Fire Crisis in California: Hospices Activate Emergency Plans

October 25 -- The Los Angeles Times reports today that more than 500,000 people have been evacuated from their homes, over 1,600 homes have been destroyed, and more than 695 square miles have burned due to the rapidly spreading wildfires in Southern California. Hospices in the area, which serve the terminally ill mostly in patient homes, are activating their disaster preparedness plans in response to the crisis.

According to hospices in the affected area, staff shortages have been the primary challenge. Many hospice staffers have been forced to take a reprieve from caregiving because they must evacuate their own homes or provide care for family members. According to Suzi K. Johnson, Vice President of Sharp HospiceCare in La Mesa, her organization is operating with a 60 percent staff reduction.

To cope with the short-staffing, some Southern California hospices contacted by HFA have temporarily modified patient care plans by replacing nonessential home visits with phone calls. Johnson reports that patients are first prioritized according to need, and in-home visits are reserved for the most pressing patients.

Fortunately, hospices in Southern California say they were well-prepared for this catastrophe. All hospices HFA spoke with had a disaster preparedness plan in place well before the fires. In 2003, fires ravaged Southern California, albeit to a lesser degree than now, and many heath care organizations reacted by revising their disaster plans to reflect the threat of rapidly spreading fire.

Hospices are working to maintain contact with all their home patients, as many have been evacuated. Juan Renteria, of San Diego Hospice and Palliative Care, describes a process typical of many Southern California hospices. The first task is to locate all hospice patients. If patients have been evacuated, they must first be found. The second step is to coordinate care between relevant parties to ensure that patients continue to receive their medications and other vital care. Finally, hospices have been working to help find housing for patients who must be evacuated. Several hospices HFA spoke with are working in conjunction with nursing homes and assisted living facilities to transfer patients out of the danger zone.

“Our staff…has been called upon to evacuate patients to safety. Staff people are working to ensure patients safety, while they themselves are being evacuated. These acts of courage have come from many staff while they are working, not knowing if they will have a home to return to,” said Lorraine Hedtke, Bereavement Services Manager of VITAS Innovative Hospice Care, one of the nation’s largest providers of hospice care.

Some hospices are using the Internet to quickly disseminate information regarding their patients and disaster plans. A FAQ [pdf] regarding San Diego Hospice and Palliative Care’s disaster plan is available from its website. Sharp HospiceCare is placing regular updates on its website. VITAS’s Guide to Coping with Public Tragedies and Natural Disasters is available online.

While most hospices maintain their own disaster preparedness plans, their plans are not integrated into a comprehensive, state or countywide disaster plan. Hospices that are part of a larger, regional healthcare organization usually have a comprehensive plan for the entire company.

Most administrators HFA contacted are impressed with the response by local public officials, even though San Diego County lacks a pre-planned, direct line of communication with end-of-life caregivers. Alejandro de la Rosa, LightBridge Hospice, said that to his knowledge, his organization has not had direct, regular contact from San Diego County officials. He said that LightBridge Hospice has received most of its fire emergency updates from local media (including radio, television, and the website for the San Diego Rural Fire Protection District).

Some nursing home residents have been evacuated to Qualcomm Stadium, temporary home of around 10,000 residents.

Gina Andres from Hospice Care of the West, Foothill Ranch, reports that some patients are suffering from respiratory ailments due to the high volume of smoke in the air. Part of Hospice Care’s disaster plan is to ensure that its patients have enough back-up oxygen tanks to see them through the fire.