Flooded with responsibility

When a care home for older people had to be
evacuated during a severe flood, staff had to decide whether to
split up the residents in order to find safe accommodation, even
though this could lead to their isolation. Phil Carpenter (pictured
left) explains the dilemma to Graham Hopkins.

Assessing risk, even when time permits
planning, usually involves calculated gambles. Emergencies mean
that risks arise unexpectedly and decisions have to be made on the
spot. Sometimes your hand is forced and this, at least, takes away
the responsibility of decision-making. However, time will
inevitably return that responsibility. This was the experience of
Phil Carpenter, care service manager at Anchor Homes, and
responsible for Firth House, a care home for 40 older people in
Selby, Yorkshire.

“In the early hours of Saturday morning the
phone rang, and I was told that there had been a power cut because
the power sub-station had flooded,” recalls Carpenter. “Police said
it would be at least 48 hours before they could do anything. There
was no lighting or heating, so we were told to evacuate. Also the
floods that had knocked out the sub-station were on their way to
Selby.” And the home was only 400 yards from the river.

This was the second Anchor home to be
evacuated within 48 hours. The other, Borrage House, Ripon, was
flooded after the River Ure burst its banks. In following their
emergency plans, both homes hit upon a similar problem. As
Carpenter explains: “The place we were to evacuate to was only 100
yards from the home. So, if Firth House flooded, so would this
place.

“When we did the plans, we never considered
floods,” he confesses. “They were purely based on an emergency in
the home, not external factors. Obviously, they have all been
revised now.”

Residents, who were woken up and evacuated
while still in their night clothes and wrapped in blankets, were in
a state of shock. “When we evacuated, we had no choice. They just
said you’re going, and we went to a social services day centre more
in the middle of the town away from the river,” he says.

At the day centre there was very little
suitable furniture. “It was early in the morning and we had
residents trying to sleep while sitting on plastic chairs.” There
was only one thing for it, decided Carpenter: “We had to go back
and get the beds. We’d only just got there when the police turned
up and told us that the river was bursting its banks and we had
only 10 minutes to get out. We said: ‘We can’t, we’ve got 40 beds
to sort out.’ The police replied that if we didn’t get out now we’d
all drown. And we just looked at each other and said, ‘Do we get
the beds? Yeah, we’ll take the risk because the residents need the
beds’.” Luckily, the promised flood remained only a threat.

“The medication also had to be transferred,”
says Carpenter. We did that with an army ambulance and police
escort – quite exciting.” But the excitement didn’t end there.
Carpenter received a call to say that the sewage pipes in the town
were flooded and raw sewage was coming up from the ground: “We had
an hour to evacuate the building.”

The residents by this time had developed a
“Battle of Britain” spirit. Carpenter set about trying to find
alternative accommodation, keeping everyone together. Social
services offered to help, “but they didn’t know how long this would
take and, anyway, we didn’t want to overburden them,” he says.
“They had been really brilliant.”

After the flood in the Anchor home in Ripon,
residents and staff were moved into a welcoming local hotel.
Carpenter tried to repeat the formula. “We rang the only hotel in
the area, but they didn’t want their hotel full of old people.”

So Carpenter decided to move residents into
other Anchor homes in the north of England. Given that Anchor runs
at 97 per cent capacity, this would mean splitting residents and
staff up, with some homes only taking one or two residents. This
would inevitably leave some residents isolated.

“But we knew that the quality of the staff,
their training and the environment would be similar to what the
residents were used to at Firth House,” says Carpenter. Social
services arranged the transport and on a stormy Wednesday evening
coaches set off for Grassington, Huddersfield, Halifax, Scarborough
and Middlesbrough. Despite long journeys for some residents,
everybody arrived safely and in good health. And, despite all the
warnings, the home was not flooded.

All residents had returned permanently by the
following Wednesday – except one. He refused to return at first
because, he said, he hadn’t been ready to leave Firth House and
wouldn’t come back just because they were now ready for him. “We
didn’t mind – he made his point,” grins Carpenter. “And then he
came home.”  

Case notes

Practitioner: Phil Carpenter

Field: Care service manager

Location: Selby, Yorkshire

Clients: Forty older people resident in Firth
House, a registered voluntary care home run by Anchor Homes.

Case history: In the autumn of 2000 bad
weather and severe flooding hit the UK. In the early hours of the
morning a power sub-station that provided electricity to Firth
House was flooded, cutting off all supplies to the home. The nearby
River Ouse was also rising. Staff and managers had no option but to
wake up and evacuate 40 frail and vulnerable older people with the
help of social services and the army. They moved into a day centre
but this, understandably, was not equipped for night-time stays.
Carpenter decided to return to the home and collect mattresses and
bedding. Although warned of dangerous and imminent flooding, it was
decided to take the risk and collect the beds. However, they were
then informed that the day centre also had to be evacuated.
Conscious that repeated temporary moves were not a viable option,
Carpenter sought to place the residents safely until they could
return to Firth House.

Dilemma: It would have been preferable to keep
the staff and residents together, but the options available to
achieve this were reducing.

Risk factor: The dispersal of residents
throughout the north of England might prove traumatic for this very
frail client group.

Outcome: The residents were moved to other
Anchor homes and were able to return to Firth House the following
week.

Arguments for risk

–
Despite the potential trauma of moving residents, circumstances had
dictated that they had to be moved, and at least there was a
reassurance that residents wouldn’t have to be moved again until it
was safe to return to their home.

–
Efforts were made to keep the resident group together and in Selby,
but it was clear that it would be very unlikely that suitably large
and vacant accommodation could be located. The only possibility
open to the management would be a move into a local hotel, but the
owners refused.

– Given
the urgency of the situation, there would be no opportunity to
assess any alternative accommodation. By sending residents to homes
within their own organisation, the management would be secure in
knowing that the quality of care, staffing and environment would
match that of Firth House.

–
Although dispersed from the staff and fellow residents they knew,
the residents would be reassured by a familiar Anchor Homes
environment.

Arguments for risk

– Despite the potential trauma of moving
residents, circumstances had dictated that they had to be moved,
and at least there was a reassurance that residents wouldn’t have
to be moved again until it was safe to return to their home.

– Efforts were made to keep the resident group
together and in Selby, but it was clear that it would be very
unlikely that suitably large and vacant accommodation could be
located. The only possibility open to the management would be a
move into a local hotel, but the owners refused.

– Given the urgency of the situation, there
would be no opportunity to assess any alternative accommodation. By
sending residents to homes within their own organisation, the
management would be secure in knowing that the quality of care,
staffing and environment would match that of Firth House.

– Although dispersed from the staff and fellow
residents they knew, the residents would be reassured by a familiar
Anchor Homes environment.

Arguments against risk

– By dispersing residents over a wide area
there was the potential for this group of very frail residents to
suffer a traumatic experience.

– The residents, who knew each other well from
the home, had built up a special rapport following the evacuation.
It would have stirred feelings of great community as embraced
during the Second World War. To then break this up before a return
to the home might be experienced as defeat and cause a troubling
sense of loss.

– The security of seeing recognisable faces,
particularly those of individual key workers and those staff who
carry out personal care tasks, cannot be underestimated. Moving
someone into an unfamiliar environment with new people can be a
terrifying experience, particularly for those residents who are
affected by dementia.

– Residents would have very few personal
possessions, adding to their isolation. This would be reinforced by
a terrible sense of loneliness for those residents who were placed
on their own.

Independent comment

This is a good example of a primary and
secondary risk not being taken into account during the planning
process, writes Les Moseley. Any emergency plan, be it for the
whole housing group, or site specific (as this was), should take
into account all potential hazards and the degree of risk faced by
the residents. In addition it’s also essential to consider the
degree of vulnerability, the secondary risk, faced by those under
threat. In this case this was recognised by the care service
manager who took action to alleviate the potentially higher
secondary risk that travel over long distances, at night, could
bring to the residents of the home. The issues taken into account
required careful consideration and are clearly identified in the
case study and on balance produced a reasonable outcome.

Risk and vulnerability assessment should be
carried out in a methodical manner thus helping to reduce the need
for decision-making in a crisis. Information is always at a premium
when situations are deteriorating so quickly. It is therefore
imperative to consider all of possible needs beforehand. Assessing
individual and group vulnerability to specific threats will provide
detailed information that will enable staff to deal with the
specific issues, such as health needs and so on. Additionally,
planning for such an eventuality should not be done in isolation.
Following a formal process means involving the relevant responsible
authorities.

Les Moseley is director of the
Coventry University Centre for Disaster Management.