Nursing home disaster plans are full of holes, OIG finds

April 16, 2012
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Despite meeting federal requirements for written emergency plans and disaster preparedness training, nursing home response plans often lack relevant information and do not follow the Centers for Medicare & Medicaid Services’ (CMS) recommended preparedness checklist for healthcare facilities, according to a new Office of Inspector General report.

For the study, which was released Monday, OIG conducted site visits at 24 nursing homes that had experienced floods, hurricanes and wildfires from 2007-2010.

OIG found many of the studied nursing homes lacked protocol on ensuring sufficient staffing levels during a disaster. Likewise, some providers did not have detailed resident care tasks for disaster scenarios, such as handling resident illness or death during an evacuation, or how to provide disaster counseling to residents.

The administrators and staff from 17 of the 24 nursing homes also reported “substantial challenges” when responding to disasters during the studied timeframe.

“Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems,” the OIG report read. “LTC ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters.”

In its recommendations, OIG suggested CMS add more specific emergency planning protocol to existing federal requirements for nursing home disaster preparedness.

Because most of the studied nursing homes had never heard of the emergency preparedness checklist for healthcare facilities, OIG also recommended CMS promote use of the checklist and included several additions to improve its effectiveness.

OIG’s suggested changes to the checklist were also included in a separate memo to CMS Acting Administrator Marilyn Tavenner.

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Colorado Proactive on Emergency Preparedness in Nursing Homes

by David Skipper, VP of Emergency Management
Colorado Health Care Association and Center for Assisted Living

The reporting of the HHS Office of the Inspector General (OIG), Gaps Continue To Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010 Report (OEI-06-09-00270), emphasizes the importance of all health care facilities to be prepared for any and all emergencies and disasters.

“Colorado, is well ahead of the emergency preparedness curve to adequately care for the frail elderly and disabled we serve,” said David Skipper, Vice President Emergency Management, for the Colorado Health Care Association and Center for Assisted Living. Skipper has more than 35 years of experience in crisis management, nuclear, biological and chemical domestic preparedness, incident command and clinical implications of weapons of mass destruction.

Extensive and ongoing education and practical capability training in emergency preparedness and response is being provided to nursing homes and assisted living residences in Colorado through a partnership between Colorado Health Care Association (CHCA) and the Colorado Department of Public Health and Environment (CDPHE). CHCA is facilitating the grant from Department of Health and Human Services to provide National Incident Management Systems (NIMS) training to every nursing home in Colorado, provide 4 statewide emergency preparedness and management courses to all assisted living communities in Colorado and revise the CDPHE Emergency Operations Plan (EOP) toolkits for nursing homes and assisted living facilities to be more user-friendly to long term care providers.

“It is important that our frail elders and disabled are not last on the priority list for evacuation, as happened with Katrina”. Skipper said.

CHCA in partnership with the Center for Integrated Disaster Preparedness (CIDP) at the University of Colorado School of Medicine. The Center serves Colorado Healthcare providers through offering free trainings across the state. These trainings focus on creating comprehensive and integrated healthcare response systems and include ICS for Healthcare, Hazard Vulnerablity and resource sharing as well as specific trainings which work to build capability in the healthcare partner communities including Nursing Homes, Home Healthcare and Health clinics. The director, Dr. Kreisberg, and the Medical Director Dr. Little have extensive experience building collaborative systems for the delivery of healthcare in a disaster.

“Colorado continues to sit on the fray of disaster planning through a system of carefully crafted deliverables, and integrated planning and response trainings and exercises” says Dr. Kreisberg.

The Center will offer a two-day symposium to invited public policy makers and emergency mamangement administrators to enter into a dialogue address the furture direction of Emergency Management in Colorado “Navigating Complex Change: Creating Continuity in Health Care Emergency Response and Recovery” June 6-7, 2012.

Nursing homes in Colorado are regularly performing full evacuation drills with community partners, identifying successes, challenges and documenting the results through each subsequent exercise and debriefing. Facilities should review CMS’ Emergency Preparedness checklist and use it to cross-check facility disaster preparedness plans and training with their community.

CHCA continues to work with CDPHE and other coalitions on emergency planning and preparedness issues to insure the safety and well-being of Colorado nursing home residents, staff and families.