma and loss may equip them to play an important role in the response and recovery of their family and community. Their knowledge of the land, their experience, their coping strategies and skills and knowledge all become important assets to mitigate the crisis, restore livelihoods and maintain well-being.

58. Older people in the developing world remain economically active throughout most of their lives and the restoration of their livelihood after disasters is particularly important: it is their first priority in recovery. For families, the economic activities of older people are a critical component of intergenerational support contributing to shelter, food, and the costs of education. Economic self-sufficiency is facilitated through measures such as financial transfers, their enrollment in rehabilitation projects that generate income or in credit or saving schemes, and their participation in skills training, education programmes, and training in literacy, numeracy and new languages.

59. Self-sufficiency can mean different things: it can apply to the ability to cope within the first 72 hours of a disaster or it can mean the long-term rebuilding of family and community capacities. Every person-and community-has unique needs and assets that come to light in the recovery stages of a disaster and emergency responses must be sufficiently flexible to accommodate these differences. A variety of community-based frameworks exist to build and sustain local capacity for emergency preparedness including the development and use of volunteer community-based consulting networks.

60. For the longer term, effective response and recovery calls for communities and governments to address systematic inequities that have compromised health and well-being in the past and that present barriers to rehabilitation and reconstruction. This requires a commitment to actions to improve the health of older people generally, including the introduction of public policies that promote active/healthy ageing, strengthen resiliency, and reduce seniors' vulnerability.

61. Priorities for Action

1. Put structures and procedures in place to enable communities to prioritize their needs collectively and to support recovery activities and the restoration of livelihoods. As part of this process, communities should develop and draw on approaches that are responsive to their unique circumstances and that are self-sustaining.
2. Develop plans around known vulnerability issues and recovery barriers associated with older people and ensure their involvement both as individuals and as participants of broader organizations that have a mandate to mobilize seniors.
3. Provide older people with the opportunities to engage across the full spectrum of rehabilitation and restoration activities. This includes engaging in a broad range of activities associated with learning, work and employment, income support, volunteering, caregiving, and social participation and inclusion.
4. Ensure the availability of sufficient funding and other resources to support and empower older people to be meaningfully engaged throughout all aspects of recovery and restoration.

SUCCESS IN MOZAMBIQUE: BUILDING LOCAL CAPACITY AFTER THE 2000 FLOODS

In 2000, Cyclone Eline and heavy rains struck Mozambique. The flooding that began in early February and stretched through to March covered 140,000 hectares of arable land. Over 45,000 people were rescued from roof tops, trees and other isolated areas; 700 people lost their lives and 500,000 were displaced.

In the aftermath of the flood, HelpAge International of Mozambique (HAIM) worked with the local non-government organization VUKOXA to address the needs of the local poor and vulnerable older people. Comprised of retired people themselves, VUKOXA carried out home visits by local counsellors or vaingeseli to identify the problems faced by older people and ensure they received essential household items such as food, blankets and clothing. The VUKOXA programme also worked closely with communities to raise awareness of older people's rights to participate in the recovery and rebuilding of their communities.

• Councils representing older people were organized in each village and worked closely with community organizations to identify vulnerable older people and coordinate the reconstruction of their homes and property.
• Older people were included in the planning and implementation of all community recovery activities, including animal distribution, access to agricultural seeds and tools, and credit for the income-generating activities.
• A social fund was established to support more vulnerable older persons in the village, using profits from a newly constructed community mill.
• Awareness raising and training was given to family members in order that they could provide home-based health assistance to frail elderly members.
• Intergenerational relations were supported by having older persons partner with school children in the planting of fruit trees at schools.

Source: Hutton, D. Older People in Emergencies: A Framing Document for Policy and Program Development. Draft Version 3 prepared for the World Health Organization. 2006.