Nursing home facilities across the Northeast are bracing for the impact of Hurricane Sandy. By law, facilities receiving Medicare and Medicaid funding are required to have emergency preparedness plans and emergency training for employees, but in many circumstances the plans are not adequately tested or flexible enough to change when needed during emergencies and employees do not receive adequate training. It is hard to forget the images of Hurricane Katrina and particularly, St. Rita’s Nursing Home, where residents perished after not being able to be evacuated safely. Fortunately, the lessons of prior natural disasters can be translated into proactive measures facilities can take to ensure that they can continue to care for residents under very dire circumstances.
Due to their location in flood zones or near water, some facilities have no choice but to evacuate their facilities in the wake of an on-coming hurricane in coordination with local and state authorities and other long term care facilities. According to a report issued by the Office of Inspector General of the U.S. Department of Health & Human Services in the spring of this year, although 92% of the 16,000 nursing homes met emergency preparedness plan requirements, only 72% of these same facilities met training requirements. However, when the OIG further scratched the surface of these emergency preparedness plans, many deficiencies were found, including the lack of planning for the death or illness of residents during evacuation, inadequate communications to families, and lack of systems to quickly identify residents and their medications in the event of evacuation. Another critical issue identified in the study was transportation issues and facilities not having secured transportation or adequate transportation if the facility needed to be evacuated. In light of these findings, many facilities have updated their plans by making provisions for pinning identification and medication lists to residents’ clothing in the case of evacuation and ensuring that their contracts with transportation companies clearly provide that they must provide needed transportation services during natural disasters.
For those facilities that do not need to evacuate, there are certain key areas to address. Facilities need to make sure that they have adequate back up generators should power be lost. Additionally, days prior to the arrival of a storm, facilities should ensure they have adequate medical supplies, food and medication for all of their residents. It is advisable to have a seven day supply of drinking water for all residents and employees. Communication should be had on a regular basis with families about the steps the facility is taking to ensure the safety of the residents and continuation of care. Depending on the impact of the storm, facilities may not be able to obtain needed supplies for several days.
Likewise, facilities need to thoroughly plan for adequate staffing during these events. In New York, the state health commissioner had mandated that nursing homes in Hurricane Sandy’s path have staffing at 150% of the normal rate to ensure continuity of care. Employees may be in need of transportation to the facility if public transit is shut down and facilities may need to consider putting together sleeping areas for employees so they can stay at the facility if roads are impassable or travel is not advisable.
There is much more to emergency preparedness than having a written plan. The plan needs to take into account the various contingencies that may arise in the event of a natural disaster and should thoroughly address coordination with state and local authorities. Adequate training of employees is paramount to ensuring a cohesive emergency preparedness plan.