North Carolina knows about hurricanes and how to prepare for them. That awareness makes it especially disturbing that at least six elder-care facilities in Eastern North Carolina failed to evacuate their residents as Hurricane Florence bore down on them two years ago.

A story by the News & Observer’s Carli Brosseau published recently gave a harrowing account of what happened next. One facility evacuated residents by boat, some were carried out on backboards covered by sheets in the driving rain. At one home, staff members, unprepared and poorly paid, stopped showing up. Residents were put on buses and delivered to shelters ill-equipped to care for them. At least 200 residents were moved more than once. Some ended up at a shoddy, oft-penalized nursing home.

The most infuriating part of Brosseau’s account is that the chaos is likely to happen again. Fortunately, Hurricane Isaias did less damage than Florence, but as this year’s hurricane season enters its most dangerous months more stories of neglect and incompetence may emerge from nursing homes and assisted-living centers. Indeed elder care facilities may now be even less prepared for a storm, given the strain that COVID-19 already has already put on understaffed and poorly run operations.

Some nursing homes and assisted-living centers provide excellent care delivered by dedicated administrators and well-trained staff. But that level is achieved despite the system, not because of it. Hurricanes and the pandemic are exposing the weaknesses in the system that is supposed to protect vulnerable people in congregate care settings in North Carolina. For-profit chains tend more to the bottom line than to their residents. Smaller operators run one or a few homes and accept fines for poor care as the cost of doing business.

This year, when North Carolina has seen more than 800 deaths from COVID-19 among long-term care residents, the legislature did not tighten accountability; it loosened it. Tucked into a COVID-19 relief law is a provision giving long-term care facilities immunity from most legal claims for the duration of the state of emergency.

North Carolina law includes bills of rights for residents of nursing homes and assisted-living facilities. Both documents begin with the residents’ rights to be treated with consideration and respect and receive care, treatment and services that are adequate and appropriate. Those rights were washed away as Florence flooded Eastern North Carolina. And they’ll continued to be ignored unless the state backs those rights with action.

Improving nursing home care requires driving out unscrupulous nursing home operators. But responsibility for tough regulation tends to get lost amid the tangled overlap of local, state and federal regulation.

Key steps …

Should Gov. Roy Cooper win re-election, as seems likely, he and state lawmakers should make it a priority to protect nursing home and assisted-living residents from neglect and exploitation. Taking these steps recommended by the advocacy group Friends of Residents in Long Term Care would be a good start:

— Add more state inspectors. There are plenty of regulations, but they are useless without enforcement.

— Increase the state’s Medicaid funding to add more staff at care facilities and improve their pay.

— Increase fines and penalties and tighten the appeals process. Too often operators wear down regulators and state lawyers with lengthy appeals that end in settlements.

— Don’t repeatedly cite bad operators. Shut them down.

There should be no more waiting. North Carolina should move its vulnerable elderly – literally and figuratively – to higher ground.

— The Charlotte Observer