Amid Fires, California SNFs Face Tough Evacuation Decisions

With wildfires threatening multiple communities in Northern California, skilled nursing and other senior living operators are facing a dilemma all too familiar to those who work in the Gulf Coast states: to evacuate or not to evacuate?

For some, the choice was clear: In Santa Rosa, Calif., officials at four Oakmont Senior Living communities evacuated 350 residents threatened by the flames, according to a Tuesday report in the East Bay Times. The fire later destroyed one of the communities entirely, and 60 of the residents found refuge at another assisted living center in Concord, Calif.

But unlike the hurricanes that have made headlines in recent weeks in the long-term care world, fires are far less predictable, and can catch facilities with even the most well-developed care plans off guard. For instance, officials in California noted that many of the residents in the paths of the wildfires didn’t realize the danger until it was too late to react.

“They burned so quickly,” California Department of Forestry and Fire Protection director Ken Pimlott told reporters this week, according to CNN. “There was no time to notify anybody. These fires came down into neighborhoods before anybody realized the fires were occurring in many cases.”

In addition, the effects stretch far beyond the immediate danger zones: The California Department of Veterans Affairs elected to evacuate 137 residents from its facility in Yountville, Calif. on Tuesday night, despite the fact that Yountville wasn’t part of an evacuation zone. Still, the air quality in Sonoma County was poor enough to necessitate the relocation of residents with severe respiratory problems and other significant health problems, the San Francisco Chronicle reported.

The California Association of Health Facilities (CAHF), which represents skilled nursing facilities and other long-term care providers in the state, says it’s monitoring the situation closely as it unfolds.

“We have sent emergency contact information to providers in the wine country so they can be in touch with their local disaster preparedness authorities in Sonoma, Napa, and Lake counties,” CAHF director of public affairs Deborah Pacyna told Skilled Nursing News.

“We have sent reminders about evacuation protocols and to be prepared with documents, medication, and current physician orders for residents who may need to be evacuated,” Pacyna said. “One concern at this point is that the wind is expected to pick up later tonight.”

The hurricanes in Florida and Texas, and now the wildfires in California, have brought renewed focus on skilled nursing emergency protocols, especially with the Centers for Medicare & Medicaid Services (CMS) poised to begin enforcing new rules regarding SNFs’ disaster prep plans. As multiple experts have told Skilled Nursing News, this process includes developing hazard-specific emergency protocols: For example, a Midwestern SNF should focus on snowstorms and tornadoes, while Western states should prepare for earthquakes and wildfires.

But evacuating can sometimes cause more harm than good. Janine Finck-Boyle, director of health regulations and policy for LeadingAge, told Skilled Nursing News that SNF operators should weigh the availability of alternate destinations, sufficient transportation, and emergency supplies along the route when considering an evacuation.

“These are frail, elderly individuals, and what decisions are made before, during, or after an event — they’re not easy,” Finck-Boyle said. “And you have to look at lots of different factors along the way.”

Research has also revealed the concrete risks associated with moving vulnerable skilled nursing residents in emergencies: A study from the University of South Florida found that residents who were evacuated during four hurricanes between 2004 and 2008 — Katrina, Rita, Ike, and Gustav — had higher rates of death and hospitalization than those who sheltered in place.

Written by Alex Spanko