And the Storms CameAnd the Storms Came……

Sarah S. Strawn, MS, RDSarah S. Strawn, MS, RD

Nutrition Services Nutrition Services AdministratorAdministrator

Alabama Department of Senior Alabama Department of Senior ServicesServices

4th State Units on Aging Nutritionists/Administrators Conference4th State Units on Aging Nutritionists/Administrators ConferenceAugust 2006August 2006

ADSS Nutrition ServicesADSS Nutrition Services

Title III—Elderly Nutrition ProgramTitle III—Elderly Nutrition Program– 18,000 meals daily18,000 meals daily– 13 AAAs and 350+ senior centers13 AAAs and 350+ senior centers– 6 production units + 1 frozen distribution unit 6 production units + 1 frozen distribution unit

Title XIX—E/D Medicaid WaiverTitle XIX—E/D Medicaid Waiver– 6,000 frozen and breakfast 7-meal packs weekly6,000 frozen and breakfast 7-meal packs weekly– 2 state operating agencies2 state operating agencies– Vendor delivers D2D to clients throughout state Vendor delivers D2D to clients throughout state

And the storms cameAnd the storms came……

Hurricane IvanHurricane Ivan—September 16, 2004—September 16, 2004– Category 3; landfall at Gulf Shores, ALCategory 3; landfall at Gulf Shores, AL

Hurricane DennisHurricane Dennis—July 10, 2005—July 10, 2005– Category 3; landfall at Navarre Beach, FLCategory 3; landfall at Navarre Beach, FL

Hurricane KatrinaHurricane Katrina—August 29, 2005—August 29, 2005– Category 3; landfall in southeast Louisiana and Category 3; landfall in southeast Louisiana and

at Mississippi/Louisiana state lineat Mississippi/Louisiana state line

State of Alabama

Each storm is differentEach storm is different

Hurricane IvanHurricane Ivan– Flood damage along the coastFlood damage along the coast– Wind damage in the interior; major power Wind damage in the interior; major power

outages; damage to homes and centers; outages; damage to homes and centers; no fuelno fuel

– Satsuma and Camden without power two Satsuma and Camden without power two daysdays

Hurricane DennisHurricane Dennis– Heavy rainHeavy rain

Each storm is differentEach storm is different……

Hurricane KatrinaHurricane Katrina– Heavy coastal flooding due to storm surge Heavy coastal flooding due to storm surge – Satsuma without power for a weekSatsuma without power for a week– Vendor home office operations paralyzedVendor home office operations paralyzed

Computer system inoperableComputer system inoperable

Traditions frozen meal plant without powerTraditions frozen meal plant without power

Shelf-stable meal supply shortagesShelf-stable meal supply shortages

– Influx of evacuees into AlabamaInflux of evacuees into Alabama– Donated meals to stateDonated meals to state

Lessons learnedLessons learned

Each disaster brings unique challengesEach disaster brings unique challengesSome plan is better than no planSome plan is better than no plan– Centralize decision making and communicationsCentralize decision making and communications– Maintain critical agency operations Maintain critical agency operations – Recognize cannot anticipate every contingencyRecognize cannot anticipate every contingency– Do the right thingDo the right thing– Guard against complacencyGuard against complacency– Incorporate relief efforts into existing structureIncorporate relief efforts into existing structure

Document!! Document!! Document!!!Document!! Document!! Document!!!Evaluate actions and revise plans as neededEvaluate actions and revise plans as needed

ENP OperationsENP OperationsClient intake forms modifiedClient intake forms modified– Vulnerability informationVulnerability information– Document services to evacueesDocument services to evacuees

Disaster kits/emergency flyersDisaster kits/emergency flyers

AAA trainings of center managersAAA trainings of center managers

Safe SheltersSafe Shelters

Vendor disaster planningVendor disaster planning

Hazard analysis by company committeeHazard analysis by company committeeDisaster plan for food service unitsDisaster plan for food service units– Developed new training manualDeveloped new training manual– State training seminar for managersState training seminar for managers– Follow-up training of local staffFollow-up training of local staff

Operational changesOperational changes– Improved computer security and back-upImproved computer security and back-up– Better employee recordsBetter employee records– Alternative menu options for disastersAlternative menu options for disasters– Invested in alternative power sourcesInvested in alternative power sources

D2D delivery challengesD2D delivery challenges

Clients without power cannot utilize frozen Clients without power cannot utilize frozen meals and fresh milk; often lack watermeals and fresh milk; often lack waterClients are the “neediest of the needy” Clients are the “neediest of the needy” Vendor has weekly client contactVendor has weekly client contactCannot “make up” more than 2 days Cannot “make up” more than 2 days Deliveries documented electronically by Deliveries documented electronically by individual clientindividual clientClients may use up emergency meals Clients may use up emergency meals prematurelyprematurely

D2D disaster planD2D disaster plan

Redefined service units to includeRedefined service units to include– 7 pack shelf stable meals + 1 gallon water 7 pack shelf stable meals + 1 gallon water – 7 pack breakfast meals +NFDM + Breakfast bar7 pack breakfast meals +NFDM + Breakfast bar

Maintain 2 day supply in stateMaintain 2 day supply in state

Meals coordinator authorizes deliveryMeals coordinator authorizes delivery

Centralized documentation approvedCentralized documentation approved

Rotate stock during holiday periods Rotate stock during holiday periods

Vendor distributes disaster planning tipsVendor distributes disaster planning tips

LimitationsLimitations

Lack of menu varietyLack of menu varietyMeals are not optimal nutritionallyMeals are not optimal nutritionally– High in sodiumHigh in sodium– Low in fiberLow in fiber

Quality loss in storageQuality loss in storage– Bread items stale and crumble; Juice and NFDM Bread items stale and crumble; Juice and NFDM

change flavor and color change flavor and color – High summer heat accelerates High summer heat accelerates

Product shortages in disastersProduct shortages in disasters

Challenge: Pool buying powerChallenge: Pool buying powerImprove shelf-stable menu options Improve shelf-stable menu options

Lower sodium entreesLower sodium entrees

Bread items more nutrient dense; less sodium Bread items more nutrient dense; less sodium

Alternatives to non-fat dry milkAlternatives to non-fat dry milk

Canned fruits in lieu of cookiesCanned fruits in lieu of cookies

Common nutrient standard Common nutrient standard

Improve packagingImprove packaging

Formal storage testingFormal storage testing

Evaluate options for self-heating mealsEvaluate options for self-heating meals

ResourcesResources

FSIS/FDA Guidelines for Retail and Foodservice FSIS/FDA Guidelines for Retail and Foodservice Establishments Affected by Natural or Other Establishments Affected by Natural or Other Disaster Sept 2005Disaster Sept 2005

http://www.foodsafety.gov/~dms/retdisa2.htmlhttp://www.foodsafety.gov/~dms/retdisa2.html

Emergency Handbook for Food ManagersEmergency Handbook for Food Managers

Twin Cities Metro Advanced Practice CenterTwin Cities Metro Advanced Practice Center

www.naccho.org/EQUIPh/www.naccho.org/EQUIPh/

ResourcesResources

Are You Ready? A Guide to Citizens Are You Ready? A Guide to Citizens Preparedness FEMA H-34Preparedness FEMA H-34 http://www.fema.gov/libraryhttp://www.fema.gov/library

Administration on Aging: Emergency Administration on Aging: Emergency Assistance Guide 2006Assistance Guide 2006

http://www.aoa.gov/PRESS/preparedness/preparednesshttp://www.aoa.gov/PRESS/preparedness/preparedness.asp.asp