How Prepared Are Nursing Homes to Respond to Disasters?

Another spate of tornadoes wreaked havoc last weekend on the Great Plains. Over a 24-hour period, more than 75 tornadoes struck mostly unpopulated areas in Oklahoma, Kansas, Nebraska, and Iowa. Six persons are known to have died in the storms.

Earlier this month, Dallas-Ft. Worth felt the brunt of Mother Nature – fortunately, although tornadoes did extensive damage in Texas, no one was killed.

Officials in the Midwest credit early warning systems and a storm-wary population seeking shelter immediately with minimizing injury and loss of life.

Perhaps the most vulnerable of all adults are those in nursing homes, however. How prepared are nursing homes to deal with emergencies and natural disasters such as hurricanes and tornadoes?

Federal rules require that all nursing homes that are certified to take Medicare and Medicaid must have written emergency plans and give their employees emergency preparedness training.

In a 2006 report on nursing homes that experienced hurricanes, government regulators found that many lacked emergency provisions recommended by experts.

From 2007 to 2010, floods, hurricanes, and tornadoes forced residents of 210 nursing homes in seven states to evacuate or shelter in  place.

In May 2010, widespread flooding along the Mississippi and Cumberland Rivers in Tennessee forced the evacuation of at least two nursing homes. Another nursing home evacuated some of its residents, and the residents of four others sheltered in place.

In a follow up report issued earlier this year on measures taken by facilities to prepare for these more recent disasters, the U. S. Office of Inspector General (OIG) in the Department of Health and Human Services found that more than 90 percent of nursing homes nationwide met federal requirements for emergency planning and more than 70 percent for emergency training.

Unfortunately, the OIG found many of the same gaps in preparedness and response found in its 2006 report, despite 70-item checklist published by the federal government in 2007 that guides nursing homes in developing emergency plans; ensuring adequate supplies of food and water; identifying evacuation routes; and transporting residents and patients, critical supplies, and equipment.

Emergency plans lacked relevant information -- including only about half of the tasks on the the checklist. Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems.

State Long-Term Care Ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters.

How Nursing Homes Can Better Prepare for Emergencies
The OIG remarked that while most facilities complied with federal regulations, the regulations themselves lacked specificity.

For example, facilities are expected to develop emergency plans and coordinate with local emergency authorities. But the authorities that review the plans may not be the same that carry them out. In one county that required emergency management review of nursing home plans, the county emergency manager reviewed and approved a plan, but the emergency manager of the fire department that responded to the nursing home’s request for assistance did not know of the home’s plan.

Helping the oldest and the sickest is a community responsibility, not just a legal duty imposed on a facility. Since the 2007 wildfires, nursing homes in San Diego County have participated in bed census drills as members of their county’s nursing home disaster preparedness and response task force.

In addition to greater facility and community coordination, the OIG recommends that the federal government promote the use of detailed emergency preparedness checklists for nursing homes, State LTC ombudsmen programs, and state survey agencies.

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