Nursing homes are in need of improving their emergency-preparedness plans to face extreme weather, a report developed by the Senate Committee on Finance and the Senate Special Committee on Aging shared Thursday.
In identifying extreme weather events that occurred in 17 states since 2018 that forced evacuations at long-term care facilities, or led to resident injuries and deaths, the report suggests that nursing homes were inadequately prepared for such emergencies. The report’s findings were backed by a series of independent watchdog audits, which pointed to short-staffing at the facilities and the state agencies that oversee them.
“This report should serve as a warning sign—as we experience more frequent and catastrophic climate disasters, long-term care facilities must be better prepared to protect residents living there,” said Sen. Bob Casey (D-Penn.).
The case of Texas, which faced snowstorms in February 2021 leaving millions of residents without power, was closely examined in the report. More than 500 nursing homes in Texas saw incidents, including electricity outages, water shortages and evacuations. Another 600 assisted living facilities reported being affected.
Highlighting findings by the Office of the Inspector General for the Department of Health and Human Services, the report also identified emergency preparedness shortfalls at nursing homes in eight states, including four nursing homes in three states—Florida, Illinois and New York— which had no emergency plan at all.
In issuing the report, legislators are calling for nursing homes to develop more robust emergency plans that are more rigorously reviewed by Centers for Medicaid & Medicare (CMS). Nursing homes can also benefit from greater coordination between power companies, health providers and health regulators. Lawmakers are directing CMS to adopt additional requirements that specifically require emergency power capacity to maintain safe temperatures.
Among the report’s recommendations is increased funding to train staff to execute better emergency plans.
“We’re willing to work with operators and people that are doing this because I know it is an expense. … I just, in good conscience, can’t say, you know, it’s not worth it,” Rep. Bennie G. Thompson (D-Miss.) said in the report.
Authors laid out policy recommendations which may affect skilled nursing operators nationwide.
The report identified that emergency deficiencies in multiple states were linked to widespread staffing shortages, difficulty retaining inspectors due to low salaries, widespread use of contractors to fill staffing gaps and the inability to conduct timely inspections due to short staffing.
“As one example, Colorado had difficulty conducting recertification surveys within required timeframes and explained that 15 of the 47 surveyor positions were vacant,” the authors wrote. “The corrective action plan cited long hours and low pay as the most common reasons for surveyor resignations, but a proposal was before the State legislature for a 3-percent salary increase, which it hoped would close the salary gap with the private sector.”
Indeed, federal lawmakers are pushing for salary increases for multiple healthcare professionals, which may result in increased federal funding for nursing homes.
Previously, Committee Chairman senator Casey secured $100 million in the Coronavirus Aid, Relief and Economic Security (CARES) Act to help survey agencies combat the COVID-19 pandemic.
Now, along with Sen. Ron Wyden (D-Ore.), Casey has called for a 25% funding increase for survey and certification activities in the Nursing Home Improvement and Accountability Act.
Beyond increasing funding for inspectors, authors advocated for mandatory minimum staffing standards supported by providing additional federal resources through Medicaid to increase wages and improve recruitment and retention of staff.
“Research has repeatedly linked low staffing levels in nursing homes to poor quality care and patient safety violations,” the authors wrote. “Increasing staff levels and reducing staff turnover would better equip nursing homes to respond to emergencies.”
The report also suggested that CMS should evaluate the feasibility of requiring nursing homes to provide residents and their families with copies of the facility’s emergency preparedness plan during intake, and once annually after the facility has completed the federally required update of its emergency plan, and evaluate the feasibility of posting emergency plans on Care Compare.
Nursing home advocates reaffirmed the findings of the report.
“The report findings released today provide further support for an already well-documented truth, as our LeadingAge LTSS Center research on the impact of climate change attests: older adults are more vulnerable to, and are at greater risk for the consequences of, climate change,” said Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services. “The increase in natural disasters highlights the need for and importance of proactive emergency preparedness – which includes sufficient staff, well-trained to execute plans that can save lives. Our mission-driven, nonprofit members share the Senators’ commitment to keeping older adults safe. We urge Congress and the Administration to address persistent workforce shortages and provide the funding needed to recruit, hire, train, and retain staff across the aging services sector.”
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