HELPING NURSING HOMES DEVELOP EMERGENCY PREPAREDNESS PLANS

Hurricane Katrina was a shocking reminder of how vulnerable older adults—especially those in long-term care—can be. Well over 500 older people, many of them nursing home residents, died in the Gulf Coast storm and its aftermath. Surprisingly, nearly 95% of nursing homes in the Gulf area met Centers for Medicare & Medicaid Services (CMS) standards for emergency preparedness when Katrina made landfall. The standards simply weren’t high enough. Those are the startling findings of a recent Department of Health and Human Services (DHHS) report. The report, Nursing Home Emergency Preparedness and Response During Recent Hurricanes, calls on CMS to require nursing homes to develop far more comprehensive emergency preparedness and evacuation plans than current standards require. It’s a wake-up call for all nursing homes and other long-term care facilities.

The DHHS report was based on a review of Gulf states’ emergency preparedness surveys, visits to selected Gulf state nursing homes, interviews with nursing home staff, local authorities and others, and a review of 20 facilities’ emergency preparedness plans. The 20 nursing homes had been affected by four hurricanes—Katrina, Rita, Ivan, and William—between 2004 and 2005. Of the 20, 11 nursing homes evacuated residents before the hurricanes reached landfall, 2 more evacuated later, and 7 did not evacuate. None of the residents of the 20 facilities died during or immediately following the hurricanes, but the inadequacy of their emergency preparedness plans did result in “a negative impact on resident health,” according to the report. Staff at nursing homes that evacuated reported that some residents suffered depression and, during transport, dehydration, skin tears, and pressure sores. Overall, nursing homes that did not evacuate reported fewer problems.

While each of the 20 nursing homes—and a full 94% of all Gulf states nursing homes—had emergency preparedness and evacuation plans meeting Federal standards, the plans were often unclear or vague, the DHHS report notes. Some of the plans, for example, lacked guidelines for deciding whether to evacuate, for providing and transporting medications, supplies, food and water, and for returning residents to the facilities. The report also found that a lack of formal partnerships with local officials and agencies made it harder for the nursing homes to get the help they needed. In addition to advising CMS to promote and support relationships between nursing homes and state and local emergency officials, the report calls on the agency to develop a “core set” of 25 required elements for Medicare- and Medicaid-certified nursing home emergency plans. In a written response to the report, CMS Administrator Mark McClellan concurred with the recommendations and noted that the agency is investigating ways to strengthen its regulations.

The full report, available at www.oig.hhs.gov/oei/reports/oei-06-06-00020.pdf, is recommended reading for nursing home and other long-term care facility administrators. So is another recent publication, Recommendations for Best Practices in the Management of Elderly Disaster Victims, a guide to caring for older adults in disasters. Drawing on their experiences while caring for older victims of Hurricane Katrina, American Geriatrics Society member Carmel Dyer, MD, and other experts at Baylor College of Medicine and Texas’ Harris County Hospital District published the guide this summer. Dr. Dyer, co-chair of the AGS Council of State Affiliates, AGS Board member, associate professor of medicine at Baylor, and director of the Harris County Hospital District’s Geriatrics Program, and her colleagues and other healthcare workers cared for older adults evacuated to the Houston area in Katrina’s aftermath. Among other things, their guide includes the invaluable rapid screening/triage tool—dubbed SWiFT—that Dr. Dyer and colleagues developed while caring for evacuees. You can find the guide at www.bcm.edu/ pdf/bestpractices.pdf. Dr. Dyer is currently working with AGS on a new chapter on emergency preparedness that will supplement the Society’s training guide for emergency medicine services staff, Geriatric Education for Emergency Medical Services. Though the 2006 hurricane season is behind us, other disasters have no season. Now is the time to plan.