Anxieties about tsunamis: The vulnerability of elderly people in Mt Maunganui, New Zealand

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We have a global problem with more people than ever before living at risk to natural hazardsThe Global Platform for Disaster Risk Reduction 2009 called for a 50% reduction in disaster related deaths by 2015 Since then there has been more significant loss of life from the Japanese tsunami in 2011.

Studies have shown that elderly people suffer more than the general populace from natural hazard events both in the event itself and the aftermath

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For instance, stats

This suggests we need to have a greater focus on the vulnerability of older people to potential natural hazards.

Wang and Yarnal (2012) call for vulnerability reduction policies that are place-based and well-designed for the increasing elderly populationThey suggest that development of rest homes should not be located in high risk areas –

Source: Klein et al. (2007). Mass medical evacuation: Hurricane Katrina and nursing experiences at the New Orleans Airport. Disaster Management and Response, 5(2), 56-61.

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I wanted to know whether Wang and Yarnal’s idea would work in a New Zealand context. I chose Mt Maunganui as this is a magnet for older people wanting to enjoy your retirement. To examine whether rest homes should be built out of at risk zones firstly I needed to ascertain whether there was a problem.

The case study was in two parts – the first requirement was to examine whether there is a problem in the first place by researching the overall place vulnerability. This involved researching the likelihood of an event occurring, examining the vulnerability of the location if an event did occur, such as assessing the topography, layout, and access routes, (this could include building strengths, building height, density of buildings – however I did not have the time to cover these aspects)

Looking at what mitigation or reduction measures currently exist, and

Examing social conditions – here again I was not able to cover this area as fully as I would have liked.

Once at identified that there was a problem I moved onto answering the question:

Would building rest homes and retirement villages out of at risk areas improve community resilience and enable faster recovery and if So, would that be feasible?

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Several key concepts underpin this research.

Sustainability combined with resilience is a theoretical standpoint that has been adopted by the hazard planning community over the last couple of decades (Tobin, 1999).

Saunders states that “A sustainable community is a resilient one; it … seeks to understand and live with the physical and environmental forces present at its location. … Creating sustainable communities means creating places that are far less vulnerable to natural forces and events, and more resilient to these events (Saunders, n.d., p. 1)”.

Resilience within hazard planning incorporates the ability for a community to cope with change, recover from the impact of an event and to see new possibilities in their new circumstances (Saunders, n.d.; Smith & Petley, 2009).

Reducing vulnerability to natural hazard events requires a different approach than hard engineering solutions or emergency preparedness. There is a need to analyse the reasons for vulnerability in the community (Wisner, et al., 2004).

As there is no consensus in literature for the parameters for social vulnerability research (Cutter, et al., 2003) this report uses the model of overall place vulnerability.

‘Vulnerability’ is a contested concept but generally means, the underlying susceptibility to be harmed whether it is a place, community, building or people group (Adger, 2006; Cutter, et al., 2003; Hufschmidt, 2011; Wisner, et al., 2004; Yoon, 2012).

Within any community there are vulnerable sub groups Yoon Describes these people as those that suffer a “disproportionate share of the effects of hazardous events (Yoon, 2012, p. 824).”

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Two key articles spelled out the issues that elderly people face during and after a significant hazard event.

Ngo notes that “Mobility problems and lack of physical strength present a significant disadvantage to elderly people in seeking refuge or relief during or after an event (Ngo, 2012)

And that In the aftermath of a disaster elderly people require a higher level of medical and dietary care. These unique needs are “rarely taken into account (Ngo, 2012, p. 449)”

Wang and Yarnal studied the aftermath of the disasters in Japan and they saw that elderly people suffered hypothermia, dehydration, and respiratory diseases (Wang & Yarnal, 2012).

Ngo further notes that “Elderly people suffer physically, psychologically, socially and economically. They have such issues as fixed incomes, physical ageing, inability to work to recover from financial loss, social marginisation and discrimination which are severely worsened by disaster (Ngo, 2012).

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I used a mixed method approach

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Firstly, I needed to ascertain whether anxieties about tsunamis were founded in reality. What I found was that Tsunamis are a significant threat to New Zealand coast lines (Berryman, 2005). The cost of tsunamis in terms of damage and loss of life is estimated to be twice as much as with earthquakes of a similar return period (Berryman, 2005).

This slide shows where regional and local potential tsunamis could originate from. Sources from 1 and 4 are of most concern. 1A and 1B Have the potential to produce subduction interface earthquakes where one plate plunges below another. This is the most likely candidate for producing a tsunami the size of the 2004 Boxing Day and 2011 Japanese tsunamis. Number 4 is undersea volcanismfrom the Tonga-Kermadecsystem.

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Historical data combined with Sediment deposits For the last 4000 years have identified that a tsunami with a run-up of over 5 m occurs, on average, every 600 to 800 years in the Bay of Plenty, with the last such event occurring in The 1400s. In other words we are due for another one. Any tsunami over 1 m is considered dangerous.

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Studies have shown that locations that are particularly vulnerable are those with extensive development close to beaches, lowered dunes, lack of high ground, and seawalls that worsen tsunami run-up. In other words welcome to Mt Maunganui. In addition there is limited escape routes, no vertical evacuation structures. The open coast between Mt Maunganui and Maketu has been identified as having particularly high vulnerability to inland penetration.

It is likely that a devastating tsunami will be preceded by an earthquake that would have an effect on the infrastructure of Mt Maunganui (Prasetya, et al., 2008).

Mt Maunganui and Papamoa are considered to have high susceptibility to liquefaction (GNS Science, 1999) which could affect the ability of buildings to withstand an oncoming tsunami (Prasetya, et al., 2008).

The electricity supply could also be disrupted affecting vertical evacuation (Civil Defence Participant, 2012).

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So what could happen if a significant tsunami was triggered by the Hikurangisubduction zone? Civil defence has estimated that the wave would reach Mt Maunganui and 50 minutes. Unfortunately it takes 1.5 hours to activate civil defence, three hours to pick and facilitating traffic control, 6 hours to evacuate Mt Maunganuiby car -

Orange -- 4 m high tsunami with an expected run-up of up to 8 m

Yellow - 6.75 m tsunami with up to 13.5 m run up

You can see from the map how vulnerable the escape routes are and how difficult it would be for people to reach the only high ground which is the Mount itself.

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Added to this as a social conditions of Mt Maunganui.

Some communities have a higher back ground level of vulnerability risk than others (Bankoff, 2012).

Community vulnerability increases as the proportion of older people increases.

the proportion of the 65+ population in the Bay of Plenty has increased over the last 3 census and at a greater rate than the average for the rest of NZ. The 65+ population is projected to rise above 25% by the year 2031.

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This figure shows the proportion of older people who live in various census area units down the coastline. The proportion of people aged 65+ in the communities along the Bay of Plenty coastline that are within the 4 m tsunami wave civil defence evacuation zone is 2 – 20% more than the national average of 12% based on the 2006 Census.

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Elderly people in the Bay of Plenty are not homogenous. There is a wide range of ability and need. The ministry of health states that “As people age there is a greater likelihood of having a disability and needing assistance (Ministry of Health, 2002)”.

As people age there is a greater likelihood of having a disability and needing assistance (Ministry of Health, 2002).

Mobility problems and lack of physical strength present a significant disadvantage to elderly people in seeking refuge or relief during or after an event (Ngo, 2012).

In rest homes most people have severe levels of disability.

Even in the community or retirement villages, almost 50% of those over 75 has moderate to severe disabilities which would significantly impact on their ability to evacuate or deal with the aftermath of the tsunami.

The slide shows just how difficult it would be to evacuate people in rest homes In a short space of time where most people have severe levels of disability. Even in the community, almost 50% of those over 75 has moderate to severe disabilities which would significantly impact on their ability to evacuate or deal with the aftermath of the tsunami.

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There are three rest homes in Mt Maunganui with a total of 183 rest home beds and two retirement villages with a total of 307 dwelling units.

Based on the above disability statistics a considerable amount of fully able-bodied people will need to be available to evacuate the rest home residents and at least 50% of the people who are over 75 in the 307 dwelling units are likely to need able-bodied help to evacuate.

The task is enormous even without considering low mobility elderly people in the community.

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Elderly people for the most part can’t run and for many even climbing stairs is a struggle even if there were evacuation structures.

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As this was a mixed method approach the qualitative interviewing added depth to understanding the issues that older people and emergency personnel face in a disaster and then I moved onto the practicalities of building rest homes or retirement villages out of at risk areas.

The rest homes and retirement villages were chosen due to their location within hazard zones. During the research I chose to extend the analysis from rest homes to include retirement villages and elderly in the community to make a statement of comparative levels of risk for these three groups to better understand vulnerability.

I interviewed: Retirement Village Manager + Civil Defence Coordinator Two Rest Homes Managers + Nurse Manager District and Regional Councils Planners Civil Defence Emergency Officers District Health Board Emergency Officer

Participants were recruited through Purposive sampling, snowball sampling and direct approach.

Thematic analysis has been used to analyse the interviews

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I used semi-structured interview schedules to enable flexibility of discussion. They covered these topics – however I found that the rest home managers needed to be asked some of the questions that I had only listed for the emergency managers and planners. I asked appropriate questions from my other schedule for rest home managers and retirement village managers. I found that they had better insight into some of the feasibility questions that I had not anticipated.

The interviewees were very willing but some had a more reticent manner. Several interviews ran overtime. Some people liked to think about these issues from many different angles. I found in 3 cases it was harder to extract information from people –these people had very succinct ways of communicating - a retirement village manager, rest home manager and a emergency officer. I asked questions from several different angles and used questions from other schedules to unearth more information. One officer appeared very tired and it was 4pm on a Friday afternoon when I interviewed her which I think influenced how she responded. So in future I may not choose Friday afternoons for interviewing.

I also found that some people gave me wonderful sound bites while others ran all their sentences together which was much harder to transcribe and find quotes. One interviewee was very verbose and liked to ask rhetorical questions instead of clearly answering mine.

As ideas came up in interviews that I hadn’t thought of I added them to later

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interviews.

The planning side of the schedules I will leave for this presentation.

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Interviews with elderly care personnel and emergency practitioners highlighted the extreme difficulties of evacuating low mobile and fragile elderly people.

Rest Home Managers were concerned with losing staff seeking to rescue their own families and how the timing of a tsunami would affect the availability of staff.

Shifting large numbers of elderly patients who have little or no mobility off the premises in a short timeframe is almost unachievable even when there is adequate staff.

There are issues of not enough staff, staff running off to save their own families, trying to get elderly up to second or third floors if the power is out, not having big enough vehicles to get all of them off the property.

in the retirement village that participated, the elderly gentleman who acts as emergency convener estimated that 60% of residents need walkers or assistance, and 80% need a toilet every 2 hours.

There are no plans for evacuation due to the decision that if there was an event of a large enough magnitude to cause evacuation, then evacuation was considered pointless. His advice to his fellow villagers was to sit in their cars in their shut garages and hope for the best as the roads would be too congested if they did try and leave.

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One Rest Home Manager was also concerned about the on-going needs of infirm elderly people if they did manage to get evacuate.

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One of the key themes that emerged through interviews was fatalism. Successful evacuation is worsened by this attitude. In Japan volunteer fire department personnel went to elderly people’s homes to persuade them to leave. Some elderly people survived due to the volunteers, however some of the volunteers lost their lives in subsequent waves trying to rescue others (Fraser, et al., 2012)

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Another key theme that emerged is triage. The term ‘triage’ is derived from the french word “to sort” (Kennedy, 1996). Triage looks at “doing the greatest good for the greatest number of people using the available resources (Kennedy, 1996, p140)”.I have adopted this word to discuss evacuation priorities. Who gets rescued first? In hindsight a better term would simply have been to call this evacuation priorities.

From the people I spoke to there was a suggestion that priorities would not focused on older people. First quote

Responsibility for rescuing elderly people over and above the lives of younger staff is a difficult choice. Second quote.

The reality of the situation is that elderly people can’t move fast and therefore the options for self evacuation and evacuation by able bodied people is reduced – Third quote.

Putting resources into rescuing people who don’t want to be rescued lessens community resilience to an event such as was experienced in Japan. It raises questions of - should they be there at all?

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An unexpected theme that has massive ethical issues was euthanasia. A rest home manager brought up this theme – first quote

Although an elderly participant had previously expressed fatalism he also expressed the desire to firmly hold on to life. – second quote

The most controversial comment that was expressed came from a council participant. According to this participant, planning for elderly people must include a discussion on whether the community accepts or not that elderly people are at the bottom of the rescue list and are likely to die. – third quote

This raises a lot of difficult ethical questions. Should we just accept the inevitable? How do we balance human rights with reducing vulnerability? The truth is that the outcome for elderly people with limited mobility is that in a significant tsunami event they would add to the fatality rate.

Community resilience to tsunami events would be improved by reducing the need for people to make difficult decisions about who to rescue, especially when some elderly people resist being rescued. This theme also interlinked with perceptions of risk.

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Although not all elderly people are equally vulnerable many elderly people in Mt Maunganui are at considerable risk as they have limited ability to take refuge in the timescales required without assistance.

The consequence of a large tsunami on elderly people would be significant.

The death rate in Mt Maunganui in a similar event size to what occurred in Japan in 2011 may be higher than in Japan for several reasons:

• There are no evacuation structures• For the most part people ignore warnings in New Zealand• There is very little training about what to do in a tsunami compared to Japan• Japan has signed escape routes, we do not• Japan has a history of tsunamis so the people are more aware of them• In New Zealand we are complacent about tsunamis because most of the severe

ones occurred before living memory and development of the coastline

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So what can we do about the vulnerability of elderly people in Mt Mauganui?

Addressing both vulnerability of the built environment and social vulnerability is essential in urban and regional planning to adequately reduce risk (Johnson, 2012) and this would ultimately improve a community’s resilience to a hazard event and its ability to recover.

two main approaches to addressing vulnerability in the built environment; location and design.

The location approach uses land use planning and zoning to “limit the amount of occupation, use and development in areas that are deemed to be at risk of hazards (Johnson, 2012, p. 644)”.

The design approach uses design and building codes to alter building and infrastructure to reduce risk (Johnson, 2012), Such as requiring rest homes to be built with several levels to allow for vertical evacuation

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Perceptions of risk is a key theme that emerged in relation to the feasibility of building rest homes and/or retirement villages in out of risk areas:

• Few people consider hazards when they decide on their desired living location (Bay of Plenty Regional Council, 2012) – first quote

• People don’t like ambiguity – leads to denial that a risk exists especially for high impact/low probability risks (Chapman, 1999) – second quote

• Concepts of acceptable risk, are not universal, can change over time (Wisner, et al., 2012), change with age. This impacts on how people view attempts to reduce risk that might affect their current lifestyle choices (Johnson, 2012) – third quote

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These perceptions and attitudes affect where we live, how we live in those locations and the combined risk in housing developments.

An elderly person may accept a higher risk level as they have few years to live but what about a young person in the same location? A development built on a higher individual risk level will mask the risk in that location as people moving into the area will assume that it is safe to live there.

Even for those people who knowingly accept the risk in that location, when a disaster strikes they still expect the authorities to save them according to the Civil Defence Officer I spoke to.

Individual risk has therefore been elevated at the cost of community resilience.

Current housing planning is only now starting to identify risk levels in developments.

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There are other feasibility issues as wellSocial spatial issues: Rest homes and retirement villages are located to fulfill a demand, Enable family to visit,Transport, Couples – one in the home, one out

Then there is the issue of human rights -

Political challenges And economic practicalities:

It is not a simple problem to fix.

Many forces, power cycles and pressures combine to create and strengthen hazard risk, such as national scale legislation and politics, international to local business interests, macro and micro scale social structures over space and time and finally topography, ecology and climate (Wisner, et al., 2012).

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There was consensus amongst participants on the fact that restricting rest homes and retirement villages from being built in hazard risk zones would improve community resilience and enable faster recovery, however when it came down to considering achieving this in relation to retirement villages

Most participants opposed restricting retirement villages.

There was far less opposition in relation to rest homes being built or shifted to lower risk locations.

Participants who deal with emergencies as part of their job description advocated strongly for reducing risk, while participants in more political roles tended towards caution against planning changes. Rest Home Managers for the most part were overwhelmed with the difficulties they face with evacuation and struggled to see how the situation could be improved.

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So yes, community resilience and recovery would be improved by moving elderly people and rest homes and retirement villages out of at risk zones

However,

A comparative risk analysis I developed (that I haven’t been able to show) made it clear that elderly people of limited or no mobility in the community are just as at risk as those in rest homes, and as such, restricting rest homes would have a minimal impact on overall place vulnerability.

This study certainly brought to light some ethical issues I was not aware of before the study. At the start of this study I was purely thinking about vulnerability in a clinical way. The interviews widened my view and showed me that it is important to study the people – the pressures, perceptions, the reasons for things being the way they are so that we have a better idea of the problems for changing the status quo.

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This study has raised a number of questions that need to be addressed in relation to encouraging low mobility elderly people to live in their homes for longer in terms of their location, vulnerability and risk to natural hazard events.

Government policy encouraging care of elderly people in their own homes shifts vulnerability from rest homes to the surrounding community where it has less likelihood of being managed appropriately.

This study has highlighted the need for social vulnerability research of elderly people in the community in particular, their preparedness and attitudes so that we can understand and appropriately manage disaster situations and reduce the suffering of elderly people.

To adequately address vulnerability of elderly people to disaster, proactive strategies such as disaster preparedness, response, recover and mitigation need to be adopted (Ngo, 2012) not only for rest homes but for the wider community.

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I will leave you with these quotes:

You have seen the problem – now what are we going to do about it?

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