Episode 16 – Disaster Response and Older Adults with Dr. Allison Gibson and Dr. Nancy Kusmaul

In this episode, Dr. Jones talks with researchers and teachers Dr. Allison Gibson and Dr. Nancy Kusmaul about responding to disaster relief as social workers and the specific concerns of aging populations within those situations.

Bios from Allison Gibson and Nancy Kusmau:

Dr. Allison Gibson is an Assistant Professor in the University of Kentucky’s College of Social Work. Dr. Gibson’s clinical and research focus is grounded in the biopsychological perspective for aging. This holistic perspective is especially applicable to individuals and families affected by issues of crisis. Within this context, Dr. Gibson has advanced knowledge and translated empirical findings into interventions to support families confronting crises and challenging life events. Her research frequently examines individuals’ social support, health promotion, and health outcomes. This work has also resulted in the creation of interventions to support individuals following a diagnosis of a terminal illness (i.e., Alzheimer’s disease, mild cognitive impairment). The biopsychosocial needs of the family as well as the individual are essential to consider when studying individuals as they approach end-of-life. Dr. Gibson has also explored crisis and transition in the context of disaster: considering the needs of older persons before, during and after an event. Dr. Gibson is passionate about geriatric social work education and is a long time member of the Association for Gerontology Education in Social Work (AGESW). She currently serves as the co-convener of the Gerontological Society of America’s special interest group on Disasters and Older Adults. Previously she was an Albert Schweitzer Fellow (2012) and AmeriCorps member (2009). Dr. Gibson teaches coursework on poverty/inequality, clinical practice, and research methods.

Nancy Kusmaul, Ph.D, MSW is an Assistant Professor at the University of Maryland, Baltimore County, at the BSW Program of the University of Maryland School of Social Work. She practiced social work in nursing homes, hospitals, home care, and adult day care. Her research focuses on long-term care services and supports, organizational culture, such as nursing home culture change and trauma-informed care. She has recently done some work on older adults and disasters. She is concerned with the experiences of direct care workers and care recipients. She is a member of the Baltimore County Elder Abuse Coalition and the Maryland Nursing Home Culture Change Coalition. She can be found on Twitter @nancy_kusmaul

Nancy Kusmaul, PhD, MSW
Assistant Professor
University of Maryland Baltimore County

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TRANSCRIPT
Transcripts are created using a combination of speech recognition software and human transcription and may contain errors. Please check the full audio podcast in context before quoting in print.

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Blake: [00:00:02] Hello and welcome to the Social Work Conversations podcast produced by the University of Kentucky College of Social Work. My name is Blake Jones. Here we explore the intersection of social work research practice and education. Our goal is to showcase the amazing people associated with our college and to give our listeners practical tools that they can use to change the world.

Blake: [00:00:25] I’m joined today by Dr. Allison Gibson who’s an assistant professor here at the University of Kentucky and our College of Social Work. And Dr. Nancy Kusmaul from the University of Maryland, Baltimore County. Welcome to you both.

Allison / Nancy: [00:00:38] Thank you.

Blake: [00:00:39] Thanks for joining us. Nancy you are Skyping in into us. We’re trying out this technology so we appreciate you taking the time to to come on to our screen and talk with us a little bit.

Nancy: [00:00:51] Thank you for having me.

Blake: [00:00:52] Sure. So, Nancy, I wonder if I could ask you to kind of introduce yourself to our audience if you were standing up at a conference somewhere. What did you say that you do in your life.

Nancy: [00:01:06] So I’m an assistant professor in social work at UBC so I teach in the bachelor program and social work and I teach mostly in the policy and the human behavior sequence and my research interests are around direct care workers who care for older adults in a variety of settings. I was a nursing home social worker or almost a decade before I came into academia. And the important work that nursing assistants in that setting the home care workers do is an invaluable and fairly invisible piece of the puzzle. And so my work is about understanding organizational culture and the way that shapes the work that direct care workers do.

Blake: [00:01:54] How about you, Allison?

Allison: [00:01:56] So I am a new assistant professor this year with the College of Social Work here at UK. Prior to this I taught for a little bit down in Rock Hill South Carolina at a school called Winthrop University. I tell folks that kind of my primary area is crisis and I had a look at that specifically with an older adults and so I’m thinking about how crisis and transitions affects different populations and particularly has the impact to kind of make them more vulnerable and I choose to look at that primarily from a biopsychosocial lens. So I do some work with Alzheimer’s. I’ve done some work related to end of life issues but I’m especially passionate about disaster work. I’ve a been the co-convener for the disaster – an older adult special interest group through the Gerontological Society of America. This is my third and final year as I’ll be stepping down from that role this year – a clinical social worker I’ve taught undergrad and graduate. While I’ve been here at UK but I seem to especially teach more of the clinical practice in the classes around poverty and inequality.

Blake: [00:02:59] So I know that the two of you are your friendship and your work together go back a few years together. Allison tell us a little bit about how you and Nancy got together.

Allison: [00:03:12] Sure. So Nancy and I were both part of a doctoral education training program early along in our doctoral education programs and we were both part of the age social work which is the Association for Gerontology education in social work program. Nancy was actually in the initial cohort of the pre-dissertation program and I was in the second year. And so we had some colleagues that kind of overlapped. And I believe it was like a social reception. We initially met and then every year when we go back for this conference GSA the Gerontological Society of America we kind of run into each other and keep having these conversations of where we kind of have some overlap. We have some interest and trauma. We have some interests kind of issues around disaster and so it’s kind of bonded into these these projects that we’re now trying to work together on to kind of help older adults when they’re affected by disaster.

Blake: [00:04:09] Nancy, I wonder if you could tell us a little bit about what got you interested in disaster work. What drew you to this field.

Nancy: [00:04:17] So the long version of that story is that before I went back to my Ph.D. I was a nursing home social worker for the better part of a decade. And so my work has mainly been in long term care direct care workers. And over the course of the past few years watching the news and seeing the reports of older adults in long term care facilities having challenges in disaster situations and talking to Allison about those issues as we’ve gotten together at our conferences has just really piqued my interest in older adults in disasters older adults in institutional settings during disasters and that whole piece.

Blake: [00:04:58] How about you, Allison?

Allison: [00:04:59] My story is a little bit different. Actually felt very inspired to get up and do something. After Hurricane Katrina I’m sure for most of us that are in kind of this generation that was kind of the first major disaster that caught my attention. And so after that event happened I got into counseling folks so I was a mental health professional and I would see some of these folks that would come back from responding from disasters that were volunteers and they would tell these stories about things that they saw, how folks were affected and it just kept getting me more and more interested. And so I ended up becoming a Red Cross volunteer. And so for a long time my research really didn’t have anything to do with disasters. But then when I took my first academic position down in South Carolina we had quite a few disasters happen in that very short period of time that I was there and so it kind of happened that my research interest kind of bridged into that because that was what the community needed at that time. So I felt like in order to kind of help my local community I needed to be doing that type of work and figuring out what we can do better for these folks.

Blake: [00:06:05] So are you saying that you were a social worker who was into advocacy?

Allison: [00:06:09] Yeah I guess I guess you can say that yeah.

Blake: [00:06:11] Yeah that’s great. You know I still remember Katrina well…

Allison: [00:06:15] …horrific…

Blake: [00:06:16] …and I was at a conference years ago in New Orleans and it still is just heartbreaking really. What happened there.

Allison: [00:06:25] It really is. And there’s still so much that we even in disaster research world we go back to that event to really talk about. I mean it was substantial – for our country as well as especially for that older adult population.

Blake: [00:06:39] Yeah. So Nancy your and Allison’s focus is on older adults in these kinds of situations. And so I wonder you know what makes them special population. Why is it so important to do research with them and figure out how these kinds of events impact them specifically?

Nancy: [00:07:00] Well I think older adults are considered a special population in disasters because they have more adverse outcomes. They are more likely to die they’re more likely to have long term impacts to their lives communities homes any number of things in disaster. And we see this over and over again in all different kinds of disaster situations even when you think about something like evacuation and shelter. They have additional layers of things that they need to deal with such as you know medications, access to medications, durable medical equipment, electricity to keep oxygen tanks running. Things like that. And access to services if they were to evacuate they’re dependent on home health care or family members as caregivers. It just adds these extra layers to preparedness and response that the average person doesn’t have to deal with.

Blake: [00:08:08] I wonder if either of you could think of of a personal story maybe that that really affected you when you were doing your research about an older adult who was in this kind of situation.

Allison: [00:08:24] Sure I can start with that – when I was working with folks down in South Carolina after the historic thousand year flood back in 2015. I was doing some research where I was collecting narratives about the experience of folks who had been affected by the disaster that were caregiving for somebody with Alzheimer’s disease specifically so that that added component of having that memory loss and being kind of responsible for that person and then making decisions about evacuation and whatnot. And one of the stories that I heard about when I went out and interviewed someone it was a neighbor that was providing care for this elderly couple just in the sense of they were kind of checking in on them and seeing you know how were they doing. And the neighbor reported that when the flooding started to you know rise into the home they went over to kind of check and make sure and they found this elderly couple just sitting in their rocking chairs watching the water fill up in their home like they had and they weren’t sure what to do. They weren’t panicked but they were just kind of sitting there waiting and watching and so him feeling like Oh my gosh if I hadn’t come over here like what would have happened because I I’m pretty sure they would just continue to sit there. And so feeling you know that that added that added pressure of needing to be responsible for them and so there are so many folks in our communities that live by themselves or are reliant on kind of those nontraditional caregivers whether it be a neighbor or somebody that checks in on them that knows them from the bingo hall or whatever it may be you know for social workers that social isolation piece. That narrative really terrified me when I think about all the impending disasters even that we’ve had this past year about how many folks just kind of get left behind in that way. So you know what can we as a community and as social workers do to be kind of responding to that.

Blake: [00:10:14] I wonder if there’s a differentiation between types of disasters so you know we’ve had the the Hurricanes in Puerto Rico and elsewhere there are tornadoes there are floods…are you finding different types of responses to different types of traumatic events?

Nancy: [00:10:35] I think that some of it is difference in kind of preparedness end – that how much warning you have to do something about it before it happens vs.. boom, it happens – it’s here and we’re responding and we’re rescuing and we’re doing some of those other things well we’re looking at the research on older adults are looking at – we’re finding that older adults in general maybe have done less of that individual level preparedness. So it’s something that there hasn’t been time for community wide. You know the hurricanes coming bearing down on the coast in three or four days there’s less support or you know they’re less prepared or less ready when something hits. And maybe other folks.

Blake: [00:11:28] Yeah I wonder for you Allison does that. What do you see in terms of the types of events that you have responded to?

Allison: [00:11:38] so having now lived in kind of three different communities and doing disaster response both in Ohio, South Carolina, and now here in Kentucky. I think there’s big geographical differences because obviously you were anticipating kind of different disastrous events here in Kentucky we’re obviously more concerned with flooding whereas maybe South Carolina might be more concerned with hurricanes. And you know Ohio tornadoes and flooding seem to be kind of the main threats and that sense so – but fires is something that’s pretty well shared across and fire is actually seems to be the thing that affects most most of all. But in terms of differences I think you know outcomes are going to be different based on the type of disaster the needs are going to be different based on the impact that’s happened. You know it makes a big difference if somebody is able to return home those versus being displaced and having to relocate for a substantial period of time which I think Nancy already kind of alluded to a little earlier. But in terms of you know in terms of overall health outcomes we’re just starting to really look at what are those long term outcomes and how do they really kind of affect folks in long term. And that’s an interesting thing to think about and study when we’re talking about older adults in that whole longitudinal aspect. But it’s especially we see the biggest difference when we talk about those long term care settings. So making those decisions on whether or not you should evacuate somebody or relocate them can have really substantial health consequences for someone you know if they are really chronic care need and we end up moving them for fear of hurricane I mean that in and of itself can you know end someone’s life a little more prematurely. So I think that it’s difficult to kind of compare those situations kind of against one another. But in terms of outcomes you know there can be a lot of negative outcomes across the board if that makes sense.

Blake: [00:13:27] Sure absolutely.

Nancy: [00:13:29] And I think Allison raises some important points about the geographic differences especially when I’m thinking about my long term care population. You know I’m worried when I was a nursing home social worker I was working in western New York. The worst kinds of disasters we generally got. There was a snowstorm that lasted a couple of days. It made it harder for workers to get to work. And maybe people would be at work for extended periods because it snowed. It’s not the same as you know a hurricane is bearing down on our community. And if I go to work I’ve left my children or my family at home potentially in danger because I had to come to work to care for these older adults. And so things like staffing needs and things like. Who is there on the ground to respond to those kinds of things. Very different.

Blake: [00:14:21] I wonder if you all could talk about the specific needs that social workers need to address in these kinds of situations. You know we have a lot of social workers that listen to this podcast obviously and so if they’re interested in this kind of work what would you say to them what advice would you give to them, Allison?

Allison: [00:14:43] I think probably the biggest thing and this is something I know Nancy and I as well as some of our other colleagues in the gerontology realm have talked about is that social workers are largely responsible for the disaster recovery. I know that shocked me when I first kind of heard some of the statistics. I was at a conference two weeks ago where there was a speaker April Naturel who spoke and said that over 50 percent of those responding in a disaster situation are social workers. And that shocked me because as an educator when I think about the academic side of that you know I don’t see disaster preparedness or even like a lot of disaster content embedded within our curriculum. I even took I think a crisis management class when I was a MSW student and we didn’t talk about disasters at all. It was a great class and I learned a ton from it. But at no point did we talk about the role social workers have in disasters and so I kind of had this misconception and almost feeling like we didn’t really belong there. And so when I got into Red Cross volunteering and I started seeing all of these social workers and responding especially within the mental health side of it – like psychological first aid it just really surprised me. I think a lot of times most folks that are in the social work role tend to get involved because there’s been a major disaster and they just feel the need to they get out there. They want to if they’re independently license they may be able to travel to another state to be able to provide that direct service to folks in that immediate need. But it’s most of the time you know we don’t hear about a lot of job opportunities or things that would be specific to social work in that way. So it’s an interesting kind of thing that here’s what this statistics is telling us. But then where is that within our curriculum – where is that in terms of kind of the jobs and the work that’s available. I bet Nancy has something to add to that.

Nancy: [00:16:31] I do because I think that a lot of times social workers find themselves responding in disasters almost accidentally that they work at it in a health care setting. That’s now dealing with injuries related to a disaster or something like that where people can’t get in or out because of the disaster or they’re working at the county social services agency or some other place where now they have all of these people who have had some effect the disaster that they are dealing with. And. And so maybe they don’t feel quite so prepared to deal with it but because of their roles. This is what they need to do.

Blake: [00:17:10] Yeah. You mentioned the term “psychological first aid” I’ve heard that term before I can’t say that I know what that is exactly what is that?

Allison: [00:17:17] So it’s kind of a method to essentially kind of screen folks to determine how High-Risk need they are in terms of some kind of disaster mental health response. It’s something that we use primarily kind of immediately following a disaster to be able to kind of gauge you know who is somebody that really needs assistance right now versus somebody who you know they’ve been disrupted but they’re doing OK really to be able to kind of pull up those folks that are maybe more high risk for some long term consequences and that mental health spectrum. So that is probably the primary method for screening folks immediately following a disaster for that emotional well-being.

Blake: [00:18:00] Interesting. Nancy I wonder if you could talk a little bit about disasters impacts on communities. It seems like that’s a part of a focus of your work. What is the impact on communities and how can social workers be a part of helping that?

Nancy: [00:18:18] Well I think I want to back up just a little bit and think about disasters and communities in terms of preparedness and response. And then longer term kind of recovery and I think social workers have important places in all of those. I mean when we think about our social training and looking at a whole person the person and the environment and community organizing and bringing together disparate groups of people all of those are critical skills when it comes to disaster planning and disaster response. And I think that social workers have roles in each of those places to do that in the coming relief. One of the defining features of a disaster is that it somehow changes the relationship of the person to their environment because something in the environment has changed. And so there’s there are things like you know physical damage to community injuries, death, separation bringing reuniting people who’ve been separated by this disaster separated from each other separated from homes, resources, and other things and and then kind of that long term recovery of a community. And what that looks like during in the home a lot of times what the research says we see is that in the immediate aftermath of the community of a disaster our community might come together in unity and strength and then further down the road maybe there’s a little bit more finger pointing and who who is at fault and who didn’t do what. And social workers can certainly help communities get through those challenging times as well.

Blake: [00:20:06] Have you looked up the concept of resilience in your work?

Allison: [00:20:10] You know I haven’t personally in the sense of really kind of measuring that on a whole but something I have looked at is older volunteers that respond to disaster so folks that are over the age of 60 that are in the disaster recovery assistance. So like Red Cross volunteers Good Samaritan volunteers those folks and we have generally found them to be kind of better prepared to do that. That type of work because of resilience. So they tend to have lower secondary traumatic stress scores. They tend to be able to kind of cope with some of the trauma. And I think that’s just because of life experience no life experience like it when you get to that age in your life you’ve been through a lot and you have a lot of examples to be able to draw on and help kind of support you in some of those challenging situations. So I think that that’s more where I have explored research at least our resilience at least in my work.

Blake: [00:21:08] You know I’m thinking of a guy that I know who is a retired engineer and he’s probably in his 70s. And at you know every disaster that happens he’s a Red Cross volunteer and he you know loads up his truck and I mean he just he really gives of himself and he’s able he’s really organized. You know as an engineer and he goes to these places and spend – he’ll spend weeks there you know he’s retired. And I just really have so much respect for him I think you know he’s an example of what you’re talking about someone using their skills to really help out. Right.

Allison: [00:21:51] And when you mention like they have benefits of them being retired a lot of the folks that do this type of volunteer work are folks that are you know have these professional backgrounds that are really well suited. And we see a lot of nurses we see a lot of social workers. We see a lot of folks with engineering backgrounds or communication backgrounds and in that type of situation there’s so much opportunity in that way to really hone in and utilize those skills. That’s like my dream Blake like that’s what I want to do when I’m retired..

Blake: [00:22:17]

Allison: [00:22:18] …is kind of go around and kind of help respond to all of these disasters when that season of the year hits.

Blake: [00:22:24] I can totally see that that’s going to be a while for you.

Allison: [00:22:26] I know I got a little but it’s time for us to work but that’s OK.

Blake: [00:22:31] So kind of looking ahead, Nancy, the future areas of research what do you what do you kind of dream about in this work that you’re doing. What do you see ahead for you and Allison?

Nancy: [00:22:46] We have all different ideas and all I think all different pieces that we want to work on. I mean personally I’m very interested in the motivations of workers who come or don’t come to work during a disaster situation that piece of what compel people to continue to help them work with older adults. People with disabilities in need during disaster situations when their own family’s health is threatened because of the situation.

Blake: [00:23:19] How about you, Allison?

Nancy: [00:23:20] I kind of have two areas that I’m really interested in exploring. The first is with I’ve been doing a lot of work with Dr. Natalie Pope here on the age friendly Lexington initiative. And so I’m really interested with these age friendly communities how disaster planning could be better incorporated into that plan. So the cities are already doing all of these initiatives to try to make communities kind of a better place for the older adult population. So it just seems very natural to me that we would use that as a platform to also consider disaster preparedness and kind of helping think about like if something happened here in Lexington how would we respond to that. So I’m looking at exploring that a little bit further over the next few years. But the other thing that I’m really interested in is this notion of financial stress and how it impacts folks in disaster. So particularly with older adults since they kind of have that shortened time you know they’re either retired or they’re really close to retirement their ability to kind of make up kind of lost income lost savings post disaster is really shortened. They’re kind of on that time limited horizon. And so when they are affected by disaster I think that they’re starting to have some data come out that says that they are more disproportionately kind of disadvantaged than that of someone of another age and they’re starting to see a relationship between financial stress and kind of poorer negative mental health outcomes. So folks that kind of experience really just stressed financial situations that are older they tend to have higher incidences of PTSD. And so that relationship hasn’t been really kind of proven. There’s just been some evidence kind of suggesting that outcome may have a relationship there. And so I’d really like to do some longitudinal analysis looking at folks who have been affected by some of these major disasters and really see was financial stress a contributor for their PTSD. And if that’s the case can we as social workers maybe be doing some advocacy to recognize that maybe older adults need a little bit more support following a disaster because of this financial situation. You know our folks that are more financially challenged are they experiencing things differently than some of their other counterparts. I mean that’s important and we need to be aware of that and thinking about how we best allocate support and resources post disaster. So I don’t know where that will take me but that’s something that I’ve been very interested in working with Jessica Walsh and Lisa Brown out of Palo Alto University and they have that shared interest as well. So at some point we’re going to really delve into that and look at that.

Blake: [00:25:58] Yeah, good. Well I feel like I would be remiss if I didn’t ask you both the “self-care question.” I tend to ask that on this podcast and with you especially you know early on in my career as a social worker volunteered on Community Crisis Response Group and we went and worked some floods in Falmouth Kentucky and eastern Kentucky and I just still remember how traumatic that was for me to go and see literally you know houses out in the middle of the road from the flood and just the families in the you know I think they put us in a church or something and they were they were it was it was really terrible. I still remember that scene. And so this is very traumatic work that you’re doing on the ground. So my question is how do you take care of yourself? What do you do for self-care? Nancy we’ll start with you.

Nancy: [00:26:52] The baseball games Allison and I were talking about before we started recording you know and work-life balance making sure that I’m making time for the important things in life.

Blake: [00:27:04] So I love the the baseball. So you go to different baseball stadiums and collect the helmets.

Nancy: [00:27:13] The little plastic helmets that you know you get your ice cream.

Blake: [00:27:17] Yes! I love that. I’m going to start doing that. That sounds great. How many have you visited?

Nancy: [00:27:25] Probably a dozen. Not very fair about that goal but I’m getting there.

Blake: [00:27:31] That’s great. That’s great. Allison, how about you?

Allison: [00:27:35] And Nancy you’ve got a long career to be able to visit all of the stadiums. I think for me I do you think I get a lot of my energy from people. So my interactions with people do kind of provide me with motivation and enthusiasm to continue doing the work that I’m doing. But I think the other piece for me that’s been really helpful is especially like gratitude and being thankful for like when I am out in a disaster setting. Like watching some of the interactions that are happening and being grateful that you know these people are here and being able to reflect on that and remember that I think the other thing I saw especially really disturbing things following the 2015 flooding and I saw therapist. I mean I’m a social worker. If I’m going to encourage other people to go talk to us for counseling. You know I think we need to be willing to do that too. So I’m not I’m not embarrassed to admit. I saw someone and I talked with them about it. And I think that it helped me be able to continue doing the work that you me and that I want to do that I think is so important. But yeah I don’t know that I would have done that right when I started my career but I think now that I have had some years on me I recognize that that is essential to be able to continue doing this type of work.

Blake: [00:28:52] Yeah. I’m so glad you mentioned that this is a conversation I have with my students sometimes about therapy and being in therapy and all of that. And I talked with a therapist one time and he said you know he was talking about therapist going to see a therapist he said you know if we don’t believe in this that’s he called it despicable. He said That’s just despicable if we don’t support each other in this way. And you know most every therapist I’ve ever talked to including myself have been in therapy and I I just really appreciate you saying that.

Allison: [00:29:27] I think there is still a lot of stigma around it even as a social worker saying that I’m like oh she you know but I really truly believe that if you’re going to encourage someone else to do that and that’s the work that you do you have to recognize that yeah.

Blake: [00:29:41] Yeah, we’re human above all.

Allison: [00:29:43] Yeah. And this and this is hard work regardless of your responding to disasters or you’re working with youth and family. I mean it is hard work and to really be able to do it as a career you really have to find that work life balance that Nancy was talking about.

Blake: [00:29:58] That’s good. Well I want to thank you both for joining me today. This has been such an interesting conversation. I’m really looking forward to to following you of course I’ll see you around Allison. But Nancy thank you so much for joining us. I look forward to reading some of your work ahead. And good luck and all that you do.

Nancy: [00:30:19] Thank you.

Allison: [00:30:21] Nancy’s got a pretty powerful Twitter account. So yeah she keeps up with some of the good stuff.

Blake: [00:30:27] All right I’m going to follow you. I’m looking forward to it. Thanks to you both.

Allison / Nancy: [00:30:32] Thank you.

Allison: [00:30:33] Thanks Nancy.

Blake: [00:30:35] You’ve been listening to the social work conversations podcast. Thanks for joining us. And now let’s move this conversation into action.

Announcer: [00:30:43] This production is made possible by the support of the University of Kentucky College of Social Work, interim Dean Ann Vail and all the faculty and staff who support researching contemporary social problems and prepare students for the social work profession. Hosted by Dr. Blake Jones, produced by Jason Johnston thanks to our Webmaster Jonathan Hagee. Music by Billy McLaughlin. To find out more about the UK college social work and this podcast visit socialwork.uky.edu/podcast