Federal report calls for changes in procedures for evacuating nursing home residents during disasters

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Aug 20 2006

The emergency evacuation plans of nursing homes located in the Gulf States during four hurricanes within the past year met federal and state regulations but had a number of problems, according to a report issued on Friday by HHS Inspector General Daniel Levinson, the New York Times reports.

For the report -- requested by Sen. Herb Kohl (D-Wis.), ranking member of the Senate Special Committee on Aging -- HHS OIG conducted on site visits and interviews with staff and administrators at 20 of the 2,526 nursing homes in Alabama, Florida, Louisiana, Mississippi and Texas. Among the 20 nursing homes, 13 had evacuated residents before the hurricanes reached land, and seven did not evacuate residents. According to the report, the 13 nursing homes that evacuated residents experienced the most serious problems, such as: unavailability of buses contracted to evacuate residents; unreliability or lack of air conditioning in alternative transportation; inadequate staff; longer-than-expected travel times, which required staff to ration food and water; failure to transport some medications, oxygen canisters and incontinence supplies; and dehydration, pressure sores and travel related illnesses, such as urinary tract infections, experienced by residents. In addition, the report finds that some of the evacuation plans of the 20 nursing homes lacked:

Guidelines on whether to evacuate residents;
Adequate estimates of the amount of food and water required for evacuations;
Recommendations on alternative evacuation routes in the event of traffic congestion;
Official arrangements with host facilities;
Guidelines on how and when to return; and
Formal partnerships with local officials.

Based on guidelines from other states, professional associations and emergency management and long-term care experts, the report recommends 25 "core elements" of emergency preparedness for the evacuation plans of the 16,125 nursing homes that receive Medicare and Medicaid funds. In addition, the report recommends that CMS encourage more collaboration with state and local emergency officials.

Comments
Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform, said, "It is too much to expect that nursing home operators can make all these difficult decisions in a very short time and with a lot of stressors," adding, "It is absolutely essential that a system be put in place up front, and the government must take the leadership role in that." In a written statement, CMS Administrator Mark McClellan, said he agreed with the report and the agency will consider the recommendations (Gross, New York Times, 8/18).

The report is available online. Note: You will need Adobe Acrobat Reader to view the report.

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.