Hurricane Dorian was strengthening in the Atlantic Ocean late last week, just as Dorothy Brown was moving her elderly husband into a rehabilitation center in northern Miami-Dade County after he fell and broke his hip.

Brown, 71, started thinking back to the last hurricane to threaten South Florida, Irma, and how 12 people died in a nursing home from heat-related illnesses amid a widespread power outage. When Brown pulled up to Franco Nursing and Rehabilitation Center, the facility had already erected storm shutters on the windows.

Then Brown looked around.

“There are not too many trees here, but a lot of power lines, and he needs oxygen,” Brown said, as forecasts for Hurricane Dorian’s expected effects on South Florida kept changing. “If this storm is coming, I’ll be back to take him to my house because I remember what happened last time, and I know my house is secure.”

Across Florida, and in the days to come throughout the Southeast, relatives, state and federal officials, and nursing homes and rehabilitation centers are struggling to make decisions about when to move patients who might be vulnerable in cases of property damage or power loss. The apprehension follows a string of tragic incidents — dating to Hurricane Katrina in 2005 — involving elderly or special-needs patients who were killed during hurricanes or the frantic days that can precede and follow a major storm.

After 12 people staying at the Hollywood Hills nursing home died in 2017, Florida leaders created new regulations and storm emergency plans for assisted-living facilities, including mandating they have generators and adequate fuel to maintain a comfortable temperature for at least 96 hours after a power outage. Last week, four former staffers at the Rehabilitation Center at Hollywood Hills were charged with manslaughter, accused of failing to move patients to safety quickly enough after the power went out.


A woman is transported from the Rehabilitation Center at Hollywood Hills in September 2017 as patients are evacuated after a loss of air conditioning due to Hurricane Irma. (Amy Beth Bennett/AP)

Florida officials remain anxious about the safety of residents in the state’s 683 nursing homes and 3,100 assisted-living centers.

On Friday, Gov. Ron DeSantis (R) noted that 120 nursing homes still had not submitted proof that they have generators, as is required by law. By Sunday afternoon, DeSantis said nursing home operators had worked throughout the weekend to make sure all nursing homes in eastern coastal communities have at least temporary generators or a plan to evacuate should they lose electricity.

“There are going to be site checks, there are going to be phone calls to make sure that they have a plan to deal with folks that are in their care,” said DeSantis, adding that the state will inspect nursing homes in hard-hit areas immediately after the storm to make sure they have power and adequate supplies.

Efforts to prepare for Dorian, however, are complicated by continued uncertainty of its final path.

Though the center of the storm is forecast to remain just off Florida’s east coast, even a small shift in its track could bring high winds onshore across central and northern Florida, forecasters warn.

Over the weekend in Miami, some assisted-living facilities were not taking any chances, even though it appeared the worst of the storm would track north and east of the city.

At the Sinai Plaza Nursing and Rehabilitation Center in North Miami, nurses and health-care aides spent Sunday afternoon loading patients with disabilities off a bus that was carrying evacuees from another facility closer to the ocean.

For relatives of elderly or infirm patients, preparing for a hurricane is an especially stressful time, experts said.

Kathryn Hyer, a professor and director of the Florida Policy Exchange Center on Aging at the University of South Florida, said relatives and caregivers often struggle to decide whether it is better for someone to ride out the storm at home or evacuate to a location outside the storm’s path.

Hyer has been studying the impact of hurricanes Katrina, Rita, Gustav, Ike and Irma on vulnerable populations. She has found that, regardless of whether people evacuate or shelter in place, “the impact of a storm increases the likelihood of hospitalizations and death.”

“The death rates over 30 and 90 days increase when people are moved. With this population — some of whom are very sick — there are shocks to the system, and their fragility is taxed,” Hyer noted.

The dangers facing patients come from health risks and the difficulties with moving people during urban evacuations. When Hurricane Rita threatened Houston in 2005, 24 residents of a nursing home were killed when their bus caught fire on a traffic-clogged highway.

“We found you shelter in place until you can’t — and that’s what we tell people,” Hyer said.

In Lake Worth, Fla., in Palm Beach County, where officials ordered a mandatory evacuation of low-lying coastal areas on Sunday, George Roth has spent the past few days scrambling to collect his shopping list to take care of his 95-year-old mother.

Joan Roth had a stroke in July and is under 24-hour home care. George Roth, 71, is from New Jersey but decided to stay with his mother until the hurricane threat passes.

Roth has collected canned food, batteries, “lots of water” and extra gasoline.

“I have coolers, first aid paraphernalia, fans,” he added.

Roth also recently purchased an electric stair chair to get her down to ground level — there’s no elevator that services her second-floor apartment.

“Still I worry, if we lose power, Mom will have to endure the heat and humidity,” Roth said.

So, as the storm approaches, Roth is studying possible routes he could take to get to his cousins should he need to quickly relocate his mother to a safer location.

“We are as ready as we can be,” Roth said. “Even with care helpers, it is mentally and fiscally demanding.”

Since Hurricane Irma, Florida has set up a robust tracking system called the Emergency Status System, which is working with state meteorologists, nursing homes and assisted-living centers to catalogue the number of beds, generators, dialysis machines and other medical equipment. They have also set up hotlines and Facebook groups for relatives who want to check in on the status of their elderly loved ones.

But the memories of Irma continue to resonate with many. Initially, that hurricane was supposed to strike the east coast of Florida, triggering widespread evacuations in south and central Florida. Irma instead skirted across the Florida Keys and struck the state’s west coast, where some people from the east coast had sought refuge.

Maia Magder, a 44-year-old speech pathologist from the District, recalls constantly worrying about her 73-year-old father and 77-year-old stepmother during Hurricane Irma. The couple live in a high-rise condominium building in Miami Shores, on Biscayne Bay.

They stubbornly refused to leave during Irma, until she repeatedly begged them. Now, they say won’t leave for Dorian, even if the forecast storm track shifts.

“They live on the top floor of a 20-story building, and every hurricane season, I worry,” Magder said. “I worry not so much about damage to the building — they have hurricane shutters and a generator — but because they’d be stuck in a building with no AC and only stairs to get down.”

Despite such concerns, often from relatives scattered across the country, the operators of Florida assisted-living facilities say they are far better prepared for Dorian than they were for some past storms.

Kristen Knapp, a spokeswoman for the Florida Health Care Association, said facilities began preparing even before hurricane season started in June.

“We have worked hard to be ready and know, for example, if a facility with 20 beds needs to move, there is another facility with 20 beds they can evacuate to and arrive to with good care,” Knapp said. “During Irma, we saw that people were moving multiple times, as the storm moved.”

In Royal Palm Beach, a suburban town about 12 miles west of West Palm Beach, the manager of the Royal Palm Beach Health and Rehabilitation Center has been assuring relatives that patients are located in a “safe building above flood level” and with enough food and water to last a week, as well as a generator and extra medications.

“It looks like they are ready,” said Maria Lupe Alonzo, who was at the center on Sunday afternoon visiting her 92-year-old husband, who has Alzheimer’s. “I feel it’s a safe place.”

At Franco Nursing and Rehabilitation Center in Miami-Dade County, many visiting relatives also expressed confidence in facility managers, despite lingering concerns about what occurred in the aftermath of Hurricane Irma two years ago.

“They learned from that, I guarantee it,” said Ella Brown, who was visiting her 94-year-old grandmother. “Do you really think a nursing home is going to allow that to happen again? I don’t think so, because that would be a real big mistake — their mistake.”

Wax reported from Washington; Rozsa, a freelance journalist, reported from West Palm Beach.