Like clockwork, stories of suffering by the oldest residents in the line of hurricanes, floods, tornadoes and other natural disasters seem to follow. Regulations dictate nursing homes and other facilities must have preparation plans in place, but the realities of how older Americans cope with a storm go beyond any piece of paper. The issue burst to the forefront again Wednesday with news of eight deaths at the Rehabilitation Center at Hollywood Hills in Florida, where workers say Hurricane Irma caused the air conditioning to fail, and they struggled to keep residents cool with fans, cold towels and ice.
A look at the issues at play in keeping the oldest safe in the line of disaster:
RISKS RISE FOR MOST VULNERABLE RESIDENTS
Time and again, natural disasters have claimed residents of nursing homes and other senior communities. The risks rise in a state like Florida, which has the highest proportion of people 65 and older of any state, one in five of its residents.
Hurricane Andrew caused a diaspora of nursing home residents, and family members frantically searched to locate their elderly relatives. Hurricane Katrina was followed by harrowing tales from St. Rita's nursing home, where dozens died. And Hurricane Harvey washed through La Vita Bella assisted living facility, and brought a viral photo of elderly women sitting in deep floodwaters while they awaited rescue.
PLANS IN PLACE, BUT NOT ALWAYS THOROUGH
The Centers for Medicare and Medicaid Services, which regulates nursing homes, gives the Rehabilitation Center at Hollywood Hills a below-average rating, two stars on its five-star scale. But the most recent state inspection reports showed no deficiencies in the area of emergency plans.
Both federal and state laws require emergency plans for nursing homes and training for staff. A 2012 report from the inspector general of the U.S. Department of Health and Human Services found the vast majority of nursing homes comply with that requirement, but that serious gaps persisted.
The plans often included unreliable transportation contracts and little collaboration with local emergency managers, the audit found.
Nursing homes in Florida are required by state and federal law to file an emergency plan that includes evacuation plans for residents. County officials released documents showing the Hollywood facility was in compliance with that regulation and that it held a hurricane drill with its staff in October.
Lisa Baker, a professor at the University of Alabama at Birmingham who teaches a class on disaster preparedness and co-authored the book "Vulnerable Populations and Disasters," said each new catastrophe brings lessons of how to improve planning and response. But she said when factors are constantly changing, it's impossible to have a plan that addresses every variable.
"I don't know that there is a perfect way," she said. "You're preparing for something that you really don't know how it's going to play out."
DANGEROUS EVEN OUTSIDE STORM'S PATH
Even though threats can be grave to seniors staying in facilities in the path of a storm, evacuations also can be deadly. When tornadoes ripped across Alabama in 2011, they flattened an assisted-living center, tore through a brand-new senior housing complex and ripped apart a nursing home, where four dozen residents massed in hallways, praying as trees crashed down and a cloud of dust rained upon them.
Some died in the tornado itself. Others, thrust into difficult moves to unfamiliar new homes, died in the days that followed.