How Nursing Homes Could Benefit From Having a Seat at the Table in Community-Wide Disaster Planning

After more than 200,000 nursing home residents and staff died in U.S. nursing homes over the course of Covid, disaster planning has taken on new meaning for the sector.

For Michael Wasserman, a geriatrician and the former CEO of California nursing home giant Rockport Healthcare Services and University of Chicago Professor R. Tamara Konetzka that reemphasis needs to start by better integrating the long-term care sector into local, state and federal public health planning.

“The tragedy that has unfolded in nursing homes during the Covid-19 pandemic is a systemic failure,” Wasserman and Konetzka wrote in a report published in Health Affairs this month. “At this time, nursing homes are not well integrated into governmental disaster planning.”

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An integrated public health approach that includes nursing homes as part of the overall health care system could help guide evacuations, better allocate resources across health care sectors and facilitate communication moving forward, the authors proposed.

Being involved in disaster planning could ensure that some of the challenges that arose with coordinating resources, especially early on in the pandemic, are not repeated. This includes allocating personal protection equipment (PPE) and Covid-19 testing to long-term care facilities.

“Early in the pandemic, federal policy makers left states and health care providers to compete with one another for limited supplies of PPE, leaving front-line staff frustrated and stressed,” the authors wrote. “Similarly, federal policy makers failed to ensure adequate testing capacity. As a consequence, early testing was focused on symptomatic individuals, and test results took days to be returned, which was a disaster for congregate settings such as nursing homes.”

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Hospitals were also “prioritized” over nursing homes when it came to testing and PPE.

As the pandemic progressed several states upped their efforts to help nursing homes, with some providing surge teams to help with staffing during an outbreak, but Wasserman and Konetzka argue that earlier integration could have been beneficial.

“From the outset of the COVID-19 pandemic, it has been clear that policy makers expected nursing homes to act largely on their own to mitigate the effects on residents,” they wrote.

Programs that already exist, such as the state ombudsman, could be used to facilitate the integration of nursing homes into community disaster planning.

Nursing home leadership is also a critical element for an effective emergency response, the authors noted.

One way to improve how nursing homes respond to emergencies going forward is to ensure that leadership is involved and prepared throughout the process. That may include enacting policy to better regulate and track that nursing homes are effectively training facility leadership for the rigors of dealing with a disaster.

Studies have indicated that only 30% of administrators felt that they were well prepared for their job while others have questioned the leadership training and preparation that directors of nursing go through, particularly in relation to emergency preparedness and response.

Wasserman and Konetzka suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management to better integrate the long-term care sector into public health planning.

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