A recent government report identified that nursing homes in 17 states are underprepared for extreme weather emergencies. The report’s findings were backed by a series of independent watchdog audits, which reported that short-staffing at facilities and the state agencies that oversee them is linked to inadequate preparation for such emergencies.
Legislators have called for nursing homes to develop more robust emergency plans that are more rigorously reviewed by Centers for Medicaid & Medicare Services (CMS), along with recommendations for increased funding to train staff to execute better emergency plans.
Jason Belden, CAHF’s Director of Emergency Preparedness and Physical Plant Services, said that in order for nursing homes to be better at emergency management, facilities need a full-time, funded position dedicated to the role.
“It’s a full time job at a hospital,” he said. “And the federal government has paid each hospital across the country to staff those positions for well over a decade, since 2003. And so when we look at how we get the skilled nursing facilities to have the same competence as an acute care hospital during a disaster and be able to stratify risk appropriately and be able to have all the appropriate plans in place in order to do that, it does require some expertise.”
Belden said that often nursing homes don’t have enough time to be able to approach every single component of the emergency preparedness plan.
“The question is, how can we get these providers to take the appropriate actions during disasters? And that’s what we’re concentrating on is connecting providers with the appropriate resources, allowing them to understand how to maintain continuity of care,” he said.
Staff turnover
Doug Farmer, President & CEO of Colorado Health Care Association, said the challenges operators face in the state are primarily around keeping emergency plans up-to-date in light of staffing challenges and high turnover rates.
“You can set a great plan, you can work a great plan, but if you have a lot of staff turnover, you have to continue to drill and you have to continue to make sure that everybody in the building understands the plan otherwise,” he said. “All the best laid plans aren’t very useful unless everybody understands what they are in and knows what to do when disaster strikes.”
Jenny Albertson, director of Quality & Regulatory Affairs at Colorado Health Care Association, said the most common feedback she hears from operators regarding survey citations is that they are not able to keep temporary staff completely trained on emergency preparedness plans.
“If you have temporary staff, you have to go through a pretty extensive orientation to meet survey standards,” she said. “And that is one that we hear about quite often. So it’s not that the emergency plan is inadequate. We hear nothing about that pretty much. But it is largely related to constant education and drilling to get people to answer surveyors appropriately upon quizzing.”
Albertson said CHCA does a hazards vulnerability analysis once a year to rank and determine all natural and manmade disasters based on location, for example, if a facility is close to a nuclear power plant.
“It’s very specific to the hazards that are adjacent and within the close proximity of that community,” she said.
Coping with power outages
Among states cited in the the Senate Committee on Finance and the Senate Special Committee on Aging report, California was cited as having high emergency deficiencies related to power outages. Yet, Belden said that despite the citations, there are many examples of power outages with little or no negative impact in the state.
“We’ve had a requirement to have emergency power for more than two decades and every skilled nursing facility in our state,” he said. “So when I looked at the report, and it’s predominantly driven by loss of power…we have thousands of examples of long-term power outages in our state with very little to no negative outcomes. So there is a dichotomy between what happens in certain other states based on the regulatory minimums,” Belden said.
Belden said about 100 to 200 providers every year that go through power outages, anywhere from about 12 to 96 hours. Yet, he said that utilities have gotten significantly better in the last few years and are prioritizing long-term care facilities to be restored.
“In the last five years, I’m aware of one facility that had a generator failure during the outage,” Belden said. “Outside of that, I’ve not seen any negative outcomes and certainly haven’t had any negative patient outcomes. Belden does concede that facilities might need to update their equipment.
In Florida, Kristen Knapp, Senior Director of Strategy & Communications for the Florida Health Care Association, said that strong relationships with our regulatory agencies and local emergency managers have helped the state remain ahead of the curve when it comes to emergency preparedness.
“We have hurricanes, so we do year-round planning and preparing for that and at FHCA we have a very active and engaged Life Safety and Emergency Preparedness Committee that is made up of nursing home administrators and operators from around the state,” she said.
As for what features contribute to improved emergency preparedness at nursing homes, Belden said there are three major components: maintaining and managing their space, processing and managing staffing during emergencies, and maintaining supplies.
“So we need those three things, specifically,” he said. “Without them, providers are going to really struggle during disasters.”
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