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