Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Recruitment
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. Staff’s Prioritization of Disaster Preparation and Making Proactive Changes to Ensure High-Quality Care in the Future
We call everyone. Make sure they have food, water, a place to go, that they have the plan… soon as they come into the program, but we kind of make sure the plan has not changed. Try to find out where they’re going. So we can do post [storm] calls if they have to leave. I’ll kind of let them know where the shelters are if they need that.(Staff 109)
Enough oxygen tanks, make sure they had enough medicine if they’re gonna be down for two weeks with no electricity. We asked if they had a generator? Did they have a place to go? Did they have enough food? Did they have enough water? All those kind of questions [are] in our template.(Staff 103)
“They can receive up to like, I believe, a 28 day supply of medications if they show up with their prescription bottle or a prescription from the VA”.(Staff 102)
3.1.1. VA Teams Provided High-Quality Care While Managing Their Own Post-Hurricane Challenges
The month after Hurricane Ian came through was very difficult. Not only because we had staff that were affected by the storms as many of our Veterans were, but even if they weren’t affected, there were so many floods and power outages and road outages that we really had trouble getting back to see the patients. It was a big old nightmare is what it was.(Staff 101)
The infrastructure took a huge hit. So, it was difficult to get in touch with some people. And again, I think what happened was we had some nurses down here who would drive out, just like I did, to check on people. And as we kept trying to get in touch with people, we found out more and more.(Staff 108)
We know who our patients are that are the most needy, and the ones we’re most concerned about because [of] their acuity levels and those are the guys we got out to see as quickly as possible. My one guy that I couldn’t find, who was up in the hospital in Sarasota, he’s the one I had to get out to as soon as I could, because we have hard time telephone communicating with him as it is.(Staff 109)
We have people [HBPC Veterans] that end up going to across the state, go up north… You’re trying to track them down, “Where’d you go?!” So, it was really a big scramble of trying to get in touch with people and tryin’ to determine where they were, what their needs were, that whole thing. Again, there’s all kinds of stories. And it’s sad because people’s lives are so uprooted.(Staff 108)
I’m not gonna say put them ahead of yourself, because you have to take care of yourself… but you gotta get out there and see them as quickly as possible. Just if anything, to reassure them that everything’s OK. We’re gonna be there for them. Help them with anything they need that’s within your scope of practice or get them to the resources, social worker, et cetera.(Staff 108)
3.1.2. VA Made Specific Changes to Improve Work Flow
When we know we’re gonna activate the system, our program assistant built census lists… they’re alphabetized by nurse so we can report. And because it’s in [Microsoft] Teams everybody can—as long as you have computer access, everybody can access it simultaneously and check a box that they’ve completed the call and there’s a comment section. So, we’ve changed that process dramatically.(Staff 101)
“We had never seen the likes of anything like this that truly, truly was like, wow, you know, this was the real deal!”.(Staff 107)
“We have procedures. We have SOPs. We actually made an addendum to change things because of our experience, where there’s workgroups workin’ on now. I mean it’s—we try to learn”.(Staff 108)
3.2. Veterans and Caregivers Felt Highly Supported by VA Care Teams
“I was very satisfied with the care. They cared, you know, they called, they cared. They worried about us, so I don’t know what more they can do for us”.(Veteran 206)
“They really care for me and I can get pretty testy at times, but they’re there”.(Veteran 201)
I had this elderly gentleman, he’s so nice. But, his power’s out. He has no phone, no way to charge his phone, but he had cell service, so I ended up getting a charger for him. There’s actually an old laptop that he could plug into the wall and then plug the charger in, or if he could keep the battery charged long enough, you know, use that as an extra charger for his phone, and to use it minimally.(Staff 109)
We put our Veterans in touch with food pantries but I can’t transport Veterans in my government car. But we have homebound patients and how are they gonna get to the foodbanks?… And then I, you know, couldn’t really go to food pantries asking for five families worth of food so that I could take it to them… I would’ve been willing to do that but there was a little bit of a logistics issue with getting some people food... So, some of our lower socioeconomic, lower people, really could’ve used maybe some food. But other than to let them know where they could go it, that’s all I could really offer. And there was plenty of places, ‘cuz like I said, a lot of aide comes into town.(Staff 106)
“They [VA staff] called me from Bay Pines, that’s our hospital, they called me right away and asked how everything was. I told them it was OK, and then she gave me the phone number to call if I needed something”.(Veteran 206)
3.3. Veterans and Caregivers Experienced Significant Challenges Due to the Hurricane, Relying Heavily on Their Social Support Networks Post-Hurricane
3.3.1. Accessing Needed Healthcare and Processing the Hurricane
The problems we have especially, and this happened with the last hurricane as well: oxygen. That’s my big thing because these people, a lot of them are oxygen dependent, they use a concentrator, concentrator needs power, they don’t have power for three to four weeks, they don’t have oxygen.(Staff 109)
Some patients have had some anxiety related to the storm. Some depression as well. Primarily on that side of things, people losing their home or having to do significant repairs to their home. That adds a lot of stress to them, and or depression to them as well. And that’s been primarily the thing that I’ve noticed overall.(Staff 102)
I saw a Veteran today that I hadn’t seen since before the hurricane. And I was talking to the caregiver… And she said, “I’ve never been so scared in my life” [as during the hurricane]. And she’s talking to me about the fact that they don’t know what they’re gonna do the next time because this Veteran, his dementia is so bad, he just basically lies there.(Staff 108)
3.3.2. Decisions to Shelter in Place or Evacuate, and for Some, Displacement
“I always call the neighbors and ask….is the electricity back on…How’s the house look, is it still standing?”.(Caregiver 305)
He lived on the beach, and he had a business on the lower level. He lived in like a, it is actually three stories, and he lived on the second story… and he was 77… [After Ian] The cars are gone, the hair salon is gone… also, his condition has deteriorated since then, you know, I don’t know if it’s stress from this [the hurricane] played a part in it. He also did have some cancer that he chose not, he had been getting treatment and then he decided that he just didn’t want to do the treatment anymore, but did the depression and the anxiety and the stress of everything [with the hurricane], did that play a part in his decision? You know, I don’t, I don’t know, so there, so there have been stories like that.(Staff 110)
I spoke multiple times to the spouse of one of our Veterans and she was calling—when I called her, when I finally reached her, they were in sort of the back hallway at one of the local hospitals. And her husband, the Veteran, was on dialysis three days a week. And she kept telling me, “He’s due for dialysis, he’s due for dialysis”. And through some miscommunications she never actually mentioned that fact to the hospital staff. So, it kind of was a strange scenario. But the dialysis clinic had just pretty much closed and told everybody go to the local hospital.(Staff 101)
I feel like I’m just coming off of a lot of stress of being like this all the time. I don’t feel like that right now, but, of course, getting this place [their new home they were renting] was, you know, the hardest thing here is so many people were affected, not a lot of places to stay. The rent is much higher… And, you know, financially I feel like we’re struggling.(Caregiver 301)
There was a Veteran, he lived down close to Fort Myers beach, his entire house—they relocated before the storm to their daughter’s place in Cape Coral and they stayed there through the storm, but their place was demolished… it was damaged severely so they couldn’t go back and live there… And here he is, he can’t go back to his home…So, this Veteran was able to get into a rental somewhat quickly. And unfortunately—and he had a lot of health problems and very, very bad COPD. And I don’t think the hurricane helped that…he had to have oxygen. He had to have a concentrator… Honestly, I tend to think, he probably would’ve lived longer if it hadn’t of been for what happened.
Interviewer: So, he’s passed away since then?
Yeah. Since then. Which is unfortunate. I mean he had severe respiratory problems. But I don’t think everything that they went through helped and he just started struggling even more.(Staff 108)
I had… two [Veterans] that lost their homes completely. Thankfully they had evacuated prior to [Ian] but since been unable, you know to return to their homes. The [hurricane] was September 28, [and it] was well into the end of the year, you know, before they were getting permanent housing… that took a lot of time. It was temporary housing situations for many, and then they were able to go home. But then, like I said, for that cluster that I had, you know, they never were able to return home.(Staff 107)
3.3.3. Social Support Veterans and Caregivers Received
Once everything went out, that was it… I just gave, you know, gave the food to some different [neighbors], next door… well they had power… had a generator over there… So, I gave him most of the stuff… that he could use and… He brought, whatever food, brought food over… That’s what I ate.(Veteran 203)
[These friends] benevolently drove down from northern Florida. A stranger. Perfect stranger and brought, brought a Westinghouse best generator because we didn’t have one, and then they left it, he and his wife left it, and went away, and we never knew who they were, except that my daughter-in-law gave us their name because she knew them somehow… Can you imagine perfect strangers drove down on a hot day, brought this lovely brand new generator, left it in the garage with my son, and took off before they could even, he could even figure out where they lived?!.(Veteran 201)
We load up, we get in there, and the entire mall is set up for FEMA and all these people, [for the disaster]. I felt so bad, I’m in there, the restaurant was almost empty and we’re in there eating shrimp. And we sat there, and I mean tears literally welled up in our eyes of like, wow, how blessed we are that we weren’t touched in that manner.(MFH Caregiver 305)
3.4. VA Staff Managed the Attitudes of Veterans Not Taking the Hurricane Seriously
They’re gonna actually carry them [evacuation plans] out and not try to stay. Like all Veterans, the ones I was mentioning to you, whose homes were destroyed, that if they didn’t evacuate, they probably would’ve been killed. These are people with significant mobility issues and what not.(Staff 111)
“We did the pre-storms [calls] trying to get everyone to, you know, take it seriously. Sometimes they do, sometimes they don’t”.(Staff 109)
“We’ve had patients that, you know, just didn’t want to evacuate that were down by the beach, that got wiped off the face of the earth”.(Staff 102)
“I think we do everything we can for them. But, again, they have the right to make bad choices”.(Staff 108)
Well, they [VA Staff member] just asked me if I’m leaving or staying, and I told them I was staying and not leaving… They just said, “Are you sure?” And I said, “Yeah, I’m sure”… I said I’ve been through all the other hurricanes, you know. This one ain’t gonna be no difference. Hopefully, there’s no more [hurricanes] like that one.(Veteran 203)
They literally, both of them tried to stay on the island, which was just dumb on their part and we said that and once we told them you need to evacuate. Literally, we’re getting phone calls right before the storm hit [from Veteran and caregiver], saying “You guys [VA staff] gotta come get us!” I was like “We can’t. Nobody can. We told you to leave. We don’t have a choice”.(Staff 102)
I got up that morning and the hurricane was gonna be a [Category] 5, and it was heading right for us, and I said, “We’re leaving”. He [the Veteran, the caregiver’s father-in-law] didn’t want to leave, and my daughter didn’t want to leave, but I said, “We’re getting out of here”.(Caregiver 207)
We were told that it [the hurricane], we were in the evacuation zone, but the people in the building wouldn’t leave. They would not evacuate, and we really didn’t have anywhere to go. I mean, one lady is 90. The other ones are in their late 70′s and the other man is 82, so, so they said they were staying, so against everything that I know to be right, I stayed with them, so we all stayed together and hunkered down and, and we survived.(Staff 110)
3.5. VA Staff, Veterans, and Caregivers Shared Lessons Learned
You call up people and they say, “Well, I don’t think it’s gonna be that bad”. Okay. And now, fortunately, because what happened is people are not gonna—because of what happened with Ian, they’re gonna be a little bit more thoughtful about it [evacuating] perhaps.(Staff 108)
Hurricane season is June 1st to November 30th and same with rainy season, everything else, always make sure that I have a 30-day supply of medication, I always watch in the news in making sure, the biggest thing is, is being prepared… you wanna make sure that you have undergarments and bed pads and anything that you need you pack. So thank God that I make a lotta lists and I did it by individual person and knew exactly what they needed down to toothbrushes, just like you’d pack up for the summer camp. And that’s exactly how we did it.(Caregiver 305)
“I’m glad I had it. And I think every household should have it or something like it”.(Veteran 211)
“My first priority is the boys [her Veterans]… the AC went. I had to go and buy window units because they had no air conditioners anywhere. So I went and bought three just for them, three window units”.(MFH Caregiver 303)
“Overall, we’ve done well, but I also realize we’re dealing with nature in a very devastating way and we’re also dealing with people who—you can tell people what they should do, they’re gonna do what they wanna do”.(Staff 108)
4. Discussion
4.1. Implications
4.2. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Veteran Characteristics | Number | |
---|---|---|
Self-Identified Gender | Male | 6 |
Female | 2 | |
Self-Identified Race | White | 7 |
Multiracial | 1 | |
Hispanic | Hispanic | 1 |
Non-Hispanic | 6 | |
Declined | 1 | |
Age Range | 70–85 | 3 |
86–95 | 4 | |
Declined | 1 | |
Education | High School | 4 |
Some College | 2 | |
Bachelors | 2 |
Caregiver Characteristics | Number (N = 5) | |
---|---|---|
Sex | Male | 1 |
Female | 4 | |
Race | White | 4 |
Black/African American | 1 | |
Hispanic | Hispanic | 0 |
Non-Hispanic | 5 | |
Declined | 0 | |
Age Range | 50–60 | 1 |
61–70 | 2 | |
Declined | 2 | |
Education | High School | 1 |
Some College | 1 | |
PhD | 1 | |
Declined | 2 |
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Haverhals, L.M.; Manheim, C.; Vega Lujan, D. Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian. Geriatrics 2024, 9, 10. https://doi.org/10.3390/geriatrics9010010
Haverhals LM, Manheim C, Vega Lujan D. Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian. Geriatrics. 2024; 9(1):10. https://doi.org/10.3390/geriatrics9010010
Chicago/Turabian StyleHaverhals, Leah M., Chelsea Manheim, and Deisy Vega Lujan. 2024. "Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian" Geriatrics 9, no. 1: 10. https://doi.org/10.3390/geriatrics9010010
APA StyleHaverhals, L. M., Manheim, C., & Vega Lujan, D. (2024). Experiences of Veterans, Caregivers, and VA Home-Based Care Providers before, during, and Post-Hurricane Ian. Geriatrics, 9(1), 10. https://doi.org/10.3390/geriatrics9010010