Palliative Care Physician Shares Post-Hurricane Reflections

The approach of a major hurricane creates a pervasive sense of anxiety and urgency to secure one’s home and seek safe shelter. In the days leading up to Hurricane Irma making landfall in Florida, it seemed that empty store shelves and long lines at gas stations happened overnight. As the Medical Director for Chapters Health Palliative Care, I had not expected that palliative care would play any significantly different role during the storm, other than that which we play every day on our busy inpatient consult service (our team averages 120+ new patient consults and nearly 400 follow-up visits monthly). Yet I found my specialty skills well-utilized during the recent hurricane in Florida.

Palliative Care during the Storm

With Hurricane Irma about to make landfall, our primary clinical site, Florida Hospital Tampa, was ramping up in frantic preparation. For me, this was a new experience and the hospital felt like a different world than the one in which I practiced every day. In addition to roughly 500 patients, more than 1,600 medical staff and hospital personnel needed to be sheltered, and there were not enough beds for everyone. Despite the bed shortage, they did manage to care for the additional people, many of whom arrived with children, elderly loved ones, and even their pets! Everyone was accounted for daily and food was served three times a day in the cafeteria. Once the winds hit a certain speed, the hospital was locked down, and all staff and any visitors still in the hospital were required to stay inside for the duration of the storm.

In spite of the fact that palliative care had not been deemed to be a specialty whose in-house presence was required for the storm, my nurse practitioner, Kathy Curran, and I stayed at the hospital because we were then following more than forty patients. We took air mattresses and our own food and camped out in our 80-square-foot hospital office with flashlights in easy reach should we lose electricity. Surgeons, hospitalists, ER docs and many others were likewise encamped. Every office, waiting room and conference room was plastered with paper over the windows and signs to keep quiet because groups of medical staff or hospital personnel were sleeping inside.

Timely Decision

As it turned out, my decision to be present during the storm was a timely one and a tribute to the value of palliative care in practice. Patients’ symptoms of pain and anxiety were magnified by the disaster at hand. Emotions ran high for patients, families and staff alike and opportunities to provide comfort were in abundance. The storm left many people with little emotional reserve to cope with difficult medical situations where decisions had to be made. Inevitably, critical discussions were necessary, and who better to have them and to effectively address symptoms than palliative care practitioners.

Families of loved ones on life support struggled with major decisions about the medical plan of care going forward. For those who had decided to liberate their loved one from the ventilator, questions about when to extubate and whether family would stay at the bedside became an even more complex decision. If family stayed, and their loved one passed quickly, they would be forced to stay in the hospital until it was safe for anyone to leave.

Wanting to be very careful that medical staff and families alike were making appropriate decisions not unduly influenced by the storm, Kathy and I offered medical and ethical guidance where needed. At one point in the ER, when we were within minutes of lockdown, and no one could travel, I spoke by phone to a son who had needed to leave his mother’s bedside to secure his home and family. I reassured him that his mother was being well cared for, that her passing had been peaceful and dignified and that she had not been alone. Not only did patients and families benefit, but the staff did as well. We reassured them that the hospital was the safest place to ride out the storm, and offered comfort by listening to their fears for their loved ones outside the hospital.

I really cannot fully describe the experience, but I am proud of how we functioned and what we contributed. Doctors and nurses all over the hospital thanked us profusely for our palliative practices during the storm. In fact, since Irma, there has been so much positive feedback about our presence that palliative care has been designated one of the required services to be present at Florida Hospital Tampa during a disaster.

What Would You Like to Read about in Future Posts?

In “DRops of Wisdom,” we want to feature posts with subject matter that interests you. Please leave a comment or email us with your ideas.

At Chapters Health System, every day is devoted to educating our patients and keeping them in the place they call home. We are dedicated to ensuring that patients, young and old alike, and their families are able to make educated decisions about important healthcare matters. For more information, please call our helpful Chapters Health team at 1.866.204.8611 or send an email to info@chaptershealth.org. 

Note: This blog is also posted on the Center to Advance Palliative Care website.

 

Mary Alfano-Torres, MD
Vice President, Chapters Health Palliative Care

Mary Alfano-Torres, MD, has dedicated her career to delivering quality palliative care services to patients facing complex and complicated medical conditions. As vice president of Chapters Health Palliative Care, Dr. Alfano-Torres provides palliative care consultations at area hospitals, meeting with chronically ill patients and their loved ones. She discusses the illnesses they are facing, offering guidance and helping them put in place realistic plans of care as they move forward.

Dr. Alfano-Torres joined Chapters Health Palliative Care in 2013. Previously, she was the Palliative Care Department medical director at Sacred Heart Health System in Pensacola, Florida. Dr. Alfano-Torres also held positions with the Center for Hospice and Palliative Care in Buffalo, New York, including attending physician and director of the Palliative Care Consultation Service and medical director of the Hospice Inpatient Unit.

Dr. Alfano-Torres has also dedicated time to educating future physicians. She held faculty positions at the State University of New York at Buffalo and Michigan State University in East Lansing, Michigan Dr. Alfano-Torres earned her Bachelor of Arts in Psychology from the University of Rochester in Rochester, New York; her medical degree from the State University of New York at Upstate College of Medicine in Syracuse; and completed her residency at Michigan State University in Lansing. She is also a fellow in family practice; a diplomat of the American Board of Hospice and Palliative Medicine; and a diplomat of the American Board of Family Practice.

 

Post-Hurricane Resources

Forbearance for Mortgage and other Loans

With many Florida homeowners suffering Hurricane Irma damage to their property, some might have trouble making their normal mortgage payment. Since so many counties across the state were declared a federal disaster area, homeowners may be eligible for a deferment or forbearance of their mortgage payment.

What does this mean? Your mortgage may be waived for a set number of months at no adverse credit effect on you. Unfortunately, it is not automatic. You must contact your mortgage lender, and apply for the deferment. Typically, each mortgage lender has a different set of rules. Therefore, it is a good idea to call and ask. If you skip a couple of payments, the lender usually will add the payments to the end of the loan without any negative impact to your credit. However, during this time, interest will still accrue.

You can look up your mortgage company via Fannie Mae and Freddie Mac.

Additionally, many banks and credit card companies are extending the same forbearance of payments similar to the mortgage companies. Check directly with your bank and/or credit card company to find out their specific policy.

FEMA Disaster Hotline Information

FEMA designated the following counties as those eligible for assistance:

Alachua, Baker, Bradford, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Columbia, Desoto, Duval, Flagler, Gilchrist, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Levy, Manatee, Marion, Martin, Miami-Dade, Monroe, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Suwannee, Union and Volusia.

Visit DisasterAssistance.gov to apply for assistance online.  If you experience difficulty applying online, you may also call (800) 621-3362 / TTY (800) 462-7585 to apply during standard hours of operation (7 a.m. to 11 p.m. Eastern Time), 7 days a week.

You can also check your application status at DisasterAssistance.gov. Survivors have 60 days from the date of a declaration for Individual Assistance to apply for assistance.

Please note that if you are eligible for an Individual Assistance grant you are not required to pay back the grant to FEMA.  There is no income threshold for Individual Assistance grants, but you may be referred to the Small Business Administration (SBA) for a low interest disaster loan to assist in your recovery.  These low interest disaster loans for homeowners and businesses from the SBA must be repaid.

When you register for disaster assistance either online or by phone, you will need the following to complete your application:

• Social Security number
• Address of the location where the damage occurred (pre-disaster address)
• Current mailing address
• Current telephone number
• Insurance information
• Total household annual income
• Routing and account number for your checking or savings account (this allows FEMA to directly transfer disaster assistance funds into your bank account).
• A description of your disaster-caused damage and losses

Free or Low-Cost Legal Advice

The following are some resources for people who might have already applied for hurricane assistance and been denied, or need legal advice for a claim.

Community Legal Services of Mid-Florida – Community Legal Services of Mid-Florida (CLSMF) is the primary provider of free legal aid for low to moderate income residents in Central Florida.

Florida Rural Legal Services – Florida Rural Legal Services, Inc. is a private, non-profit corporation, which provides free civil legal services to indigent families and low-income elderly people in thirteen counties of South Central Florida.

Bay Area Legal Services– Bay Area Legal Services is a non-profit, public interest law firm that provides civil legal assistance to low-income residents in the Tampa Bay region.