Nursing home plans face little scrutiny
Panel reccommends new emergency management standards
TALLAHASSEE — Two months before a dozen residents died in sweltering heat after Hurricane Irma at the Rehabilitation Center at Hollywood Hills, the nursing home submitted a plan to county administrators to show the facility could handle crises like a missing resident or a major storm.
The 43-page emergency management plan had errors: typos and an outdated hurricane drill copied and pasted from the previous year. The plan was approved by Broward County, anyway.
Last week, amid pressure to improve the state’s hurricane response and prevent similar tragedies, a House committee released post-Irma recommendations, including new standards for such emergency management plans. But the recommendations say little about how to increase oversight that might have flagged problems in the Hollywood facility’s plan.
“The enforcement is just not there,” said Brian Lee, a former state long-term care ombudsman who now directs a longterm care residents’ advocacy group. “The evaluation of the plans — the assessment of the plans — is pretty ambiguous.”
Legislators say that more specific plans for oversight and enforcement will fall to committees that decide to craft or take up legislation based on the recommendations, or to rulemaking that would task agencies with more responsibility. But it is unclear if or how many of those recommendations will make it from the report to legislation considered by a full chamber.
The Agency for Health Care Administration — which regulates hospitals, nursing homes and assisted living facilities — sets criteria for the emergency management plans that longterm care facilities must submit yearly to their respective counties. It falls to county emergency management offices to review and approve those plans.
“The evaluation of the plans — the assessment of the plans — is pretty ambiguous.” Brian Lee, directs a long-term care residents’ advocacy group
But in most counties, verifying those plans is little more than a paper check that confirms the plan contains the components mapped out by AHCA.
AHCA spokeswoman Shelisha Coleman said the agency “is reviewing the [hurricane] report, and we will work with any legislators that have proposals regarding the committee’s recommendations.”
In Broward County, where the Hollywood nursing home was based, staff members conduct a “paper review” of the plan after it is submitted to ensure the plan meets requirements, said Miguel Ascarrunz, director of emergency management. But those reviews do not verify what is self-reported in the plans.
Hazard drills are conducted entirely by the facility, which also grades itself on those drills in afteraction reviews.
After Irma, the Broward emergency management division began conducting on-site visits, Ascarrunz said. But with a staff of fewer than two dozen, the division has only completed visits to the county’s hospitals and about five of the 300 nursing homes and assisted living facilities.
The visits also are assessments more than inspections, Ascarrunz said. “The plan approval process is still a paper review, as long as they meet all the checklist criteria elements to include in their plan.”
The report, from the House’s Select Committee on Hurricane Response and Preparedness, sets out four recommendations pertaining to emergency management plans, including adding specific criteria for contact information and hardening plans, providing some information from the plans to family members and requiring that facilities submit their plans within 90 days after being licensed.
But the recommendations are much less specific on how to ensure plans are being read.
Rep. Chris Sprowls, R-Palm Harbor, said the report does not provide specifics so committees can decide how to codify more oversight.
“The recommendations are designed to be just that, recommendations to the committee,” he said. “The actual legislation that comes out of the committee process will be far more prescriptive, specific about the issues.”