Taking care of the elderly is never an easy job, but doing so in a crisis situation such as the double whammy of super storm Sandy and Wednesday’s nor’easter is particularly challenging.

“From the nursing home perspective, one has to do all of the things that you have to do at home on steroids,” said Audrey Weiner, president and CEO of Jewish Home Lifecare, which has nursing home campuses in Manhattan, the Bronx and Westchester as well as 1,000 home care clients and 800 day care clients.

For starters, by law, nursing homes have to have extras of everything – water, food, medicines, linens – as well as have generators that have been topped off and properly tested, Weiner said.

Staffs in the disaster area put in double shifts and slept at the facilities so that residents had continuous care and little break in their routines – something important to residents who may be easily confused or upset.

Social media outlets like Twitter and Facebook became additional tools for facilities to use said Audrey Waters, the public relations director of the Metropolitan Jewish Health System, whose Menorah Center for Rehabilitation and Nursing Care on the beach in Brooklyn sustained first floor wind and water damage. Following Twitter, she said, allowed facility staff to keep abreast of what was happening in their communities, and families of residents could check on their loved ones in MJHS’ facilities because staff members took photos of residents and posted them on Facebook.

While handling a natural disaster like Sandy is no walk in the park for nursing homes, because of their contained campuses, the chaos is more controlled than for home health agencies said Michelle Mendelson, vice president of New Jersey’s Meridian At Home, whose staffs and clients are scattered across communities.

Like many home health agencies in the disaster area, Meridian At Home’s staff spent countless hours before the storm arrived contacting clients, making sure they had a disaster plan and extra supplies in place and transferring high-needs patients to facilities or the homes of their families, if needed.

But it’s the aftermath of the storm that presents the most difficulties for home health agencies.

“Our biggest challenge right now is finding patients,” Mendelson said four days after Sandy hit.

With phone lines down, flooded streets and electrical lines and trees blocking roadways, just getting to clients is a nightmare, she said. The agency was also struggling with finding gas and getting clients on oxygen living in homes without electricity to shelters.

Some elderly patients who remained at home despite mandatory evacuations found themselves in emergency situations unable to contact first responders or with nowhere to go with hospitals full, and in some cases, in crisis mode, noted Richard Goldstein, executive director of Greenwood House in Ewing, N.J., about an hour’s drive from the ocean.

Watching the wreck around him and the desperation of home-bound, elderly citizens with health needs got Goldstein doubting the practicality of federal government encouraging the elderly to receive care at home instead of going into long-term care institutions.

“As we do this (push for more home care) and there’s more and more people (at home),” he said, “are we going to be able to take care of them when we have a disaster like this, or are more people just going to pass away because you can’t reach everybody at home and they can’t get to the hospitals and nursing homes and get the help they need?”

Nobody in his nursing home, he said, went without heat, electricity, regular meals or medications.

When recovery is complete, home health agencies and long-term care facilities will be facing another crisis of sorts: a financial one.

The financial impact of the storm and its aftermath will be huge said Weiner and Mendelson. They said they expect their biggest expenses will be in staff overtime and lost revenue from services that went unprovided, such as due to day program closures or home health aides who couldn’t reach clients.

While the near future will mean hours of assessment and facing the financial impact of the storm, the managers of home health agencies and long-term care facilities are looking forward to honoring their staffs for their colossal efforts, often in the face of great personal loss.

“There’s nothing I want to do more, when it all calms down, than get to thank every single person who made sacrifices to come here and take care of our elders or did the same thing in our community,” said Weiner.