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Just about every week there are headlines about some weather-related disaster — a flood, tornado, hurricane, wildfire, or something else — somewhere. Although these events are becoming increasingly common, this doesn’t mean that they’re easier to manage, less dangerous, or less psychologically damaging. More than ever, your disaster preparations need to address different scenarios, the lessons learned, and ways to protect your residents’ and staff’s emotional well-being before, during, and after a weather-related event.
A Delicate Balance
“Situations that we feel we can do something about are far less stressful than those we can’t, and so it’s important to prepare for disasters. However, talking about disaster planning could increase anxiety, so it has to be done carefully,” said David Smith, MD, CMD, president of Geriatric Consultants in Brownwood, TX. For residents, especially those with neurocognitive disorders, less may be more. “You might simply reassure them that the facility and their family have things taken care of and not to worry. This is just one tactic, of course. It might be different in a setting where more residents are cognitively intact,” he said.
Discussing the science of weather and what experts are saying might be helpful for some staff and maybe a few residents. However, it is best to use this kind of information sparingly. Patricia Bach, PsyD, RN, a California-based clinical gero/neuropsychologist, said, “Being knowledgeable and staying on top of current predictions and expert guidance is helpful.” She suggested signing up to receive real-time alerts from local weather agencies and other sources. “These can be helpful for facility leaders and others in decision-making roles, and they can help family members stay on top of the situation.”
Ensuring that staff have the resources and confidence to deal with a disaster is essential, Dr. Smith stressed. “There absolutely needs to be teamwork. During pre-planning, it’s the ideal time to give staff a sense of participation and empowerment that will benefit their response and, hopefully, reduce their stress and anxiety.” Ultimately, he said, “Pre-planning is almost a laboratory for improving one’s culture. Take advantage of this opportunity.”
Drills and tabletop exercises can help increase everyone’s confidence about handling a disaster. They also present a chance to identify the residents and staff who may need extra support during an actual disaster. Observe people for signs of anxiety, fear, confusion, indecision, or other emotions or behaviors. “These might give you a clue about people whose mental health or well-being are more likely to suffer during a disaster,” said Dr. Smith. “You then can discuss what their particular fears or concerns are and address these in advance.”
Ultimately, there is no one-size-fits-all model for how people will respond to a disaster. “My experience is that some people for whom weather-related disasters are part of life are more resilient. They’ve been through such horrible things; they have strong internal coping resources,” said Dr. Bach. Others who’ve never experienced a tornado or other disaster only know what they’ve seen on the news or in movies, which is often terrifying. They may also need reassurance.
How Experience Impacts Perceptions
Discussions around disaster response are necessary, and it’s important to listen to different viewpoints. For instance, Anna Fisher, PhD, director of quality and education at Hillcrest Health Services in Nebraska, recalled, “We recently had severe high winds. Under citywide protocol, sirens sounded. This was upsetting and confusing to some residents and communities, as they associate such sounds with a tornado.” The result was questions asked by some providers in the area about whether sirens are appropriate for high winds or if they cause more worry than good.
When Hurricane Ida was threatening New Orleans last year, many in the area — including nursing home residents and staff — couldn’t help but think back to Hurricane Katrina and the devastation that storm caused. Hearing that Ida could be worse surely made it challenging to keep people calm, Dr. Fisher observed. She knows this from experience: “Here in Nebraska last spring, concerns about flooding raised angst because of a disastrous flood that occurred in 2019.” She added, “We experienced the physical and psychological effects of a flood. As a result, any predictive rainfall at times injects anxiety in people. It brings back all the memories and stress. We need to learn to deal with this and find ways to help curb the anxiety caused by past experiences.”
Dr. Fisher suggested, “If we can equip people with the knowledge of what a weather-related disaster is and what we might expect, they are better prepared from a psychological standpoint.” Justin Watson, MPA, healthcare coalition coordinator for the Omaha Metropolitan Healthcare Coalition, added, “When it comes to the psychological effects of a disaster, we can prepare with partnerships, building relationships with behavioral health organizations and practitioners, and training for psychological first aid” (see the sidebar).
Focus on Lessons Learned, Not Shoulda, Woulda, Coulda
“Despite all your planning and best efforts, you absolutely cannot preplan for all possible contingencies. Each disaster is extremely nuanced, and a lot of issues go into decision-making,” Dr. Smith observed. Although it is important to learn lessons from each and every disaster, he said, it’s important not to second-guess and dwell on regrets or what could have been done differently.
“Involving all the stakeholders in preplanning is the best tactic to help prevent people from dwelling on regrets,” Dr. Smith said. There may be some contingencies that you would have had to be clairvoyant to anticipate, he offered. Instead of torturing yourself over these, focus on what you could do to anticipate, address, and even prevent such surprises in the future.
While you’re assessing your disaster response and planning for the future, take time to recognize your staff for their efforts. “Staff often make a lot of sacrifices before, during, and after a disaster to keep their residents safe and comfortable. They do this for the benefit of the residents and often at great personal expense. They need to be rewarded and thanked for their efforts,” Dr. Smith said.
Reflecting back on lessons learned can and should be a positive effort. As Dr. Fisher said, “With each disaster, we further our understanding of our environment and the weather. What we learn will help us better prepare for the next one, even though every disaster is different.”
Mr. Watson stressed, “We are learning from each disaster how to be better prepared and to expect and prepare for the unexpected. And we can and should do a better job of communicating to the public what we’ve learned from these events.” He added, “Not only does this help those outside of facilities prepare for disaster. It also helps them feel confident that their loved ones are safe with us, and this helps their psychological well-being before, during, and after a disaster.”
In this episode Karl Steinberg and Elizabeth Galik discuss our cover story on natural disasters and mental health, new guidelines for aspirin usage in older adults, how to minimize the risk of resident-to-resident mistreatment in post-acute and long-term care, and the new Clinical Practice Guideline (CPG) for pain management.