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How Cities Can Protect Elderly Residents in Climate Disasters

(Bloomberg) —

One of the deadliest climate events in the US, Hurricane Katrina inflicted a devastating and uneven toll along the Gulf Coast: More than two-thirds of the estimated 1,330 people killed in hard-hit Louisiana were over the age of 60. 

The 2005 storm wasn’t an anomaly. In disaster after disaster, older adults have made up the majority of death tolls. They accounted for three-quarters of deaths in Washington state during the 2021 heat wave in the Pacific Northwest, and more recently, more than two-thirds of casualties during Hurricane Ian in Florida. Perhaps most infamously: All but 96 of the more than 739 Chicagoans who perished in that city’s deadly 1995 heat wave were age 60 and over. 

And stories of their experience play out on repeat: of older people left behind in homes without air conditioning or power, or access to food and critical medical supplies; of inadequate efforts to transport the vulnerable to emergency shelters; and of nursing homes failing to move their elderly residents to safety. 

“There’s a presumption that all ages experience risk and climate the same way, and the reality is that that’s just not the case,” says Danielle Arigoni, managing director for policy and solutions at the National Housing Trust. 

Her new book, Climate Resilience for an Aging Nation, details the ways in which the needs of this fast-growing demographic have remained largely overlooked in disaster and climate resilience planning. It also offers insights into creating livable and age-friendly communities, drawing from her previous experience at the US Department of Housing and Urban Development and AARP.

As urban planners, “we’re trained to think about vulnerable populations by looking at race, income or even disabilities,” she says. “But age is such an intersectional issue, and it magnifies some of the risks that exist within each of those cohorts because you often have a lot of things happening at once.”

Bloomberg CityLab recently spoke to Arigoni about the misconceptions over challenges older adults face during disasters, and what it means for cities to adopt an age-focused preparedness plan. The interview has been edited and condensed for clarity.

What are some misconceptions around how older adults experience extreme weather events?

The first is mobility. I’m haunted by the idea that 1 out of 5 people over 65 doesn’t drive anymore. The presumption that people can just get in their car and drive away from the wildfire, or move to a hotel because the hurricane is coming — that’s a pretty radical departure from reality. That was certainly the case with some of the fatalities [from the Maui fire] in Hawaii. People have become accustomed to relying upon friends, family or paratransit for their mobility. In that very short window of time when they needed transportation, it wasn’t available. 

There’s also a presumption that people can prepare sufficiently to withstand power outages or shelter in place for two weeks. But a lot are living on the very edge financially, or they may be relying upon services like Meals on Wheels, so the notion of stockpiling is just not really feasible. And for someone who has an oxygen tank or who needs a lift or any kind of medical equipment, it is not just an inconvenience — it’s a matter of life or death.

Then there are those who live in assisted care facilities. 

First of all, something like 4% of older adults live in congregate facilities, 96% do not. And about 30% of them live for the most part alone. 

There’s a presumption that because older adults in institutional settings, someone is there to look out for them. After Katrina, there was a recognition [of the actual reality] because of the horrific stories of older adults submerged in water in their wheelchairs in nursing homes, unable to evacuate. 

That led to the passage of the Emergency Preparedness Rule in 2016, which required any facility that receives Medicare or Medicaid funds to have in place an evacuation plan and to do training to prepare for a disaster — which sounds great on paper. However, subsequent efforts, particularly under the Trump administration, sought to roll back some of those reporting requirements, citing that it was a burden to institutions. And so what we have now is an uneven patchwork of enforcement across states.

And that led to the tragic disaster during Hurricane Ida in 2021, where more than a dozen residents of nursing homes in southeast Louisiana died after being  moved to a former pesticide warehouse owned by the nursing home owner Bob Dean. Those who survived experienced horrible conditions.

That was following what the state had prescribed. But no one was really checking that the warehouse was a suitable alternative. So there’s uneven enforcement, and an uneven understanding of what an appropriate evacuation and emergency management plan looks like.

The other challenge is that there are a lot of places where there happen to be a lot of older adults — these could be multifamily apartment buildings, or naturally occurring retirement communities — that haven’t been formally designated as Medicare or Medicaid facilities. Those are completely not covered at all [by the rule]. 

To New Orleans’ credit, they recognized this challenge and put in place a new law requiring owners of buildings where eight or more older adults live to at least have some backup power in place. Again, on paper that sounds great, but it’s pretty easy to dodge that requirement. There are a lot of holes in the safety net that people aren’t necessarily aware of.

So how can a city better incorporate older adults in their climate resiliency efforts?

Starting from the more macro level, I think, cities have the opportunity every day to drive towards more climate-friendly housing and transportation solutions. That means smaller and more densely developed housing that also integrates sustainability features and reduces carbon emissions.

The great news in doing that is you’re also solving for some of the isolation challenges that we see older adults experiencing. Whether it’s missing middle housing or apartment buildings, those are places where people are going to look out for and check in on one another. If a community only has single-family detached homes and retirement communities, people are not going to benefit from that sort of connective tissue that we know can save lives during a disaster.

Similarly, investing in safe walking and safe biking provides redundancy for older adults, so when the roads do close or when support efforts can’t reach older adults by road, there are other pathways to get there. There’s a great story out of Oregon about a cycling brigade that used bike routes to get water to people after a wildfire because the roads were shut down.

And having that robust transit system, and bolstering the ability of older adults to use transit, means buses can be deployed in times of crisis. They can transport people to shelters, or they can be mobile resilience hubs.

That brings me to Babcock Ranch, the solar-powered planned community in Florida that was largely undamaged by Hurricane Ian while nearby retirement communities in places like Fort Myers were hit hard. That wasn’t through sheer luck, right?

It’s a counterpoint to Levittown — if that was the model for development 60 years ago, then maybe Babcock Ranch is the model for the future. It was designed as an all-renewable-energy-powered development for tens of thousands of people, with a mix of housing types. It was built above sea level, with battery storage baked in, underground [utility] wires, and a community room that also serves as a shelter for the broader community, not just residents.

It was designed to support biking and walking throughout — mind you, it’s still a relatively greenfield location, so there are limitations to that. And it’s built to withstand the effects of hurricanes. If those developments can come through unscathed, if the power can stay on and people can remain safely housed, and if there’s a community facility that allows other people to come and be safe, that sounds to me like a winning solution. 

Read more: What People With Disabilities Know About Surviving Climate Disasters

That’s not to say that it’s affordable or diverse or inclusive in the way that a good community should be, but certainly there are elements of it we should seek to replicate. And we’re sort of in a golden era for that at the moment. In my day job, I spend my time thinking about how we can get climate investments into affordable housing, and there have never been as many resources as there are now for retrofits. There’s a ton of resources in the Inflation Reduction Act. Similarly in the transportation sector, there’s more incentive now for shifting away from autocentric transportation systems to multimodal systems.

You mentioned how some of these infrastructure solutions can also address the isolation challenge among older adults. What role does social infrastructure play during a disaster?

A lot of the mechanisms built during the Covid-19 pandemic can be repurposed or extended to address that challenge. In Portland, Oregon, they used something called a Joint Volunteer Information Center, in which trusted intermediary community-based organizations go out and deliver food, adult diapers or services that were needed to keep people safe. 

They used that same infrastructure to quickly deploy portable heat pumps between that heat dome in 2021 and the following summer in 2022 to low-income, older adults, and make sure that they got air conditioning in their homes. That was only possible because those community partnerships already existed. 

For cities that are thinking about that now, what should be their first step?

The very first step would be for local officials to map out where older adults live, and getting people together in the same room who can share resources and knowledge to fill some of the gaps. I’m thinking about Tompkins County in upstate New York, where the emergency management team acknowledged that they had a need for a special needs registry — which is a program in which older adults can self-identify to say, Someone needs to come check on me” — but had difficulty maintaining the list for bandwidth reasons.

Meanwhile, the Council on Aging, which provides services to older adults in the exact same region, was sitting right next to them. It’s this natural sort of connection point that they could be working together, but they hadn’t because these are two different disciplines that often work in silos. 

So every single decision that a locality makes these days needs to be put through the filter of: Will it help us become more resilient to climate change?

To contact the author of this story:
Linda Poon in Washington at lpoon12@bloomberg.net

© 2024 Bloomberg L.P.

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