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Nursing Homes' Hard Choice: Stay or Leave?
Managers in Florida Weigh Risks As They Monitor Wilma Forecasts

By Peter Whoriskey
Washington Post Staff Writer
Sunday, October 23, 2005

NAPLES, Fla. Oct. 22 -- A hurricane is forecast to hit this city, a mandatory evacuation order is in effect for coastal areas, and many residents are packing up and fleeing.

The 108 residents of the Lakeside Pavilion nursing home, however, are staying put.

After days of gazing at the Weather Channel and the Web site of the National Hurricane Center, the operators of the home have decided not to evacuate the patients, most of whom are in wheelchairs and some of whom would have to be transported with intravenous lines, feeding tubes or oxygen tanks.

It is the kind of decision that "hampers your sleep," said nursing home administrator Bill Maggard.

"I made a decision yesterday that I think it's safer to keep my residents here," he said Saturday.

The decision to stay or flee in the event of a hurricane can be difficult even for the able-bodied. But as the evacuations for hurricanes Katrina and Rita showed this year, the decisions made at nursing homes more likely could be a matter of life and death. Several nursing home patients died in Louisiana because they were not evacuated before Katrina hit, and in one case the owners of a home were charged with negligent homicide. On the other hand, several nursing home patients perished because they were evacuated; they died in transit.

There are 28 nursing homes in Collier County, where officials were preparing to bear the brunt of Hurricane Wilma. And of the seven that are in the coastal area where a mandatory evacuation order is in effect, three had been evacuated by Saturday, officials said. The others were either preparing to evacuate or were still waiting to make a decision based on the forecast of the storm's path and severity.

As nursing home operators pondered their decisions, forecasters issued a hurricane warning for all of southern Florida, including the Keys, as Wilma displayed her destructive power on Mexico's Yucatan Peninsula. Though the storm was downgraded to a Category 2, its sustained winds, clocked at 100 mph, raked the Mexican coastline for the second day, tearing off roofs, downing trees and power lines, and forcing tourists and residents trapped in hotels and shelters to seek refuge on higher floors. At least three people were killed.

"Never in the history of Quintana Roo have we had a storm like this," the Associated Press quoted Felix Gonzalez Cantu, the governor of the province that includes the resort sites of Cancun, Playa del Carmen and Cozumel, as saying.

On Saturday, modern storm history was made when a tropical storm formed in the Caribbean, 125 miles south-southeast of the Dominican Republic. It was the 22nd tropical storm of the current hurricane season, the highest number on record.

The World Meteorological Organization, the U.N. agency that names storms, has dubbed the latest one "Alpha," using the first letter of the Greek alphabet because, after Wilma, it had run out of letters from the Roman alphabet. (Names beginning with Q, U, X, Y and Z are never used.) It was the first time meteorologists have had to turn to the Greek alphabet to name a storm. The hurricane season does not end until Nov. 30.

In Florida, where Wilma is expected to make landfall sometime on Monday, Collier County's emergency management director, Dan Summers, estimated that about half of the county's residents have evacuated in the face of what is expected to remain a Category 2 storm.

It is on such predictions that Maggard and others have based their decision to stay or go.

"If it's Category 1 or 2, we'll sit it out here," said Gewaldine Cherisme, the receptionist at Heritage Healthcare and Rehabilitation Center, a nursing home in the mandatory evacuation area.

If not, they do have contingency plans to evacuate. "If we leave, we'll leave tomorrow morning," she said.

The Lakeside Pavilion, a pleasant one-story building in a residential neighborhood that looks like an elongated version of the single-family homes around it, can withstand a Category 3 hurricane and storm surge, Maggard said. The home sits just outside the mandatory evacuation area.

"Now, if it comes off the Yucatan as a Category 4 or 5, then I have to live with that decision," Maggard said. "People will second-guess me."

In fact, he has already second-guessed himself. Earlier in the week, after Wilma had swirled up overnight into a Category 5 storm, Maggard said he was certain that he would evacuate. He arranged for two 57-seat buses, as well as for some box trucks to carry mattresses, medicines and other supplies.

But when the forecast intensity dropped to Category 2, he scratched those plans -- though given enough time, they could be resurrected.

The evacuation to prearranged locations in Tampa and Ocala could take as long as six to eight hours, he said.

"You have to weigh every aspect: Can they stand a trip of that magnitude?" he said. What does it do to that dementia or Alzheimer's patient to be taken out of that secure location and . . . thrust into a different situation?"

One of the most difficult aspects has been the shifting forecasts for intensity and timing.

When Hurricane Charley hit last year, they were caught a little off guard, too.

"We thought we were safe and sound, and he turned right at the last minute," Maggard said. "We said, 'Oh, my God.' We were hit with winds of 85 to 100 mph. But we did fine."

With Hurricane Wilma, he said he is glad not to have evacuated earlier, when it was forecast to hit Saturday night.

"One would say it's going to be a Category 2, and then another would say it's going to be a Category 3," he said, referring to the different reports. "It's the uncertainty that has been so difficult. It was a very tough decision."

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