Emergency planning for nursing homes

There have been a number of high-profile reports about the difficult decisions nursing homes have to make during an emergency. The General Accountability Office (GAO), which is the independent, bipartisan investigative arm of Congress, conducted a major study analyzing what went wrong during the evacuation of nursing home residents during Hurricane Katrina. As a result of this study, many nursing homes and long term care facilities throughout the country are now taking added measures to develop more comprehensive emergency preparedness plans. Additionally, Medicare and the Department of Health and Human Services are creating new regulations regarding what they’ll require of hospitals and long-term care facilities in disaster planning. Our guide to emergency planning will tell you what you need to know – and why planning is important.

Is an evacuation plan necessary?

Even if you live in a region where hurricanes are rare, you may still be exposed to tornadoes, power outages, chemical spills, nuclear plants, bioterrorism or a flu pandemic. So what does this mean for a parent living in a nursing home? One of the toughest decisions a nursing home administrator will ever make in a disaster is whether or not to stay by “sheltering in place” or evacuate residents to a safer haven. Moving residents who have complicated health conditions and those with severe dementia can place the resident in harm’s way. They're exposed to traffic accidents, long rides on jammed highways and possibly bad weather conditions. If the disaster is community or region-wide, the shelters they reach may be understaffed to meet their needs, placing them at an even greater risk. Experts agree that in most cases – regardless of whether the nursing home decides to stay or evacuate – planning and preparedness can make a significant difference in the comfort and safety of nursing home residents during an emergency.

What does a good emergency plan look like?

Here are some suggestions of what to ask nursing home administrators and directors of assisted living facilities.

1. The Plan. Do you have a plan? When was it last updated? Does it meet state and federal standards? What guidelines did you follow to create the plan (e.g., an accrediting body or CMS)? Do local first responders (e.g., police, fire department, paramedics and township officials) have a copy of the plan and do you have written agreements with them as to who will do what in an emergency?

2. Communications. How will you let me know if my parent is being evacuated? What alternative forms of communication do you have when land and cell phones are not working? For example, will there be a central phone number I can call or website that will give continuous updates on the status of residents and any evacuation plans? How will your staff be able to maintain communications with each other? How will responders be informed of my parent’s identity, contact information, health conditions and medication schedule? Will each resident wear an identification tag containing vital information?

3. Transportation. How will you transport residents, especially those who are in wheelchairs or need ambulance assistance? Do you have contracts with transportation companies to assist in an evacuation? What is your back-up plan if they are overwhelmed by demands of other health care facilities in the event of a mass evacuation?

4. Staffing. What type of training has your staff received in disaster response and evacuation? How often does your staff review your emergency preparedness plan? When was the last time your staff ran through a practice drill? What type of staff and how many would remain on the premises during a shelter-in-place scenario? Who will accompany residents to shelters during an evacuation and how long will they remain with the residents? Can family members volunteer to assist? How will you maintain enough staff to care for residents during a flu pandemic?

5. Mobilization Centers and Housing. Where are the designated mobilization centers and shelters cited by the Red Cross and NDMS in case of an evacuation? Where would I pick up my mother during disaster evacuation? Do you have arrangements with other facilities to provide housing for residents?

6. Supplies. What type of emergency supplies do you have in reserve and how long will they last (such as food, water, oxygen, flashlights, medications)? Do you have generators and how long can you operate on them? How will supplies be transported with residents during an evacuation (especially personal medications)? Does each resident have a personal emergency supply kit [] to take with them during an evacuation?

These are a lot of questions, but you’re entitled to ask them. And while you’re at it, create an emergency preparedness plan for your own household. It pays to be prepared.  

The bottom line

• As a result of a number of high-profile problems at nursing homes during Hurricane Katrina and other emergencies, Medicare, the Department of Health & Human Services and other entities are calling for nursing homes to adopt emergency preparedness plans.
• No location is immune to the possibility of an emergency: hurricanes, earthquakes, tornados, power outages, flu pandemics and problems at chemical or nuclear plants are just a few situations where an evacuation might be necessary. So it’s important for everyone to be prepared.
• You should feel comfortable asking your parents’ nursing home, assisted living or long term care facility directors detailed questions about their emergency preparedness plan. It should include detailed and specific evacuation plans including destinations and transportation; communications; ample emergency supplies for the nursing home residents; back-up generators and more.