Thomas Billings Jr. and his wife, Sarah, decided to ride out Hurricane Ian in the family room of their Naples ranch home, close to Edgewater Beach.
About two hours after the storm’s landfall, Billings was returning from fetching something from a bedroom when he found his wife lying facedown, according to a Naples Police Department report.
As floodwaters seeped into the home, he moved Sarah, 73, to the bedroom. But the 79-year-old man did not have the strength to lift her onto the bed, the report states. The man was only able to escape the rising waters by floating his wife and himself to the back lanai.
He survived but Sarah drowned, a death that the county medical examiner concluded was complicated by a heart attack.
Florida has strict laws requiring nursing homes and assisted living facilities to plan for disasters like hurricanes. But few rules exist to protect an increasing number of elderly people with chronic health conditions who live at home, including some who rely on electric-powered medical equipment like dialysis and oxygen machines.
Hurricane Ian provided a brutal lesson in how vulnerable that population is to the harsh conditions during and after a major storm.
Medical examiners in Florida have so far linked 112 deaths to Hurricane Ian. Almost 60% of those were people age 65 or older. Chronic medical conditions like heart attacks and respiratory illnesses were contributing factors in one-third of reported deaths, records show.
The average age of those who died was 67.
“There is no one who is required to make sure they evacuate or that their home environment will keep them safe,” said Lindsay Peterson, an assistant professor who conducts disaster preparedness research at the University of South Florida’s School of Aging Studies. “They are much more vulnerable, and we see that in these statistics.”
The reports suggest many would still be alive had they evacuated.
Nine people died because power outages meant they could not operate oxygen or dialysis equipment, including a 70-year-old diabetic in Charlotte County who went a week without dialysis.
Delays in 911 responders reaching patients because of the storm were cited as contributing factors in another five deaths. One was a 79-year-old woman in Orange County whose operation for a fractured hip was delayed because the hospital she was taken to had no running water.
Even some who survived the worst of the storm later succumbed to its aftermath.
Four residents suffered heart attacks and died while they were trying to clear up storm debris, reports show. A 58-year-old man with existing heart problems collapsed and died after walking up seven stories of a Naples condo tower where he and his wife were sheltering. The elevator had stopped working after the lobby flooded.
Trends suggest the number of seniors receiving medical treatment at home will continue to rise. The Centers for Medicare & Medicaid Services estimates that home care expenditures will reach $201 billion by 2028, a 73% increase from 2020.
More needs to be done at state, local and federal levels to protect that population as hurricanes increase in intensity, Peterson said. Home health centers and dialysis centers are required to have post-storm operation plans, she said.
Other states, including Ohio, have gone further with laws that require home health visitors to check in with their clients before a disaster and offer assistance and advice.
Those with health conditions can turn to special-needs shelters, which include generators to power medical equipment and are staffed with nurses.
But it’s not always easy to convince people and their caregivers to commit to staying in a shelter, Peterson said. Elderly people with dementia may feel distressed in a busy shelter where there is always light and noise.
“People associate home with their safety, especially older adults,” she said. “How do we convince them this is not safe for you anymore?”
Both Hillsborough and Pinellas counties maintain a registry of those who have special medical needs and might struggle during an emergency like a hurricane.
Pinellas counts 2,643 people on the registry, which includes information on their evacuation zones and whether they have their own transportation. About 4,000 people are on Hillsborough’s registry, with more than 1,600 listed as needing transportation to evacuate.
Both counties operated special shelters during Ian, with roughly 400 people and 110 caregivers staying at three shelters in Pinellas. Hillsborough housed about 400 people and 40 caregivers across five shelters, officials said.
The shelters are intended as a last resort for people without the resources or time to travel to a hotel or stay with friends or relatives, said Ryan Pedigo, director of public health preparedness in Hillsborough. But he acknowledged that some — including those with medical needs — won’t take advantage of the free facilities, and that many people wait until it’s too late to evacuate.
“You can’t wait until eight hours before landfall to make that happen. People need to take the initiative to leave earlier and evacuate,” he said. “I don’t know if it’s complacency or people flat-out don’t want to go to a shelter.”
Joy Weidinger’s husband of 58 years, Douglas Weidinger Sr., was listed among Hurricane Ian’s dead.
The 79-year-old Punta Gorda man, who suffered from chronic obstructive pulmonary disease and asbestosis, relied on an oxygen concentrator, a device that provides oxygen-rich air.
When power stopped working, he switched to portable oxygen canisters the couple had ordered for the storm.
But his health deteriorated, his wife said, in part because he was so stressed about the hurricane. He died Sept. 29, one day after the storm made landfall.
The medical examiner in Charlotte County cited the interruption of power as a contributing factor in his death.
“We hooked him up to the concentrator, but by the time we did it, it was too late,” she said. “We all have a time to go.”
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Tampa Bay Times Hurricane Ian coverage
HOW TO HELP: Where to donate or volunteer to help Hurricane Ian victims.
FEMA: Floridians hurt by Ian can now apply for FEMA assistance. Here’s how.
THE STORM HAS PASSED: Now what? Safety tips for returning home.
POST-STORM QUESTIONS: After Hurricane Ian, how to get help with fallen trees, food, damaged shelter.
WEATHER EFFECTS: Hurricane Ian was supposed to slam Tampa Bay head on. What happened?
MORE STORM COVERAGE: Get ready and stay informed at tampabay.com/hurricane.