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With hospital closed by flooding, CMs help out
Employees on payroll during renovation
Sharon Spencer, RN, was working around the house on a Saturday evening when she got word that Columbus (IN) Regional Hospital, where she is employed as a case manager, was being evacuated because of a flash flood.
"I knew there was going to be rain over the weekend, but the flood took everybody by surprise. I contacted my boss to see if I could help, but my access to the hospital was cut off by the flood," Spencer says.
Columbus Regional Hospital was damaged by record flooding and storms on June 7, 2008, when Haw Creek flooded 12 inches above the 500-year flood level. The hospital safely evacuated 157 patients within three hours, but the majority of the hospital remained closed until Oct. 27.
Following the flood, the hospital administration made the decision to continue paying all 1,800 employees while the flooded areas of the hospital were being restored and rebuilt, says Jim Bickel, CEO of the 225-bed regional hospital.
"While the hospital was closed, the hospital's people were open for business. Staff members assisted the community in a variety of projects. Not only was this the right thing to do for the hospital, it was the right thing to do for the community," he says.
Many of the case managers at the hospital were assigned to community agencies to put their skills to work helping people whose homes were destroyed by the flood find the resources they needed.
In the first days after the flood, Kristie Leonard, RN, a case manager at the hospital, was given a variety of assignments that ranged from assisting the public health department in giving members of the community tetanus shots and working at an urgent care center to cleaning hospital furniture that was damaged in the flood and sorting donated clothing items at a local charity's headquarters.
Eventually, Leonard was assigned full time to United Way to assist in community case management along with several of her peers from the hospital.
Spencer, who has asthma, was unable to do some of the work because of the mold and mildew that followed the flood. For her, the most frustrating part of the situation was waiting until she got an assignment.
"I felt very frustrated. I felt like I needed to be doing something," she recalls.
When Spencer attended one of the hospital's long-term recovery meetings, she and other case managers volunteered to help people who lost their homes find community resources.
"We felt like we had a lot of knowledge we could share and that this was where we could help the most," Spencer says.
Spencer and other case managers from the hospital set up the long-term assistance office at United Way, canvassed areas that had been hard-hit, and identified clients who needed help.
"None of us had any disaster training at all. We were all hospital-based case managers. We knew how to take the information we had and the needs to the clients and apply them to the practice of case management," she says.
The case managers began by going through the Yellow Pages and calling every business and individual that might be a good resource for their clients. The list ranged from contractors to electrician, plumbers, building supply companies, or wrecker services.
"We developed our own list for community resources and shared it with United Way's 211 national database for health and human services information," Spencer says.
In turn, the 211 database shared information on organizations and individuals who would provide free services for people in need.
"The case managers worked as a team with the volunteer action coordinator and the construction manager at United Way to help coordinate services for people," she says.
When she joined the other case managers at United Way, Leonard contacted people who were affected by the flood to assess their immediate needs. Some had lost their homes to the flood and were in hotels or temporary housing.
"Making sure people had a roof over their heads and food to eat was our first priority. As the weeks went on, we worked to help people get back into their homes, or if that wasn't possible, to find appropriate housing. We worked with FEMA to help people who had lost their homes find community resources and helped support them emotionally as well," she says.
Long-term recovery efforts
When funds became available, the case managers worked with the long-term recovery committee to get materials and supplies that people could use to repair their homes.
Many of the clients didn't have flood insurance, and the money they received from FEMA didn't cover all the damage, Spencer says.
"The area that was hit the worst was a neighborhood of rental houses for the working poor. Their rent was low, and many had lived there quite a while. Following the flood, they were faced with paying twice as much rent in an area where there was already a shortage of affordable housing," she says.
Renters received reimbursement from FEMA only for their possessions.
"Initially, we worked with the city government and the landlords to help find housing for these people," Spencer says.
Her case management background helped Leonard connect her clients with community agencies "but there were a lot of unknowns that we had to deal with on a day-to-day basis," she says.
"I was familiar with some of the community resources from my work with patients at the hospital who needed help with food or housing after discharge. It was nice to learn what other services are available," she says.
Now that she has returned to work at the hospital, Leonard anticipates putting her new knowledge to work.
"The work helped me understand what community resources are available and gave me a better understanding of what the patients I encounter may face in their lives, whether it's financial, physical, or emotional baggage," she says.
Leonard returned to work at Columbus Regional in October but in the new role of discharge utilization coordinator.
When the hospital flooded, the case management department was in the midst of a reorganization project and continued to work while the hospital was closed. A few weeks before the hospital reopened, Leonard and the other case management staff spent three weeks working with their new manager and new peers to identify what their new roles would be.
Spencer has continued working at United Way as the case management supervisor for the agency's long-term recovery efforts.
"I'm still a hospital employee. I'm working here because of a cooperative effort between the long-term recovery team and the hospital," she explains.
Spencer supervises 10 lay case managers who are volunteers and work part time and follows about 25 clients as well.
"We screen our clients for their needs and identify resources to help them. They may need something as small as drapes and blinds for their home or as big as having their entire home rebuilt," she says.
The experience has given Spencer knowledge that she and her fellow case managers can use as they struggle to find community resources for their patients.
"I'm going to be able to take back resources we've never thought about before, so it will be much easier to help patients find help they need. If we have patients who are having difficulty with rent, I'll know people on a first-name basis who can provide assistance," she says.
On June 7, the Columbus area received more than 10 inches of rain during the morning hours.
By late afternoon, water started flowing into the hospital parking lot and entered the basement.
The hospital basement where the laboratory, pharmacy, information services, and electrical/ mechanical systems were housed was completely flooded and the first floor of the hospital had 6 to 8 inches of water. Total damage is estimated at $210 million.
Hospital staff began the evacuation process around 6:30 p.m., transporting patients in wheelchairs and on stretchers, recalls Tom Sonderman, MD, chief medical officer.
"It took four to six people to carry the patients and others to hold flashlights and open doors. The patients were transferred to other facilities by ambulance and by school bus. By 9:30 p.m., all the patients and staff were safely out of the hospital," he says.
The hospital began offering outpatient services at locations across the community within the first week after the flood. A Carolinas MED-1 mobile emergency unit, based at Carolinas Medical Center in Charlotte, NC, relocated to Columbus and was open on the hospital campus by June 23. The hospital opened its interim emergency department within the hospital building on Aug. 1 and reopened the inpatient and surgical services inside the building on Oct. 27.