Less than 48 hours before Hurricane Laura made landfall near the Texas-Louisiana border, Orange resident Tanya Lewis was packing her bags and preparing to evacuate to a hotel in Houston when her phone rang.
It was Senior Rehabilitation and Skilled Nursing Center, the Port Arthur nursing home caring for her 60-year-old mother, Drusella Lewis, who’d recently tested positive for COVID-19.
The day before, staff had informed Lewis that residents of the facility would be staying put, and her mom, though asymptomatic, would remain quarantined on the coronavirus ward. But now forecasters were expecting the storm to strengthen into a major hurricane, and the nursing home had come under a mandatory evacuation order. They would be moving her mom, who has diabetes and high blood pressure, to a facility somewhere outside of Dallas. They didn’t mention the name.
In the week since, Lewis has been trying to check up on her mother by dialing the number in her phone that a nurse had called her from when they first arrived at the nursing home they evacuated to, which turned out to be in Corsicana — more than 250 miles northwest of Port Arthur.
“That’s the only way I can get in touch with them,” she said. “It’s not like someone gave me a number for the facility or let me know how I can keep in contact.”
Lewis’s mother is one of 506 residents of long-term care facilities who, as of Friday morning, were still waiting to come home, according to the Texas Health and Human Services Commission. Tanya Lewis, who returned to East Texas after the storm passed last week, says she calls the number every couple of days, but she can’t get anyone to call her back with updates about her mom.
“Especially when you have a COVID patient, you would think they would call often because of her situation and her condition. But I have not been receiving any calls,” she said.
She hasn’t spoken directly to her mother since Aug. 13 — the day her coronavirus test results came back positive. She doesn’t know when she’ll be coming back home.
“I did tell them to tell her that we love her and we miss her and hopefully we’ll see her soon,” Lewis said.
Residents of more than 100 East Texas care centers for the elderly or disabled, including 33 nursing homes and 43 assisted living facilities, were sent to far-flung corners of the state under emergency evacuation plans during Hurricane Laura, according to state health officials.
Though Texas emerged relatively unscathed in the aftermath of the storm, which hit Louisiana as a category 4 hurricane last Thursday, the experiences of long-term care residents and their families demonstrate the complexity of protecting society’s most vulnerable during simultaneous disasters of a global pandemic and a weather emergency.
Texas health officials have not said how many of the evacuated residents had active coronavirus infections, but state records indicate at least nine nursing homes reported plans to move COVID-19 patients. Statewide, nearly half of nursing homes report having at least one active coronavirus infection among residents or staff.
Evacuating nursing homes is challenging even under more normal circumstances. Being moved is stressful to frail residents and may worsen their health problems, research has found. And hastily relocating patients makes it difficult to implement infection control measures that public health experts say are crucial to slowing the spread of coronavirus, which has been disproportionately deadly among the elderly.
But remaining in place is not an option during a hurricane, and federal regulations require nursing homes to develop and practice emergency preparedness plans.
“We’ve been entrusted to take care of these folks, and it’s always difficult on them to move them,” said Ron Payne, CEO of Southwest Long Term Care, which operates nursing homes and assisted living facilities across Texas and Oklahoma, including the Port Arthur facility that relocated Tanya Lewis’s mother. Despite the extra challenges posed by the pandemic, the evacuation went as smoothly as any evacuation Payne’s been involved in, he said.
Payne said he was "shocked" to hear of Lewis's situation. "That is not our way we do business," he said, adding that he would take it up with nursing home staff.
Nursing homes are in charge of making arrangements with other facilities that can accept temporary transfer patients and to arrange emergency transportation for an evacuation, said Kevin Warren, chief executive of the Texas Health Care Association, a nursing home trade group.
Keeping track of patients’ medications, keeping the medications refrigerated, making sure the transportation can accommodate wheelchairs, keeping loved ones apprised of the situation, mitigating “transfer trauma” on residents with dementia or other health problems — all are logistical difficulties even during more usual hurricane seasons, Warren said.
The pandemic ramped up those challenges and added new ones: Do the staff have adequate protective equipment? Are the COVID-19 positive residents appropriately isolated?
“From all the conversations that I had with providers ... it all went very smoothly,” Warren said.
Isom Ramsey, a volunteer ombudsman who works as an advocate for residents at a nursing home in Beaumont through the regional Area Agency on Aging, said he’s had as difficult a time getting information about residents’ whereabouts as some families have in the aftermath of Laura.
“It’s horrible,” Ramsey said. “Somebody just calls and tells them, ‘We’re evacuating, and we’ll be in touch.’ And they don’t include any details.”
Ramsey himself was unaware his facility was evacuating until after the storm, when he got a panicked call from the daughter of a resident who was trying to find information about her mom; she learned her mother had become ill during the evacuation and was hospitalized over 100 miles away.
By the time they were able to get more information, the woman’s mother was stable and back home in Beaumont, Ramsey said. The nursing home had not called to tell the family that they were returning the woman to Beaumont.
Even though Southeast Texas escaped the worst of Hurricane Laura’s impact, property damage has prevented many from returning home — including hundreds of residents of long-term care facilities.
Brian Lee, executive director of the Austin-based nonprofit nursing home watchdog Families for Better Care, said the storm exposed the importance of state oversight of “the nuts and bolts” of facilities’ disaster plans. Regulators should make sure homes are keeping families informed, particularly those who have been barred from in-person visits since March, he said.
“That’s a lot of folks to be moving around in a COVID environment,” he said. “It’s a difficult situation right now for the facilities and providers and for the residents.”
Payne, the Southwest Long Term Care CEO, said on Thursday that residents of the company’s Port Arthur facility should be able to return over the weekend, after an insurance company completes an assessment of some minor damage to the building during the storm.
That was news to Tanya Lewis, who, as of Thursday night, said she had still not received an update on her mom.
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