Winter Storm Uri, Mortality, and Health Care Use of Nursing Home Residents
What did Winter Storm Uri reveal about nursing home preparedness? The deadly storm exposed serious gaps in emergency planning and care continuity. For many residents, it became a matter of life or death. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Brian Downer to discuss how Winter Storm Uri impacted nursing home mortality and health care use—and what lessons should be learned.
Downer:
If you don’t have an assistive device to help move someone from their bed to their chair, that can really cause an issue, both for residents and staff, more so than just some of the inconveniences that you and I might experience with the power outages. There’s certainly things that can really have a pretty immediate consequence to a residents health and wellbeing.
Intro
Schenk:
Hello there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. We are talking about emergency preparedness in nursing homes, but specifically the ramifications of Winter Storm Yuri in Texas from a few years ago. What kind of, what can we learn from that? What does the data tell us what we should do tomorrow? But we’re not, we’re certainly not having that conversation alone. We have the fantastic Brian Downer to walk us through that process.
We have Dr. Brian Downer, PhD. Brian is an associate professor at the University of Texas Medical Branch School of Public and Population Health. He studies healthcare outcomes for older adults with a focus on dementia, nursing home care, using national Medicare data. Dr. Downer. Earned his PhD in gerontology from the University of Kentucky and completed an NIA postdoctoral fellowship on Minority aging at the UTMB Cley Center of Aging.
The UTMB School of Public and Population Health highlights research efforts to reduce healthcare disparities across aging populations.
And we’re so happy to have him on the show today. Brian, welcome to the show.
Downer:
Hi, thanks.
Schenk:
Really looking forward to it. I would love just to start off the show with tell us about how you came to write this paper. And when I say the paper, I’ll make it in the show notes for everybody.
But you wrote a terrific paper about Winter Storm, Yuri, am I saying Yuri? Correct that yeah. Winter Storm Yuri and nursing homes in the state of Texas. So start us off with what made you wanna do that?
Downer:
Yeah, so it came about for a few different reasons. My research focuses on outcomes of nursing home care.
So I have an interest in the subject matter just from a professional perspective. But then there’s also a personal reason for being interested in this project. And that’s I live in Galveston, Texas and have been living in the area since 2014, so we. My family and I, we lived through winter storm uri and got to experience power outages, the unusually cold weather. And so it added a personal motivation for the paper as well.
What was the impact of Winter Storm Uri on nursing home residents in Texas?
Schenk:
From just a 40,000 foot view, what did your paper talk about and what were the kind of, what are your opinions about what we can go from here?
Downer:
So to kinda give people a little bit of a sense about the paper so a winter storm Yuri happened in February of 2021.
And for most parts of the country, temperatures in the teens and twenties wouldn’t be overly problematic. But for Texas, that’s quite unusual. And as a result of some infrastructure concerns with the power grid, there are these widespread power outages that lasted for several days across the states, and so we were able to get our hands on some data that indicated whether a nursing home reported.
Having experienced a power outage or some type of water shortage. So we had information about kind of their utilities and if they ever lost water or power during the storm. And so we were interested in whether residents of nursing homes experienced that. One of these outages was if they had adverse healthcare outcomes and we were particularly interested in hospitalizations, ER visits, mortality, and we were also able to look at physician visits both during the week of the storm and then for.
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About six weeks after the storm. And so basically what we found is that residents of nursing homes that experienced an outage had similar amounts of visits and visits, hospitalizations and ER visits. There didn’t seem to be much happening in those outcomes, but those residents did have higher mortality in the weeks after winter storm uri.
And so we were interested in figuring out what exactly might be, the longer term health effects of a storm, such as winter storm URI occurring in a place that we wouldn’t typically expect to see this type of weather event to occur.
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Why are nursing home residents especially vulnerable during extreme weather?
Schenk:
Other than the thermostat, what are some of the things that are affected when the power goes out at a nursing home?
Downer:
Yeah, the, so this is where talking with some of my clinician colleagues was really helpful. They immediately went to any type of medical device that requires electricity. And so there’s certainly the obvious, life sustaining types of things, but even something like, an electrical powered like, bed or a mobility device things that, from a day-to-day standpoint, if you don’t have.
An assistive device to help move someone from their bed to their chair, that can really cause an issue both for residents and staff. So it’s, more so than just some of the inconveniences that you and I might experience with power outages. There’s certainly things that can really have a pretty immediate consequence to a resident’s health and wellbeing.
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What surprised you most about the findings from this study?
Schenk:
Brian, can you think this is what I’m having trouble wrapping my head around is in my mind you have a terribly powerful winter storm. It comes down, lights go out, power goes out. But you what you and in my mind, it would be the implications. Would be immediate, but from what I hear you describe it, that you looked at mortality rates for months later and they were higher.
So like I, I’m trying to understand how we get from A to B and why there’s that length of that duration of time.
Downer:
Yeah, and that was one of the things that surprised us actually with this paper is that given the winter storm, it was a very acute shock to the system. And even if you look at.
Some of the power outage data, you know these really abrupt effects for a couple of days, and then. Monday, Tuesday, Wednesday is when things were really bad, but then by Saturday, the temperature turned back to normal. People were back to their daily routines.
And so we were expecting to see these very kind of immediate consequences, especially around things like ER visits and hospitalizations. We did see abrupt changes in physician visits but we were a bit surprised by not. Seeing longer lasting effects around mortality. We weren’t able to quite dig into this much in this particular analysis, but it could be, consequences from, missed physician visits or disruptions to daily care that then don’t.
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Kind of manifest into the outcome until maybe a few weeks later. This is what was interesting about this project, is that there’s been a lot of research done on the consequences of hurricanes where there you do see pretty consistently these longer term lasting effects.
But for a hurricane, it could take weeks to recover from that storm. So you could have pretty long disruptions to regular care that we weren’t detecting with the winter storm uri, we saw a big dip in physician visits that immediately recovered back to pre-storm levels in the weeks and the weeks after.
So I don’t have a really great answer, I guess to your question, but it is a little bit unclear as to why we didn’t. See these mortality differences until a few weeks after the storm had passed.
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Were certain types of nursing homes more affected than others?
Schenk:
Were you able to draw any conclusions other than you have a higher mortality rate for the places that the power went out? Like any other conclusions that you can draw?
Downer:
So that’s part of the area of our, some of the future work that we’re interested in doing. One is looking at some of these maybe causal mechanisms that might explain why residents of nursing homes that experienced these disruptions were at higher mortality.
We’re also interested in how certain facilities may have been more affected than others. Looking into things like staffing levels maybe overall. Quality measures, things that might indicate whether there were certain nursing homes that were more adversely affected by the storm.
I think looking more closely into things around we could use the MDS for example, to look at maybe the type of care that people were receiving during the week of the storm and see if we can maybe link disruptions into daily care and see if that was part of what was causing this increased mortality. Things that we can also look into and we have discussed looking into this might be among certain resident populations, people with dementia, for example, who might be especially vulnerable to disruptions to daily care or people with other, highly comorbid types of conditions.
Who might be. At the greatest risk for mortality.
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Schenk:
Did you, are you privy to any data with respect to how the people were passing? Was there a particular pathology that, stuck out from the statistics?
Downer:
So there’s and I would encourage people if they’re not already aware of this, but there was a really great senate report called Left in the Dark that really goes into a lot of detail and some of these contextual things that, the data that we have don’t allow for, but they’re interviewing, nursing home administrators and really talking about, what was it specifically about the storm that was so devastating to older adults? One of the things that we can do through some other data sets is look at the cause of death. I think what’s challenging is we have maybe mortality that’s directly attributable to the storm versus things that are maybe further.
Downstream from the storm. That’s more of a consequence from Yeah. Disruptions to like daily care, for example. Yeah, so there is data available where we could look at and incorporate information around specific causes of death and then try and attribute that specific instance of a person’s death and attributing it directly back to the storm.
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Schenk:
I see that I’ll have that in the show notes left in the dark. The impact, the 2021 Texas blackout on long-term care, and that’s United States Senate. Like I said, Senator, what senator was that?
Downer:
I can’t recall. Casey, it’s a center, Casey, it’s a wonderful rapport. And actually they’re, they were how we were able to get the information about whether nursing homes experience some type of disruption.
I see. So it’s a, yeah, it’s a really fascinating read. It really puts into perspective how challenging that week was for residents and staff.
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Schenk:
This is the storm where Senator Cruz was going to Mexico. This is that. Yes, this is that storm, isn’t it? Yeah. Yes. That’s the one for sure.
Alright, so was there anything in the data that could tell you, because you mentioned hey, maybe in the future we can look to see from a mechanical standpoint. Like why is the power went off in one place or the other? Is there anything that you could.
You can come to a conclusion with respect to the nursing homes on this grid or the nursing homes that have, I don’t know, backup power generators or whatever. There’s something that could be done in that regard.
Downer:
So in this specific project, we didn’t have that data available to us, but I, that’s where I’ve been looking into.
So there is, and I’ve been able to get access to it. There is like publicly available data about so we know where the nursing homes are located, obviously. And then we can through that kind of geocoding, the longitudinal latitude, like we can place the nursing homes and piece together, where they are in relation to these different power grids.
So like using where I am, for example, with that University of Texas Medical Branch, like that power grid is. Much different from a stability standpoint than just your regular kind of residential power grid. And there’s a nursing home in Galveston that’s relatively close to UTMB and it’s probably on a different power grid than the other nursing home that’s a bit further down the island.
So it’s really big. Kinda lift in terms of the data required, but we, you could piece together, I think, where nursing homes are located and what their power grid supply is. This is getting a little bit.
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Schenk:
Go ahead. I was gonna say, because in Texas, one of the big things is that you don’t have a standard grid.
It’s who knows. Wild west.
Downer:
And that’s exactly what I was.
That really brought to the public’s attention, just the unique intricacies of the Texas power grid. And I, at least for me, I don’t think many people really realize that Texas doesn’t draw on emergency energy supply from other states. And that’s what made it, ’cause Louisiana and these other kinds of bordering states, like they were also experiencing the same winter storm.
It wasn’t. Just Texas, that was where this was occurring. And so there were certainly power outages in things in these other states, but I think those states had a bit more resilience built into the system. And it wasn’t as emergent of an event as it was for Texas. And it really comes back to the vulnerabilities of the power grid of Texas that really made this a more devastating event than it maybe could have been or should have been.
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Schenk:
I’m sure that there are advantages. That’s the good thing of living in a federal republic. There are advantages to running your experiment the way you do in Texas, but again, you have, as you mentioned, you have the, you have to weigh the advantages of being independent versus, when you really need a helping hand, being able to at least stretch hand out and get it, you know what I mean?
What steps can facilities take to better prepare for future storms?
Is there anything that you’ve uncovered in your research that if you had a family that has a loved one in a nursing home in Texas, at least. What advice would you give them about this situation?
Downer:
Yeah, it’s certainly a couple of things. I think one is that, emergency preparedness is a year round.
Process. Obviously for people in Texas and even the Gulf Coast and Atlantic Coast, like we’re all familiar with hurricanes. We’re coming up onto the start of hurricane season here in a few months and summer and fall is a time where people are on guard and now it’s, that.
Even in the winter months, we need to be prepared. Houston got a couple images of snow earlier this year and it brought back memories of the winter storm area a bit about is the power grid going to hold? So if you do have a family member who you know is a resident of a nursing home, I would talk to the nursing home about what their.
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How can families ensure their loved ones are protected during emergencies like Winter Storm Uri?
Downer:
Emergency plans are, and how quickly can they implement those plans. And I think now it’s, thinking about disasters that. Maybe we wouldn’t typically expect it, for our area. I will say that information about a nursing home’s disaster preparedness and how well they’ve performed that type of information is publicly available.
It can be difficult to find, you really have to dig for it. But as part of the state inspections, nursing homes will have to provide information about their evacuation plan. Do they have a backup power supply? Do they have another nursing home that they could send residents to in the case of an evacuation?
So that information is available, and if you have a family member who’s in a nursing home, I would recommend people maybe try and talk with the nursing home just to find out what types of plans are in place. And that way if there are considerations that need to be made, specific things about your family member in terms of medications or other kind of health related needs, you can make sure that the nursing home is able to help meet those.
Yeah, so I, finding out about nursing homes’ kind of emergency preparedness plans, I think can really go a long way in helping keep residents safe.
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Schenk:
Very well said. Brian, thank you so much for coming on the show and sharing your knowledge with us and all the good work that you’re doing.
Yeah, thanks. I really enjoyed it. Folks, I hope you found this episode educational. If you have an idea for a topic you would like for me to discuss, please let me know. If you have an idea for a person that you’d like for me to talk to, please let me know that as well. Also be sure to enter the win the.
Nursing home abuse podcast mug. Make sure you let us know which decade of ladies hairstyles that you like. Again, 1960s is the correct answer, but you can put whatever you want. It could be the eighties. That was the aquanet decade. I think. I could be wrong. I’m speaking around a place. This is coming from a man with no hair. Anyway, good mansplaining. So new episodes of the podcast come out every single Monday. And with that folks, I’m gonna get outta here. We’ll see you next time.
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