By Kevin Warren

President and CEO of the Texas Health Care Association

 When large-scale floods occur, nursing homes and assisted living providers often face an agonizingly difficult decision. They can keep their fragile residents in their buildings — known as sheltering in place — and hope high waters do not enter their facilities. Or they can attempt to move residents out of the facility, an action sure to confuse and jeopardize the safety of the vulnerable persons in their care.

This is what confronted long term care providers all along the Gulf Coast bracing for Hurricane Harvey, which eventually dumped an unprecedented 50 inches of rain on the region, overwhelming local, state and federal emergency responders.

Harvey devastated more than 43 counties, forcing the evacuation of more than 100 nursing homes and affecting more than 4,000 nursing facility and assisted living residents. Other providers — working closely with local authorities — sheltered in place.

At any of these facilities, there are countless stories of the staff heroics, as nurses and staff prioritized their residents’ care over their own families and personal property. Even staff in areas unaffected by Harvey stepped up to lend a hand, making space for residents who needed to be evacuated. They pulled together as an industry and worked closely with local, state and emergency officials, and they can’t be thanked enough for the long hours and dedication.

However, that’s not the story being told. Instead, both social and traditional media have focused on the unfortunate events that occurred as part of one facility’s efforts to evacuate their residents in a city that took on over 26 inches of rain in 24 hours, days after the hurricane had made landfall. According to the city manager, the entire city was underwater, and some emergency shelters had to be evacuated because of the historic flooding.

In my 23 years in long term care, I have never known anyone working in a facility who would stand by carelessly as residents suffered. They were placed in a position no one wants to be in as they sought to do what they believed was right for their residents.

One of the untold stories of Texas’ response to Hurricane Harvey is the hard work and sacrifice made by staff in dozens of affected long term care facilities. Many didn’t leave their facilities for multiple days, getting little rest and trying not to think about what was happening to their own homes and property. They often had to entrust the care of their own loved ones to others.

Long term care providers follow the orders of local authorities regarding the need for mandatory evacuation. However, when a mandatory evacuation has not been called, these facilities are faced with determining the best course of action for their residents. Unfortunately, the information available is not always clear and the planning and preparation made doesn’t always align with the circumstances presented. It can be a very complex decision, even in the best of circumstances.

When determining whether to shelter in place or evacuate, issues such as external risks and exposure for the residents and staff must be evaluated, as well as the availability of evacuation support resources at the time the need for evacuation arises. All of these and other factors must be weighed against the first option: shelter in place. The health and safety of long term care residents is the top priority of any skilled nursing facility.

Past large-scale disasters, like Hurricane Katrina and Hurricane Sandy, taught the country many lessons on emergency preparedness. We should look closely at how we can learn from the successes and challenges faced in Florida and Texas over the last several weeks.

With the support of families and local communities, long term care providers are taking care of their residents as well as residents from other facilities in the affected region against incredible odds. I am proud of the efforts of nursing home staff who selflessly did whatever it took to ensure the safety of their residents in extremely difficult situations. Let’s not lose sight of those efforts either.

And as Texas comes together to heal and to rebuild, let us learn and ensure that we are always prepared moving forward.

Kevin Warren is the president and CEO of the Texas Health Care Association, which advocates for better long term care for Texas seniors.