IceStorm 98 Study

This organization has existed in and of itself for 15 months. It used to be called Homecare and Placement Services and was administered by the Health Unit. So it's actually been in existence for almost 30 years (1969). Fifteen months ago the governance system was changed so the organization was moved "out from under the auspices of the Health Unit". The Ministry of Health under new legislation set up a new board. Currently there is a Ministry appointed board of consumers and general public (mostly seniors).

The organization is very large and is not just contained in the building where the interview is taking place. The organization is responsible under legislation for all of the publicly funded health services that exist in people's homes. This includes all post-hospital discharge care, etc. Everything from simply frail and unable to do basic things for yourself for whatever reason. The agency works for on an average over 3,000 people a day. Services are provided to over 11,000 different individuals a year. The majority of the people that are receiving their assistance are seniors.

The staff for the organization is “surprisingly small”--under 200 people. The majority of the staff are health care and social service professionals. Thirty percent are support staff. The budget is just over 24 million dollars per year.

Sears says the timing of the ice storm was really bad because it was vacation season for the staff and secondly, a very busy season for their clients because it's the only period when hospital elective work is not being done so there are more sick people at home.

The Thursday morning of the ice storm, Sears was on vacation. The organization has a bad weather policy because most of their work is done on the road. On Thursday morning she got a phone call very early in the morning from one of the directors of the agency. For the first time ever, the bad weather policy was enforced and people were told not to come to work. The office was closed. She says that this is a staff protection policy and this is a reasonable policy to have. All of the telephone calls were re-routed electronically through their Northbrook office because it was O.K. One of the clerical people there was able to make it to work and she was handling all urgent phone calls. The office at Counter Street had power but staff were not able to reach the office.

The directors and managers at home would respond to these urgent calls for changes in service, new patients coming in, setting up service, etc. This worked well. Later on in the afternoon, Sears heard a state of emergency declared over the radio. Sears was familiar with emergency plannning because of the agency's connection to the Health Unit for 30 years. They knew what their role was.

As soon as the state of emergency was declared, Sears implemented their emergency response policy. This means that Sears has the authority to order people to work outside of anything else. It allows rules to be broken. People can be taken off vacation. She called one of the directors and informed him that they were going into emergency response mode. At 2:30 that afternoon they moved from a standstill operation to emergency mode. This means that they go above and beyond what they normally do.

Directors of corporate and client services were informed and they in turn informed every manager that they could locate. They were able to enlist two case managers. This brought together a team of 7 people that were immediately mobilized, Sears included. They met at the Counter Street office. They would then implement their emergency plan. Within half an hour of their arrival, the power went. This meant no more phone service and it also meant problems with accessing the client files as they are kept in a database. The agency runs by computers.

Not knowing how long they would be without the system, they took the first half hour and divided up the jobs. They had to figure out how to gather enough client data to actually go into response mode. In semi-dark emergency lighting the managers went through the building and gathered up the rolodexes to try to obtain needed information. Within 24 hours of the beginning of the storm it was determined that there were 3,187 people receiving their services. Some of these are life support services--dialysis, ventilators, etc. They knew that they had to relocate their offices. She notified City Hall that they were open. She asked the emergency response desk in the City if anyone had taken on the role of providing healthcare in shelters. She offered to have her agency take it on. They said they would get back to them.

In the meantime, Sears became aware of the Hotel Dieu establishing a shelter for the frail, elderly, and sick people. Knowing that this was their key population group, she chose to set up their new emergency office in Hotel Dieu. They actually had offices in every one of the hospitals. This was initiated by Thursday afternoon. She proceeded to notify Hotel Dieu senior administration that they were on site. They used their case managers to determine the "at risk" people. These people were contacted to see how they were and to make alternate arrangements for care services if necessary. In addition to this role, if anybody else came to them seeking assistance of a type that they could provide, they would not worry about whether or not they were eligible, had a health card or anything else. They would assist if they could.

When a case manager couldn't be reached, it was assumed that the entire case load may be at risk and these people were contacted. Every one of their terminal patients was assumed to be at high risk of needing something different than would normally be available. This took the group of seven workers until 9:30 that evening to contact each one of these people. Sears tells of one elderly man who lived in a third floor apartment in a bad section of town. He was on oxygen and was unable to get down the stairs. The elevators were out. He was "effectively isolated and scared". Sears clients were invited to come to the shelter at the Dieu. Their taxi fares were paid for by Sears’ agency if they had no other way to get to the shelter.

At the same time as this was being done, City Hall called Sears back and asked her to set up health care in the shelters. This role was taken on. Sears contacted their nursing agencies. She wanted to ensure that there was at least one R.N. and one R.P.N. at each one of the municipal shelters. Sears’ agency would cover the expense of this. The nurses’ agency would be contracted to do this work. The two main agencies that Sears was able to utilize at this time were the V.O.N. and Allcare Healthcare services. They were the only two agencies at the time who could free up staff from doing home visits. Sears said that it was a "massive undertaking of communication and orchestration". By 7:30 Thursday evening there was one shelter with assigned nursing staff and by 8:00 p.m. there was one other one.

The head of the Department of Family Medicine contacted Nancy Sears and asked if there was anything that they could do to help. She said yes because she wanted to be able to have a back up system in place to provide care to the shelters. Physicians and medical students and a Hotel Dieu nurse were sent in to be back up for the nurses at the shelters. They worked together as a team. By 9:30 Thursday night they were able to reach about 98% of the people that they had identified as high risk. There was little left for them to do. They shut down for the evening. They remained on stand by. Voice mail messages were left for all of the staff that if they could get in to work, they were needed.

They drove home through the blackened city over the downed power lines. Nancy says it was an "amazing experience". She says that she was astounded.

She realized that the staff were as much victims as the people they needed to help. This has never been planned in any scenario. A dependant’s care shelter was established for their staff's dependants. So if the reason their staff couldn't get to work was because you couldn't leave somebody alone, they were brought to this shelter. One of the workers had their teenagers volunteer to manage the staffing of the dependant’s shelter. It turned out that only children came.

By Friday, Napanee's office was fine. Northbrook was totally operational. The Counter street office was the only office still in bad shape. They were operational. They had the power back, the electronics system was back. It was just the roads that were the problem. There was a full staff briefing on Friday. They were told there were no rules. Continue to contact the people identified as risk priorities as well as low risk priorities. By Monday Sears wanted all 3,000 clients contacted and located and a system set up for all of those without power or at high risk that needed to be contacted on a daily basis. Job descriptions went out the window.

Lists of people being admitted to the shelters were sent to Sears’ agency. These lists were manually checked for those patients that couldn't be reached. Medical equipment and supplies were delivered to the shelters on a daily basis. This continued through the weekend.

Sears says there were some situations where they had to convince people to come to the shelter. Some people refused. They kept in touch with these people on a daily basis. On Saturday the KGH got involved and called Sears’ manager. They were "falling down on discharging people from the hospital". There was a meeting scheduled for Sunday. Sears was ready to defend their position. The KGH said they had no beds left. There was an issue. People did need to be discharged because people needed to get in. KGH had no shelter at this point. KGH needed to be informed about the position of the access centre-- that they had about 150 of their clients in shelters which meant that there were still 3,000 clients being taken care of in their homes (via telephone calls, etc.). At this point, communication greatly improved.

Hotel Dieu shelter was packed. They began screening and sending people to the KGH and St. Mary's. Sears’ agency had to track their clients. There was no place to go for the people who had to be discharged from KGH. They were too sick to go to the Hotel Dieu shelter. They were barely medically stable (i.e. two days post-op, open wounds, etc.). Senior management had to come up with a way to deal with these people. They decided to set up a ward in the hospital to take care of these people. The physiotherapy room was selected. This had never been done before. Hospital beds were supplied by Respicare. The ward was set up by Sunday evening. By Monday at noon people were being admitted to what they were calling the "guest house" at KGH.

On Monday Sears got a hold of the Ministry of Health (the local office in Kingston). She was told to contact Toronto. She did and told them that she was spending money. Their response was "whatever you do is fine, send us the bill". By Monday all but six or seven of their patients had been contacted. They contacted the City emergency desk. Each of these persons was assigned to either army personnel or police personnel. The last 6 or 7 were found.

Late Monday afternoon it was determined that the KGH and St. Mary's shelters were no longer needed. They were consolidated into one at KPH. Sears services were moved to KPH. New clients were found. Clients that previously didn't need any assistance, now needed. The ice storm caused the access centre's client list to grow (permanently).

On Friday the City of Kingston undeclared its emergency but all of the other municipalities were still in a state of emergency. It was clear that staff were exhausted. They were working above and beyond. In addition to their own jobs, they were volunteering at other places. Psychologically they needed a boost. Staff were on call for the weekend. They were told to pull back for the City but to remain on standby.

Nancy says staff were suffering from "emergency fatigue". Not so much stress. This emergency didn't end. People were tired of it and wanted to get back to normal. The emergency lasted too long. One of her biggest roles was to support the staff. If they needed things for their home (i.e. candles, kerosene), Nancy set about to find it.

Operations were slowly and consistently downgraded. It was "fun". As bad as it was in Kingston, Brockville was even worse.

Funds spent because of the ice storm are at least a quarter of a million. Costs are still being calculated and broken down. New patients are "ice storm costs".

Nancy says that rather than all of the hospitals and healthcare agencies do their own evaluations about what worked and what didn't work, it has been asked that an external evaluation of how the system worked be done.