Nursing care patients return home

When Valerie Grimsinger and other residents of her Rancho Bernardo nursing home returned Thursday morning from a three-day evacuation, they were greeted with smiley-face balloons and large signs that said, “Welcome Back.”

“It was really a jubilant thing to come back here,” said Grimsinger, 73, who is recovering from hip replacement surgery.

It had been a far different scene Monday morning when Grimsinger and 51 other residents of Remington Club Health Care Center were told that encroaching wildfires would force them to leave and in most cases be moved to other nursing homes. The anxiety was palpable, the chaos upsetting.

Even so, everything unfolded according to a plan crafted for just such a disaster. Staffers called in ambulances and other transportation, handing residents their medications and copies of their medical records before they departed.

Stress and hardship can worsen medical conditions and sometimes cause deaths among the elderly and infirm. Seven evacuees in San Diego County -- six older than 60 -- died this week during or after leaving their homes or health facilities.

But by most reports, the evacuations carried out during this week’s series of infernos went as well as could be expected, especially given the size of the undertaking. Fourteen nursing homes in San Diego County evacuated nearly 1,200 residents, according to the latest estimates from the state Department of Public Health. Two acute-care hospitals and a psychiatric hospital in the county temporarily shut down.

Eighty-five assisted-living facilities, which housed as many as 2,189 seniors, also were emptied, as were an untold number of independent-living centers.

“I’m kind of amazed that the casualties have been as low as they are,” said Denise Nelesen, a program specialist with San Diego County’s Aging and Independence Services.

Officials at some nursing homes said they followed the same mandatory evacuation orders in place for the general population, but at least one said he evacuated his facility voluntarily because of the smoke. It was not clear late Thursday whether any facilities had been destroyed or damaged by fire.

One hospital and 11 nursing homes had been given permission to reopen from state officials, who are ensuring that conditions and air quality are adequate, said Kathleen Billingsley, deputy director of the Center for Healthcare Quality at the California Department of Public Health.

As the wildfires raged out of control Monday and Tuesday, nursing home residents and other elderly evacuees were taken to Qualcomm Stadium, the Del Mar Fairgrounds and Race Track and San Diego High School. Some remained at Qualcomm, but most who needed advanced care were taken to hospitals or nursing homes, some as far away as Orange County.

The experience stands in stark contrast to previous disasters, such as Hurricane Katrina, in which some nursing homes imperiled residents by deciding not to evacuate or failing to find transportation for evacuees. In one instance, 35 people died at St. Rita’s Nursing Home in St. Bernard Parish after its owners decided not to evacuate. (The owners were acquitted of negligent homicide and cruelty.)

In Southern California, “they’ve learned the lessons of hurricanes Katrina, Rita and Wilma,” said Robert E. Roush, an aging expert at Baylor College of Medicine in Houston, who leads national efforts to help elder-care providers prepare for disasters. “I’ve been very favorably impressed.”

Dr. Debra Saliba, a researcher at UCLA’s Borun Center for Gerontological Research and the Veterans Affairs Greater Los Angeles Healthcare System, said much has changed since she studied how nursing homes responded in the 1994 Northridge earthquake.

Then, 56 of 87 nursing homes with disaster plans acknowledged that they did not take account of such potential problems as missing staff, impaired communication and insufficient water and generator fuel. Five months after the earthquake, only half of the inadequate plans had been revised, her team found.

Despite the progress, nursing homes today face difficult choices between leaving residents in place or evacuating.

“Particularly with these more vulnerable populations, that’s a really tough decision,” Saliba said.

In an evacuation, the residents are vulnerable to dehydration, temperature changes and skin breakdowns. But if they wait, they may not get out in time.

Shortly after 4:30 a.m. Monday, a charge nurse called Remington Club’s nursing home administrator at home to report that residents were receiving automated calls ordering them to evacuate. After driving to the facility, administrator Scott Tarde arranged for the transfers by 8 a.m.

Forty-seven residents were evacuated within 100 minutes to three other facilities, Tarde said. Five residents went home with their families.

Some asked him more than once what was going on “because they would forget where they were going,” Tarde said. “We just kind of did a lot of validation. ‘We’re going to another building. We want to make sure that everybody is safe.’ ”

Experts say the mental health toll of a disaster often doesn’t end when it is over. Seniors and others who are frail may require counseling or long-term help to cope with the resulting trauma. Dale Phillip, 55, who is recuperating at Remington Club from a car accident, said she didn’t foresee lasting problems from the short evacuation.

“I think tomorrow they won’t even remember it, to be quite honest,” she said of her fellow residents. “They weren’t happy during the interim. Now that they’re back here, it’s like all is forgotten. I think most of them are just thrilled to be back.”

charles.ornstein@latimes.com