Hurricane Caregiving: What's Best For Frail, Elderly?

Aug. 31, 2011— -- As the sole caregiver for his 83-year-old mother, Ted Martini wrestled with how best to protect her as Hurricane Irene threatened North Carolina's nearby Outer Banks. He and his mom, who suffers from vascular dementia, could ride out the hurricane in their home. Or, they could jump into the car and try to outrun the destructive winds and water.

"I honestly felt either way was a bad decision," Martini said Tuesday from their house in Beaufort, N.C., which lost electricity for two days, but weathered the storm without damage. "If we stay home, we have a chance that things will be bad. If we go on the road...it would be days and days of excess stress on her, and discomfort and fear."

Like other caregivers, Martini faced the dual burden of needing to keep his mother safe while making sure he could continue meeting her needs in the midst of a monster storm. He knew how much she counted on him to be there.

When Joan Martini, a former New York City paramedic, retired to North Carolina, her son Ted, a graphic artist living on Staten Island, moved down too. Over time, she suffered multiple strokes and transient ischemic attacks, called mini-strokes, which made her physically unsteady and prone to agitation when her routines were disturbed. In the last few months, she began using a walker to get around the house and a wheelchair to go out.

Once an avid reader and knitter, she spends most days in bed or on a couch, quietly watching her son cook, clean and care for their home. She gets twice-weekly visits from nursing aides, and receives at-home physical therapy through a home health care agency.

Before the storm, the nursing aides told Martini his mother would be safest in the small, single-story house they've shared the last six years, since Martini sold his pub to care for her 24/7. "She really needs constant eyes on her," he said, as he described the worry he feels every time he leaves her, even briefly.

Caregivers From Online Forum Offer Long-Distance Support

Martini also sought advice from fellow caregivers he'd met through the online community created by AgingCare.com. Last Thursday night, he posted an account of his dilemma, describing how he was "going nuts" choosing between "being stuck on the road" or remaining "barricaded in the house." He described how he tried to get a reservation at a hotel across the street from a hospital, only to learn it was fully booked and didn't have a waiting list. "Wish us well. I hope I'm making the right decision."

Because their neighborhood wasn't under a mandatory evacuation, Martini opted to stay where his mother would feel safe and he could more easily "keep a happy attitude and make preparations." His goal was to keep her "calm and occupied."

He boarded up the windows and re-charged cell phones. He bought flashlights, batteries, non-perishable food, bottled water, extra disposable underwear for his mother, and "ice like crazy," to keep the contents of the refrigerator and freezer cold as long as possible if the power went out. He filled the bathtub should they need more water to flush toilets. The local pharmacy agreed to refill prescriptions for some of his mother's medications, even though it was three days too early to renew them.

"My main concern was not to disrupt anything; to keep everything as consistent as possible for her."

His mother slept as Irene unleashed her first round of local fury Friday evening, knocking out the electricity. Martini kept his transistor radio on and watched his cell phone for text messages from his county's emergency management alert system. The phone kept him connected to an AgingCare.com member from Florida and another from Washington State, who called "every hour making sure I'm OK. Especially when I was in indecision mode, they were giving me real strong support, keeping me updated on news I couldn't get."

On Saturday, he let his mother stay in bed. "I usually get her up, but she was comfortable in bed," he said. "I think she felt safe."

Red Cross Says Some Frail People Fare Better in Shelters

The American Red Cross, which puts safety first, says some frail patients fare better in shelters, which evaluate their medical needs and have nurses and emergency medical technicians available to address urgent issues.

However, going to a shelter "is always going to be the last thing you want to do," said Jim Judge, executive director of Lake-Sumter EMS Inc., in Mount Dora, Fla. "If you're in a good, solid home ...you're going to be far better off...as long as you're not in a flood-prone area."

Judge, a member of the American Red Cross Scientific Advisory Council, advises families worried about an elderly parent or grandparent to ask local emergency management offices if they have plans to shelter "the elderly, the frail, individuals that might have medical conditions such as oxygen dependence." Aides or caregivers can accompany them during shelter stays, he said.

Caregivers and families should make sure to ready emergency kits well in advance of disasters. These can be assembled in a duffle bag, backpack or suitcase -- preferably on wheels, which are easier to maneuver -- and stored under the bed, so they can be rolled out for use at home, or taken to a shelter during an evacuation.

Although disaster preparation focuses on food, water and medications, "the biggest problem we run into is oxygen for oxygen-dependent patients," Judge said. Because power failures cut off the flow of life-saving oxygen through electric-powered devices, patients may want to consider portable machines that can be plugged into a car's DC adapter and run off the car battery, he said.

Caregivers can be instrumental in diverting frail patients' attention from the disaster, Judge said. Play music on a battery-operated or hand-cranked radio. Laugh, talk, joke. "Anything that will keep the individual's mind off what is happening."

AgingCare.com offers tips on emergency planning for frail elders. The Alzheimer's Association has prepared a disaster tipsheet with special considerations for Alzheimer's patients. The American Red Cross has a Disaster Preparedness for Seniors booklet, and has established a"Safe and Well" website to help friends and relatives stay connected during a hurricane or other natural disaster.