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In May, U. S. Secretary of Health and Human Services Mike Leavitt predicted in a CNN interview that the bird flu virus strain will make its way to the United States in the next few months — and then he said America isn't ready. Yet advocacy organizations for older citizens are working to help change that and to better meet the unique demands of the aged during any crisis.

"I think preparedness for any of the potential disruptions or disasters lends itself one to the other. It's a way of thinking as much as responding to a particular crisis or episode," explains Donna Doneski, deputy director of public affairs for the American Health Care Association.

The AHCA represents more than 10,000 long-term care facilities such as nursing homes, assisted living facilities and residences for the developmentally disabled.

Prompted by Hurricanes Katrina, Rita and Wilma in 2005, the AHCA and the National Center for Assisted Living released in April their new Disaster Planning Guide: A Resource Manual for Developing a Comprehensive Preparedness Plan. The 150-page how-to handbook covers both natural and man-made disasters such as fires, tornados, bomb scares, hazardous accidents in a community, bioterrorism, hurricanes, pandemics and more. The planning tool outlines recommended actions with or without evacuation, transportation, housing, finance, insurance and even legal issues. It also includes checklists to help long-term care facilities take action before disaster hits.

Doneski credits the Florida Committee on Disaster Preparedness and the Florida Health Care Association with developing the manual. "They have certainly been down the road before and have some of the United States' best-known experts in this," she says. At the last AHCA annual meeting, several Florida officials conducted a comprehensive disaster-preparedness seminar.

According to the American Geriatrics Society, more than 1,000 residents of the Gulf Coast died in the August 2005 storm and its aftermath, and roughly 75 percent of those deaths were among adults 65 and older. On May 22, Dr. Carmel Bitondo Dyer, representing the AGS, testified before the Senate Special Committee on Aging to appeal for additional federal funding to improve care for older adults during disasters.

"It would be a real mistake not to learn from this experience," Dyer testified, referring to response failures after Hurricane Katrina. Dyer is director of the Baylor College of Medicine geriatrics program and cared for older evacuees in Houston. She told the senators that some elderly evacuees "languished on their cots unnoticed, usually suffering in silence as busy volunteers attended to the needs of more vocal and able-bodied evacuees."

Dyer and other geriatricians, geriatric nurse practitioners and social workers have developed a team dubbed SWiFT (Seniors Without Family Triage) and together created the SWiFT Screening Tool©. Using this method, healthcare providers can transfer seniors in greatest need to residential facilities and refer those with lesser needs to a local case manager. The screening process also plugs in local volunteer agencies to help seniors locate family and friends.

Use of such a triage method was one of many recommendations Dyer had for the Senate committee. Others included a tracking system for the elderly and other vulnerable adults, such as a color-coded bracelet system; separate shelter areas for older adults; and region-specific evacuation plans and services.

While America gears up for another hurricane season, which meteorologists predict will be above average with a potential for at least one major hurricane to strike the United States, the possibility of a flu pandemic also looms large. And a flu outbreak could be especially devastating to older populations. That's why HHS, the Centers for Disease Control and Prevention, the AHCA and other organizations released a comprehensive checklist in May to help long-term care facilities assess and improve their preparedness specifically for responding to pandemic influenza. The checklist is designed to help facilities self-assess the strengths and weaknesses of their current planning efforts.

"Based on the many differences between facilities, and their different patient populations, each facility will need to adapt this checklist to meet its unique needs and circumstances. This is a very helpful exercise because working with this checklist will help facilities better plan for other emergency situations," Janice Zalen, AHCA senior director of special programs, says.

The AHCA submitted a statement to the Senate Special Committee on Aging on May 25, encouraging that long-term care facilities be included in the National Disaster Medical System and better integrated into the overall national response plan.

"America's hospitals are seen as the key community, healthcare and societal focal point when it comes to handling medical crises, and indeed, our nation's hospitals have the expertise and capacity to play a central, vital role," the statement reads. "However, as a 2005 study by the Research Triangle Institute indicated, skilled nursing facilities could also play a key role in time of public disaster and public health emergencies. According to this study, skilled nursing facilities provide not only highly trained medical staff, but available beds — both of which are at a premium during times of crisis."

The statement particularly recommends that, during these crisis periods, the federal government:

· Waive the three-day hospital stay requirement for reimbursement under Medicare Part A.

· Allow for changes to Medicare "spell of illness" requirements, so that an interrupted hospital stay won't affect coverage.

· Provide for Medicaid coverage across state lines.

· Temporarily relax the "survey process." Doneski explains that even after a disaster, federal inspectors may show up for routine inspections. "If you're looking for the water supply, and it's been cut off, you kind of have to make allowances for that," she says.

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