• Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters

    Wednesday April 25, 2012

    Federal regulations require that Medicare and Medicaid certified nursing homes have written emergency plans and provide employees with emergency preparedness training. In a 2006 report about nursing homes that experienced hurricanes, the Office of Inspector General (OIG) found that emergency plans lacked many provisions recommended by experts. In response, CMS issued guidance checklists for emergency planning of health care facilities, long-term care (LTC) ombudsman programs, and State survey agencies (SA). The OIG conducted this study released April 2012 to assess emergency preparedness and response of nursing homes that experienced more recent disasters.

    For this study, the OIG analyzed national survey data to determine compliance with Federal regulations. They also conducted site visits to 24 selected nursing homes that experienced floods, hurricanes, and wildfires in 2007-2010. They interviewed nursing home administrators and staff, local emergency managers, and representatives from State LTC ombudsman programs and SAs. They also compared the emergency plans of each selected nursing home to the CMS checklist for health care facilities.

    The OIG found that most nursing homes nationwide met Federal requirements for written emergency plans and preparedness training. However, they identified many of the same gaps in nursing home preparedness and response that were found in the 2006 report. Emergency plans lacked relevant information including only about half of the tasks on the CMS checklist. Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems. LTC ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters. SAs reported making some efforts to assist nursing homes during disasters, mostly related to nursing home compliance issues and ad hoc needs.

    The OIG made three recommendations to CMS and one recommendation to Administration on Aging (AoA). CMS agreed with their recommendations to revise Federal regulations to include specific requirements for emergency plans and training, update the State Operations Manual to provide detailed guidance for SAs on nursing home compliance with emergency plans and training, and promote use of the checklists. AoA also agreed with their recommendation to develop model policies and procedures for LTC ombudsmen to protect residents during and after disasters.

    The top 10 disaster prone states, as ranked by historical statistics on disaster declarations are Texas, California, Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas and Missouri.

    Sources: Department HHS Office of Inspector General; CMS; Long Term Care Ombudsman

    The National Long Term Care Ombudsman Resource Center link: http://www.ltcombudsman.org/issues/emergency-preparedness

    Office of Inspector General April 2012 Report:

    Nursing Home Emergency Preparedness and Response Report 2012

    OIG Memo to CMS April 13, 2012:

    OIG Emergency Memo April 13-2012

    CMS Emergency Preparedness Checklist:

    CMS Emergency Preparedness for Every Emergency checklist revised Sept 2009

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