Skilled nursing facilities (SNFs) in Florida and elsewhere in the Southeast are facing an enormous test.

Hurricane Irma forced an unprecedented number of evacuations prior to making landfall in Florida early Sunday morning, with the storm’s size and severity creating complications as SNFs executed their emergency plans. Irma is expected to weaken by Monday morning, but the difficult and costly recovery process will pose steep challenges.

As of Sunday evening, about 400 SNFs, assisted living communities, and other health care facilities had been evacuated, the Wall Street Journal reported. Likely, this is the largest evacuation ever of licensed senior care facilities, according to The Washington Post.

Whether they evacuated residents or not, Florida SNFs began carrying out their emergency preparedness plans as the storm approached, Kristen Knapp, director of communications for the Florida Health Care Association, told Skilled Nursing News on Friday. As a matter of law, these emergency plans include mutual aid agreements with other SNFs that can serve as evacuation sites.

To help facilitate the pre-storm evacuations, SNFs throughout the state were routinely updating and checking the FLHealthSTAT website, where facilities share their bed availability and emergency contacts, and note whether they are evacuating or sheltering in place. Most SNFs throughout the state were asked to check in on the website twice daily, while those in Miami-Dade County evacuation zones were asked to update as much as possible, Knapp said on Friday.

The shifting path of Irma as it approached the state made it all the more critical for information to be constantly flowing, she emphasized. In the lead-up to the storm, there were some SNFs that went from being receiving facilities to being in mandatory evacuation zones.

The size of the storm — which blanketed the entire Florida peninsula on Sunday evening — meant that SNFs in neighboring states were also providing bed availability, Knapp said.

SNFs not in a mandatory evacuation area faced the difficult decision of whether to relocate residents or shelter in place.

Kennett Square, Pennsylvania-based Genesis HealthCare (NYSE: GEN), one of the largest skilled nursing providers nationally, decided in some cases to evacuate. As of Friday, the company had evacuated 111 residents from its Lakeside Pavilion center in Naples and was evacuating 118 people from its Orchard Ridge center in New Port Richey. This was done out of “an abundance of caution,” and the residents were going to other Genesis buildings in the state, Vice President of Public Relations and Communications Jeanne Moore told SNN.

“Safe and appropriate transportation has been arranged for our patients, and members of our clinical staff will be accompanying our patients on the trip to the other centers,” she said. “Each patient will travel with his or her medications, belongings, et cetera. Our clinical teams at each center are ready and waiting to admit and begin caring for our patients. In addition, we have called in additional staff members and members of our regional management team to assist.”

Even though it was located in a mandatory evacuation zone, all 147 residents and patients of Ponce Plaza Nursing and Rehabilitation Center sheltered in place, at the facility in Miami’s Little Havana neighborhood.

Ponce Plaza was running on generator power as of Sunday evening, but the residents were relatively calm, administrator Desiree Sebastian told NPR.

Facing the Aftermath

Irma churned over Florida during the day on Sunday, and it was forecast to continue lashing the state throughout the night. As the storm weakens — which is expected to happen Monday — it will become clearer how seniors and other Florida residents fared during the storm, and how much damage Irma has left in its wake.

Generally, SNFs wait to receive an all-clear from local authorities, then send plant ops people in to determine the damage to buildings, Knapp said. Once the facility is declared safe, the SNF begins to execute on its reentry plans.

The official rule is that a receiving skilled nursing facility can exceed its maximum licensed bed capacity for a period of 15 days after an emergency, in order to accommodate as many evacuated residents and caregivers as it can safely manage, according to Knapp. This might involve moving extra beds into private rooms, or even putting mattresses on the floor.

Considering that Irma might create extraordinary circumstances, it remains to be seen whether exceptions will be made to the 15-day limit, she said. Already, executive orders have been issued allowing nurses who are not licensed in Florida to come to the state and assist after the storm.

Facilities also will be focused on bringing in workers who can relieve those staff members who were on duty through the storm, including those who accompanied residents to evacuation sites, Knapp noted.

On the caregiving front, SNFs will have traumatized residents who need special attention.

“These people will be devastated if they can’t go back to where they were, if they’ve lost a home or treasured possessions,” said Terry Fulmer, president of the John A. Hartford Foundation, an organization dedicated to improving the care of older adults. “They’ll be anxious, they may be depressed, withdrawn, fearful, so providers will be watching for those persistent problems and getting the supports required to [restore] some semblance of normalcy.”

A facility’s staff also will be affected by the storm and needing an extra level of support, Fulmer told SNN. A high proportion of care professionals are women who likely will have competing needs and desires to be at work caring for seniors versus at home supporting their own families, she noted.

Ponce Plaza’s Sebastian is one of these women.

“Many [of our staff members] are moms, including myself, who’ve left our small children at home,” she told NPR. “We don’t have cell service. Many people don’t have cell service or do not know how their families have fared. I think my staff is more anxious than the patients.”

It’s clear that support from individuals and organizations around the country will be needed to help seniors and their care providers following Irma, and Fulmer expects that this help will be forthcoming. For its part, The Hartford Foundation has a website of resources related to the hurricane crisis.

While they no doubt will welcome help, those on the front lines in Florida are doing all they can to weather the storm and start the rebuilding process.

“Our folks are working around the clock,” Knapp said.

Written by Tim Mullaney