SNFS disasters waiting to happen
HHS spots holes in nursing homes’ disaster plans
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.