A staggering number of nursing homes reported challenges in meeting the care needs of their residents during public health emergencies and natural disasters due mostly to inadequate staffing, with transportation, communication and infection control and prevention also being among key areas hampering these efforts.
This is according to the latest report issued Wednesday by the Office of Inspector General (OIG).
“Nursing homes explained that some of the challenges associated with emergencies were rooted in broader staffing shortages that existed year-round and were compounded by the Covid-19 pandemic. Some nursing homes described ongoing difficulties with staffing shortages, such as having to rely on external staffing agencies to fill vacancies, which is very expensive,” OIG’s analysis noted. “These underlying staffing challenges raise concerns about how nursing homes will be able to effectively respond to an emergency.”
These findings are based on a survey OIG conducted in June 2022. The survey results show that an estimated 77% of nursing homes located in areas at greater risk for natural disasters reported experiencing challenges with emergency preparedness activities, and yet despite the concerns, nursing homes did manage to fulfill emergency requirements set forth by the Centers for Medicare & Medicaid Services (CMS).
“We found that even those nursing homes that meet the Federal requirements for emergency preparedness face challenges with critical aspects of emergency preparedness,” OIG’s report noted.
Staffing is a major obstacle
Among the top concerns cited by nursing home administrators across seven topic areas, the biggest challenge had to do with activities related to ensuring proper staffing during emergencies. Moreover, an estimated 62% of nursing homes reported at least one challenge regarding staffing. Among concerns posed by staffing, burnout among workers and commitments from workers to assist with evacuations led the list.
Other challenges
Besides staffing, key problems identified by nursing home administrators include staffing, transportation and communication as well as securing beds for evacuees and planning for infection control and quarantine during emergencies, with half or nearly half of all nursing homes surveyed citing concerns in these areas.
With transportation, 50% of nursing homes reported at least one challenge with establishing agreements with transportation companies.
And, nearly half of nursing homes reported at least one challenge related to developing and maintaining a comprehensive communication plan with community partners, staff, and family members of residents is critical for ensuring continuous care for residents during emergencies, with the most cited challenge being lacking an alternative means for communicating during an emergency such as a satellite phone in the event of phone or email service disruption. Many nursing homes also had problems obtaining advanced equipment, such as an automated emergency notification system for contacting interested parties.
Moreover, almost half of nursing homes reported at least one challenge in planning for infection control and quarantine during emergencies, with about 44% of nursing homes reporting difficulty developing infection control and quarantine protocols for emergencies. Also, an estimated 36% of respondents reported challenges with preparing to isolate contagious residents during transport or at a receiving facility. Facilities also had a hard time tracking resident exposures to contagious infections that occur during emergencies.
OIG also noted that only 24% of nursing homes in areas at high risk for disasters received a deficiency for not meeting emergency preparedness requirements during their most recent compliance survey.
Meanwhile, availability of community resources also contributed to the nursing homes’ experience with preparedness activities, with an estimated one in five nursing homes reporting difficulties coordinating preparedness activities with multiple community partners.
OIG’s findings were based on a survey of a random sample of 199 nursing homes located in geographic areas rated by the Federal Emergency Management Agency (FEMA) as having a very high or relatively high risk for natural hazards.
The survey, sent to nursing home in June 2022, asked administrators about 49 activities of emergency preparedness capabilities that are important for ensuring safety of residents during emergency events and asked them to rate these in terms of how much of a challenge they perceived it to be for their facility. OIG researchers then counted the top two levels—“major challenge” and “moderate challenge”— collectively as “challenges” and determined the prevalence of those challenges.
In all, OIG received responses from 168 nursing homes and projected the results to all 3,097 nursing homes in the FEMA risk areas.
