NEW ORLEANS — Many of the families of nearly 850 nursing home residents evacuated to a Tangipahoa Parish warehouse for Hurricane Ida have joined a swelling group demanding answers about the botched operation and who signed off on it.
Since Hurricane Ida, families, lawmakers and advocates have been frustrated by multiple investigations that have not clearly determined who is responsible for the safety of nursing home residents.
Parish emergency management officials said oversight is ultimately the responsibility of the Louisiana Department of Health, the agency tasked with regulating the nursing homes.
But LDH says it’s the nursing homeowners who are responsible for guaranteeing their residents’ safety in the event of a storm. Those evacuated to the Independence, La. shelter were all residents of nursing homes owned by Bob Dean, who also owns the warehouse where they were sent.
His seven homes did submit timely evacuation plans to the state and their home parishes. However, the details included in those plans painted less than a clear picture of what the evacuation would really look like.
For example, in nursing home evacuation planning documents submitted to the state, capacity limits listed for the warehouse varied between the seven nursing homes and from year to year. Some listed 150 residents as the maximum number who could stay there. Others listed 750.
Those discrepancies weren’t caught by parish or state officials charged with reviewing the plans. By the time LDH inspected the warehouse for the first time, after the first residents had already arrived, the wheels were already in motion. Dean’s nursing homes ended up evacuating 843 residents to the warehouse, nearly 100 more than even the highest capacity limits submitted by the homes’ operators.
It’s a disheartening reality for the family members of loved ones who say they suffered in squalor for days surrounding the storm.
Five deaths have now been directly linked to the storm and the evacuation to Independence, but 27 more have died since, leading their family members to question whether those deaths were linked to the quality of care, or lack thereof, they received while at the warehouse.
Ernie Galiano lived down the Bayou for more than 50 years with his bride, Joyce. They raised three daughters and after a successful career in the oil business, he retired at the age of 51.
He liked classic cars and pulling classic pranks on his friends.
“He had a boat most of his life and would take his friends fishing. He always made the sandwiches and he would leave the cheese wrapper on,” said Sadie Bennett-Galiano, Ernie’s daughter.
Joyce passed away a few years ago and until this past summer, Ernie lived alone in the house they made a home together. He fell in his bathroom on Memorial Day, and he needed surgery, followed by inpatient rehab at South Lafourche Nursing and Rehab in Cut Off.
His family said when they signed the evacuation paperwork when checking him in, it listed the address for what is now Landmark of Plaquemine, a nursing home in Iberville Parish, as the evacuation site.
Bennett-Galiano said her sister got a call just days before the storm to say there was a change of plans. Their dad would be going to a “sister facility” in Independence.
She said the news was a surprise, but according to state records, that Independence facility was always part of the plan.
Evacuation plans and surveys submitted by the nursing homes to the state and their four home parishes show the seven facilities had all listed 129 Calhoun Street in Independence as one of their primary evacuation sites.
“He called us last from his cell phone while he was evacuating,” said Bennett-Galiano. “And that's the last time we spoke to him before the hurricane hit.”
For five days, hundreds of nursing home residents laid on mattresses on the floor as the generator powering lights and A/C intermittently went out.
Hurricane summaries written by some of Dean’s administrators that were filed with the state indicate Dean ordered residents out of one of the three buildings they were housed in because he was afraid the structure wouldn’t withstand Ida’s Category 4 winds.
Then during the hurricane, one of the remaining two buildings began taking on water, forcing the residents into a single cramped building.
“Can you imagine what the story would be right now if he had left and spread out in three buildings? One of those buildings got knocked down? I mean, that was the prudent thing to do,” said Dean’s attorney, John McLendon about the decision to consolidate the residents.
Residents reported many of their diapers and clothes weren’t changed, permeating the room with the smell of urine and feces, and those who were changed had no privacy because there was so little space between them.
Louisiana law does not restrict what types of buildings can be used for a nursing home evacuation as long as the site meets a minimum set of requirements, such as having a generator available on site.
Sarah Babcock, the Chief Administrative Assistant for Jefferson Parish, said the fact that the evacuation site was a warehouse isn’t necessarily a problem.
“Even if they're going to another nursing home, there's not a bed waiting for them,” she said. So they're still sleeping on air mattresses or cots in hallways or cafeteria spaces or recreation spaces. And that's really the same as our shelters.”
Advocates for nursing home residents see the entire situation at the warehouse as a problem. Richard Mollot, the executive director of the Long Term Care Community Coalition, said the state should never have allowed a warehouse to be used as an evacuation site.
“The nursing home got paid for the days that those residents weren't in a safe place, weren't in a warm bed, but on a mattress in a warehouse. How is that fair and how is that appropriate?,” Mollot said. “The state's responsibility, and the state also gets paid to do this, is to ensure that residents in nursing homes are safe and are treated humanely 24 hours a day, seven days a week, 365 days of the year.”
How Did It Happen?
Exactly 16 years before Ida struck, Louisiana was rocked by Hurricane Katrina. More than 1,800 died, including many nursing home residents.
Thirty-five residents drowned at St Rita's Nursing Home in St. Bernard Parish, and more than 20 died at La Fon Nursing Home in New Orleans East after both homes failed to evacuate.
To prevent a tragedy like that from happening again, Louisiana lawmakers in 2006 passed Act 540. The law mandated the creation of a Nursing Home Emergency Preparedness Review Committee to closely review the plans for the state.
It also requires nursing homes to submit their full emergency preparedness plans to their home parishes for review, before sending a summary of the plans to the state.
Records indicate parish officials made no recommendations to the evacuation plans for any of Bob Dean’s nursing homes in at least three years.
LDH admits that the committee met to create the model that the nursing homes use to create their plans, however a spokesperson said, "it's been dormant for several years and LDH Secretary Dr. Courtney N. Phillips has directed that it be reconstituted."
The law was vaguely written, according to Tulane’s Rebecca Rouse. Before she was the school’s Associate Director of Emergency & Security Studies, she worked with the Department of Defense and FEMA on disaster mitigation strategies for over a decade.
“When you’re doing emergency planning, that's the most basic level of preparedness: I’ve drafted the plan and tucked it into a drawer. Maybe we get it approved, maybe it’s on a clipboard. Maybe some of the people have even read it,” Rouse said. “The reality is you have to test those plans, you have to test them for failure.”
LDH said they aren’t required to be given even the full evacuation plan. Instead, they get detailed checklists consisting mainly of Yes/No questions that the nursing homes fill out to confirm that they’ve met the minimum requirements for what they need in their evacuation plans.
But Rouse pointed out that summaries like the ones LDH gets don’t take into account many of the factors on the ground. With nobody to think about the logistics of how an actual evacuation would play out, problems can arise.
“You certainly have to do more than just have a plan and say ‘well, we’ve got these folks lined up,’” she said. “The ambulance service, they’re going to come and help us evacuate folks. Well guess what, if everybody else in town has the same ambulance service lined up, is that really going to work when the time comes? And how is it managed? Asking those kinds of critical questions is beyond what you see in that law.”
Unanswered Questions Remain
The state revoked the licenses for all seven of Dean’s nursing homes in September, but Dean is appealing on the grounds that his workers followed the evacuation plans submitted to parish and state officials.
That appeal process could take months or years to work through the courts. McLindon said he expected it would take at least nine months before any arguments are heard.
In the meantime, the state legislature has expressed interest in revising the Katrina-era laws surrounding nursing homes to clarify oversight responsibility and ensure nursing home residents are cared for adequately during hurricanes.
“I think everyone’s on the same page, we want to make sure that this type of situation doesn’t happen again. It’s a question of how to make that happen,” said Thomas Pressly (R-Bossier City), who sits on the Joint Medicaid Oversight Committee.
Pressly said that he expects some kind of legislation related to nursing home evacuations to come up during the legislature’s March session.
“Certainly we don’t want people that are moved to facilities for up to five days and potentially longer where they are in deplorable conditions,” he said. “I think there needs to be a minimum standard even for those places that they’re removed to.”
One simple change to state law could prevent tragedies like what happened in Independence from reoccurring, Pressly reasoned.
“LDH reviews these plans but there’s not the actual second step of approving the plans. That’s something that I think we need to address, either legislatively or LDH needs to have internal rules that actually goes that extra step,” Pressly said. “If you look at the section of law that’s dealing directly with evacuations pursuant to hurricanes, it says review but it doesn’t say approve. A simple fix there would be adding that second line of approving the plans that are put forth.”
Rouse said a change to state law is not enough to fix the problem, that there needs to be manpower and equipment dedicated to a comprehensive review effort.
“That all sounds good, and it sounds like a political mandate that we see all the time. But where are the resources to support that? Who’s going to do that? Who do I hire? Where do I get the transportation to send my teams out to inspect?” Rouse said of the proposed legislation to charge LDH with approving the plans.
“Putting it into law isn’t quite enough. You have to resource it and back it up with more than words.”
Ernie Galiano’s evacuation to the warehouse ended in tragedy. He died at 74 of aspiration pneumonia less than two weeks after he was rescued..
His daughter says he had trouble swallowing and a history of food getting into his lungs and causing infections.
“It concerns me that he didn't get the proper medical attention while they were evacuated,” Bennett-Galiano said. “Was his food shredded?”
Bennett-Galiano hopes that the tragedy that defined the end of his life will be the last of its kind in Louisiana.
“My hope is that the guilty parties are held accountable,” she said. “More than that, but it never happens again. No one should be treated that way.”