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Still Weathering the Storm, One Year After Sandy

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While Superstorm Sandy forced many people to relocate from destroyed homes, it also drove many others deeper into isolation inside their own homes. Natural disasters hit the vulnerable especially hard. For those who are older, ill, injured or otherwise limited in mobility, a disruptive force like a storm or power outage can further limit their ability to get out, whether prompted by fear and anxiety, disaster-related depression, lack of transportation services or an increasingly unfamiliar community.

This can lead to a downward spiral of isolation, depression and anxiety. While most people have resumed their lives one year after Sandy, some have not -- and encouraging their recovery has lessons we can learn, for ourselves or those we take care of.

Resume Pleasurable Activities
Rosalie, a 58-year-old school teacher, rode out Hurricane Sandy on the second floor of her flooding Garretson Beach home alongside her husband, who was recovering from hip replacement surgery. The two survived, but the subsequent stress of displacement, applying for home-repair aid and taking care of her husband was so great that Rosalie's hair turned stark white. While people around her were getting back to their lives, Rosalie -- a normally social person -- slept poorly and became sad and anxious.

With the help of therapists and a form of therapy that has been used successfully after 9/11 and Hurricane Katrina, Rosalie identified several pleasurable activities that the storm had washed away. She previously read poetry daily, had lunch regularly with friends, and bought herself a small treat every payday. To help her reclaim her pre-storm joy, therapists had her build these activities back into her life -- actually writing out a schedule to help her commit.

"I bought myself something!" her therapist quotes Rosalie as saying, once she committed to her schedule. "She was so excited. It's something small, but it brings joy into your life and begins to affect the way you think and live."

So if your mother's knitting was destroyed in the flooded basement, take her to buy new yarn. If your own weekly card game has been on hold since the storm, get your group to commit to a first meeting. We encourage clients to schedule six small pleasurable activities into their lives each week. These are powerful engines to help reverse that downward spiral.

Reframe Thinking
For many homebound elders who are locked in a cycle of anxiety or depression, the hardest thing to do is to change the way they think. But that is just what they need to do.

Cognitive behavioral therapy is a process that helps anxious or depressed patients change their behavior, one step at a time and in their own homes. A key tenet is to encourage patients to break the cycle of negative "automatic thoughts." After Sandy, a vulnerable 79-year-old woman, whose son-in-law braved gas shortages to pick her up, feels extreme guilt that she failed to evacuate and a family member put himself at risk to rescue her. An 80-something resident living alone near the shore fears that every dark cloud will turn into a devastating hurricane.

While it's tempting to say, "Don't worry about it," or "Stop feeling that way," it helps to draw your loved one into conversation that looks at the evidence for why they feel the way they do, then slowly transform negative thinking into positive thinking. For the 79-year-old rescued by her son-in-law, help her understand why she feels such extreme guilt. Perhaps it's because she ignored advice to evacuate. Maybe that's because Hurricane Irene did not impact the area just the year before, or because she didn't think she had anywhere to go. Continue the conversation until she realizes that her decision made sense at the time, and next time, with more information, she will make a different decision.

In the weeks and months following Sandy, one of our nurses on Long Island worked with several distressed older residents who grew anxious each time the sky threatened rain. To help them break down their worst-case-scenario thinking, she posited a series of statements and questions: Didn't it rain before the storm, with no dire consequences? ... We had plenty of warning for Hurricane Sandy, but those in the know aren't issuing warnings for this dark sky ... Let's go through our evacuation plan together, so you're comfortable with it and it's fresh in both of our minds.

The Best Defense: a Good Offense
In a post-Sandy OEM survey of residents in New York City's flood-prone Zone A, only half the respondents said they had taken "additional action to prepare for a future hurricane or other disaster."

The better prepared we are, the better we can weather the next storm -- which can bring peace of mind during this next hurricane season, especially for elders and others who need help getting around and carrying out activities of daily living.

Lilly Hill, a home health aide who stayed overnight for four days in a row to help the elders living in a congregate care building in the Rockaways during Sandy, has been working hard since the storm to ensure that she knows the evacuation plan for every resident. "We are definitely better prepared," she says. "We know that as soon as an evacuation is announced, we have to have our clients' bags packed, with phone numbers, medications, flashlights -- everything they need."

As Sandy showed, access to pharmacies and other providers can be lost in a devastating storm, so keeping good records and knowing your options are a must. An evacuation plan is only as good as the transportation you can secure during an emergency, so make sure you know your options and plan ahead.

Looking forward is the best way to face the future.

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