SNFS dis­as­ters wait­ing to hap­pen

HHS spots holes in nurs­ing homes’ dis­as­ter plans

Modern Healthcare - - FRONT PAGE - Jes­sica Zig­mond

Nurs­ing home rep­re­sen­ta­tives last week high­lighted the strides they’ve made in dis­as­ter pre­pared­ness and train­ing, but also ac­knowl­edged spe­cific ar­eas that re­quire im­prove­ment. That was the re­sponse to a new re­port from HHS’ in­spec­tor gen­eral’s of­fice find­ing that while most of the na­tion’s nurs­ing homes met fed­eral re­quire­ments for writ­ten emer­gency plans and pre­pared­ness train­ing, many of the same gaps the in­spec­tor gen­eral iden­ti­fied in a 2006 re­port still ex­ist. In the new re­port, the of­fice noted that emer­gency plans “lacked rel­e­vant in­for­ma­tion—in­clud­ing only about half of the tasks on the CMS check­list,” and that nurs­ing homes had prob­lems re­lated to un­re­li­able trans­porta­tion con­tacts, lack of col­lab­o­ra­tion with lo­cal emer­gency man­age­ment and res­i­dents who de­vel­oped health prob­lems.

Over­all, 92% of nurs­ing homes met fed­eral reg­u­la­tions for emer­gency plans and 72% for emer­gency train­ing be­tween 2009 and 2010, which was slightly less than the 94% of nurs­ing homes that met re­quire­ments for plan­ning and the 80% that met reg­u­la­tions for train­ing in 2004 and 2005. For this most re­cent re­port, the in­spec­tor gen­eral’s of­fice ex­am­ined na­tional sur­vey data and made site vis­its to 24 nurs­ing homes that had ex­pe­ri­enced floods, hur­ri­canes and wild­fires be­tween 2007 and 2010.

“Ka­t­rina was a wake-up call for all kinds of folks, nurs­ing homes in­cluded,” said Tim Graves, Texas Health Care As­so­ci­a­tion pres­i­dent and CEO, re­fer­ring to the 2005 hur­ri­cane that was one of the na­tion’s worst nat­u­ral dis­as­ters. Based in Austin, the Texas Health Care As­so­ci­a­tion rep­re­sents about 500 skilled-nurs­ing and as­sisted-liv­ing fa­cil­i­ties. Graves also serves as chair­man of the Amer­i­can Health Care As­so­ci­a­tion’s dis­as­ter plan­ning com­mit­tee.

The AHCA is a group of af­fil­i­ated state health or­ga­ni­za­tions that rep­re­sents more than 11,000 not-for-profit and for-profit nurs­ing home, as­sisted liv­ing and sub­a­cute-care providers that care for about 1 mil­lion el­derly and dis­abled peo­ple ev­ery day.

Since Hur­ri­canes Ka­t­rina and Rita, Graves said, nurs­ing homes have be­come bet­ter at prac­tic­ing their emer­gency plans more reg­u­larly; be­com­ing more so­phis­ti­cated in how they de­velop their plans; reach­ing out to lo­cal provider groups for food, util­ity and phar­macy needs; and ex­e­cut­ing their plans when dis­as­ters oc­cur.

And in Texas, his group ad­vo­cated for a change that the state Leg­is­la­ture ap­proved a year ago. Be­cause of the new law that took ef­fect in Septem­ber, nurs­ing homes, as­sisted-liv­ing fa­cili-

ties and hospice-ser­vice fa­cil­i­ties are given the same pri­or­ity as hos­pi­tals when util­ity providers re­store power af­ter ex­tended power out­ages.

Ac­cord­ing to the in­spec­tor gen­eral’s re­port, 17 of the 24 se­lected nurs­ing homes re­ported fac­ing “sub­stan­tial chal­lenges in re­spond­ing to dis­as­ters.” The prob­lems in­cluded trou­ble fol­low­ing the plan as it was writ­ten, neg­a­tive ef­fects on res­i­dents’ health be­cause of evac­u­a­tion and lo­gis­ti­cal prob­lems re­lated to trans­porta­tion and com­mu­ni­ca­tion.

The re­port rec­om­mended the CMS re­vise fed­eral reg­u­la­tions to in­clude spe­cific re­quire­ments for emer­gency plans and train­ing, up­date the state op­er­a­tions man­ual to pro­vide guid­ance for sur­vey agen­cies on nurs­ing home com­pli­ance with emer­gency plans and train­ing, and also pro­mote the use of check­lists. Also, the re­port rec­om­mended the Ad­min­is­tra­tion on Ag­ing de­velop poli­cies for om­buds­men to pro­tect res­i­dents af­ter dis­as­ters.

Texas providers last week un­der­scored the need for bet­ter trans­porta­tion and com­mu­ni­ca­tion dur­ing dis­as­ters. Graves said trans­porta­tion is a “chronic is­sue,” par­tic­u­larly in hur­ri­canes, when nurs­ing home op­er­a­tors de­cide to evac­u­ate res­i­dents. He said the state’s public safety depart­ment has con­tracts with mo­tor coach com­pa­nies to have about 1,400 buses avail­able for the public in a dis­as­ter, and that his group is work­ing with the depart­ment so that some of the un­needed buses could be used for nurs­ing-home fa­cil­i­ties.

Mark McKen­zie, pres­i­dent of Dal­las-based, post-acute provider Se­nior Care Cen­ters, said it’s im­por­tant for nurs­ing homes to work with state and lo­cal emer­gency agen­cies and also have copies of emer­gency plans from those or­ga­ni­za­tions. On April 3, a tor­nado hit the com­pany’s Green Oaks Nurs­ing and Re­ha­bil­i­ta­tion fa­cil­ity in Ar­ling­ton, forc­ing an evac­u­a­tion of 129 res­i­dents. Two res­i­dents sus­tained non-life-threat­en­ing in­juries and were trans­ferred to acute-care fa­cil­i­ties. Green Oaks— which re­opened three wings of its fa­cil­ity April 20—fol­lowed its plan, and there were no fa­tal­i­ties. But the dis­as­ter high­lighted sys­tems and pro­cesses that re­quire im­prove­ment.

“We want copies of the city or county’s emer­gency pro­cesses in our build­ings,” McKen­zie said, adding that while the fa­cil­ity’s providers ap­pre­ci­ated the buses to trans­port pa­tients, they did not know what the city could pro­vide. He also said a rep­re­sen­ta­tive from the long-term-care sec­tor and se­nior com­mu­nity should be in­cluded in a com­mu­nity’s emer­gency re­sponse team to un­der­stand what the com­mu­nity can pro­vide in dis­as­ters—and that the lo­cal com­mu­nity un­der­stands the needs of nurs­ing home res­i­dents.

“Our col­lab­o­ra­tion with fed­eral, state and lo­cal re­spon­ders is solid, and will only im­prove as more of the new pro­to­cols we’ve es­tab­lished grow in us­age,” the AHCA said last week in a state­ment. “That’s the bot­tom line the (in­spec­tor gen­eral’s) re­port failed to high­light—over­all, our fa­cil­i­ties have the proper pro­ce­dures in place, and are rou­tinely up­dat­ing them to pre­pare for the next nat­u­ral dis­as­ter.”


Nearly seven years af­ter Hur­ri­cane Ka­t­rina, many nurs­ing homes still have the same pre­pared­ness prob­lems, the HHS says.


There were no fa­tal­i­ties re­ported af­ter a tor­nado April 3 hit Green Oaks Nurs­ing and Re­ha­bil­i­ta­tion fa­cil­ity in Ar­ling­ton, Texas. The fa­cil­ity re­opened three wings last week.

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