Mass rest home evacuations: how did the elderly fare?

1 November 2012

FIONA CASSIE reports on  Canterbury DHB nurse leader, Becky Hickmott's and researcher Dr Claire Heppenstall's presentations (to the Baby Boomers & Beyond Symposium) on how  elderly evacuees fared after the mass rest home evacuations that followed the  February 2011 quakes in Christchurch.

Urgent phone calls from a rest home to Civil Defence on 22 February requesting bandages and head torches had Becky Hickmott puzzled at first.

But when the rest home explained “the cracks are so big residents keep falling down them”, she started to get a glimpse of how big problems were for the city’s residential aged care facilities.

Hickmott, a nurse leader at Canterbury District Health Board, told the College of Nurses symposium that she was seconded as health liaison to Civil Defence soon after the quake hit.

As the calls kept coming in, it eventually became clear that quake damage and liquefaction meant nine residential care facilities had to be closed and alternative homes found for more than 500 older adults.

In the end, nearly 300 of the city’s frail elderly were bussed and flown to facilities outside Christchurch and a further 200 to facilities within the city, in an urgent evacuation made even more challenging by damaged roads, files sometimes buried in liquefaction, and struggles to contact families with power and phone networks down.

Hickmott said some patients ended up being sent off with their name and details written on one arm and their medication on the other. Many were flown out by defence force Hercules to more than 125 facilities stretching from North Auckland to Invercargill.

She believes the majority of families were very grateful but subsequent media headlines highlighted that the urgent evacuation in a highly stressful time was not without critics or fault. “We have to acknowledge that we got some things wrong,” says Hickmott, particularly communication and evacuating long distances by bus.

But the motivation behind the evacuation was clear – Christchurch was determined not to be “another Hurricane Katrina” with its tales of abandoned rest home residents. And traumatic evacuations of the frail and elderly in the middle of the night by Hercules were done with the best of intentions.

Hickmott says it had feared that the mortality rate of the elderly evacuated outside of Christchurch would be high but a subsequent study, led by Dr Claire Heppenstall, on the impact of the mass evacuation, found the highest mortality rate was amongst those evacated to other facilities within Christchurch.

The study did find increased mortality in out-of-town hospital and psychogeriatric care evacuees, though the numbers were very small, so they may not be statistically significant. The overall mortality rate of Christchurch residential care residents in 2011 was similar to previous years, and the mortality rate of the evacuees moved out of the city was actually less than for those evacuees who stayed in the city.

Heppenstall says the result was interesting, especially given the negative media reporting at the time, and the research team is unsure why the difference occurred.

“Possibilities include that people who were already too unwell to travel were moved within the city, or the stress of living with aftershocks and damage, or difficult living conditions for example the damp, cold, portaloos etc.”

Hickmott was later given the task of organising a fair repatriation of the evacuated residents back to a Christchurch with 600 fewer residential aged care beds than pre-quakes. An expert panel set guiding principles, including a strong desire to return, that relocation would not create harm, compassionate grounds, and adverse affects on separated families. A travel subsidy was also provided on compassionate grounds to fund families to travel and see their evacuated loved ones.

Hickmott says it was sometimes challenging tracking evacuees down because they were subsequently shifted again. She went personally to many out-of-town facilities, where she talked first to the manager, before talking to the resident themselves about whether they wanted to return to Christchurch or another location and what their family wanted. Lastly, she spoke to the family or their power of attorney.

She says some of the interviews with non-verbal residents were challenging but each resident was given the chance to share their wishes about returning. One example was a son who told Hickmott about his mother, “It’s no use speaking to Mum. She’s hardly spoken ten words in the last two years”.

“But when I spoke to her, she lit up and said ‘yes, of course, I remember the earthquake – I had to lie down and was put in a freezing cold plane’,” recalls Hickmott. “The son was gobsmacked and cried.”

Sometimes, she found that the military carrying out the evacuation had been just too thorough. This included finding in one out-of-town rest home a Christchurch gentleman who wasn’t on any rest home evacuation list. It turned out he lived near one of the homes and was seeking out help “when the military just scooped him up and flew him to Auckland”. A similar thing happened to a couple of elderly people just visiting a rest home. “You’ve got to hand it to the military. They were very thorough.”

Hickmott paid tribute to the Canterbury District Health Board and rest home staff who, while having to deal with their own quake problems, also dealt with sometimes “challenging family dynamics” as family members disagreed on where their loved one should be located.

All evacuated residents wanting to return to Christchurch were back home by Christmas, says Hickmott – except for one who was keen to celebrate Christmas in her evacuee rest home before making the return trip.

The Impact of the Mass Evacuation of Older People from Residential Care Facilities Following the Christchurch Earthquake, a presentation by Dr Claire Heppenstall to Canterbury District Health Board.

Some key learning points from mass rest home evacuation

• Older people are very resilient.

• No larger overall increase in mortality.

• Overnight evacuations should be avoided whenever possible.

• Informal carers were distressed by the lack of communication about evacuation.

• Maintaining contact and support from family and friends was important.

• Anxiety was the most frequently reported adverse event.

• Transfer of clinical information to receiving facilities was poor and needs improving – electronic record system would help.