As Florida prepares for yet another hurricane, it serves as a reminder that nursing homes in the area, as well as in other regions prone to extreme weather events, face rising risks and must maintain continued vigilance in following and developing rigorous emergency preparedness plans.
Research highlights that older adults are particularly vulnerable during climate-related emergencies due to factors such as chronic health conditions, mobility issues, and cognitive impairments. These vulnerabilities can severely limit their ability to respond to disasters independently, according to Natasha Bryant, senior director of workforce research and development at LeadingAge’s LTSS Center.
For instance, during natural disasters, many older adults may require medical equipment reliant on electricity, making power outages life-threatening, and often facilities aren’t adequately prepared, she said.
And although a national framework has been established to safeguard citizens from climate-related disasters, the emergency response system does not fully address the unique challenges faced by older adults during such events, said Bryant, who is co-author of a chapter in a new book titled, Climate Justice and Public Health.
Bryant points out that public health departments often overlook older adults in their planning, with federal regulations having been weakened recently. Meanwhile, staff at organizations feel unprepared due to a lack of training in developing effective preparation and response strategies.
“One of the things we’ve been seeing more of during these natural disasters and events is that people are not really thinking about the needs of older adults,” Bryant told Skilled Nursing News. “Government agencies have emergency preparedness plans, but a lot of times there’s nothing specific to the older adult population. Even the public health departments are not necessarily thinking about what are some of the needs of those older adults.”
The Centers for Medicare & Medicaid Services (CMS) introduced an emergency preparedness rule in 2016, which mandates that nursing homes develop comprehensive disaster plans, conduct staff training, and test their policies to ensure they are ready to implement them in a crisis.
However, enforcement of these requirements has varied, raising concerns about the actual readiness of facilities across the country.
The state of preparedness in nursing Homes
As a result, many nursing homes still lack effective relocation plans tailored to the needs of older adults. Inadequate planning can lead to dangerous situations, as seen in previous disasters where older residents were moved to unsuitable shelters that could not accommodate their specific health requirements, Bryant said. Specialized shelters for older adults exist but are not always used, leaving some facilities to manage the crisis independently.
A significant barrier to effective emergency preparedness is often financial, she said. Many nursing homes operate under tight budgets, making it challenging to allocate resources for comprehensive staff training and emergency supplies. Insufficient staff training exacerbates this issue; even when policies are in place, a poorly trained workforce may struggle to execute them effectively during high-stress situations.
“One of the challenges is funding. Our providers have a lot of expenses, and resources are tight,” Bryant said. “I don’t know if CMS is providing any money in terms of the staff training [for the plans], but then that is an additional expense and resources that the facility would have to come up with to support it … That is another area that [CMS] could support.”
Lessons learned over two decades
In Houston, where the threat of extreme weather is ever-present during certain seasons, Barry Goldstein, CEO of Seven Acres Jewish Senior Care, said facilities have evolved over time and are now able to safeguard their vulnerable residents against climate-related events. That said, more needs to be done.
Goldstein recalls a time when nursing homes were largely unprepared, operating on loosely defined plans that fell apart in real crises.
Prior to 2001, the threat from climate change wasn’t as serious as it is today, he said, and the true moment of change began in 2017 with Hurricane Harvey.
“[Back then] you got things done, but [climate-related contingencies] weren’t taken very seriously by anybody until Hurricane Allison [in 2001],” Goldstein said. “[The industry] became a little more focused, and then the surveying began.”
The challenges began to intensify, but it was the catastrophic impacts of Hurricane Rita in 2005 and Hurricane Ike in 2008 that truly reshaped disaster protocols, he said.
The lessons learned from these storms – and more so Hurricane Harvey – have led to significant improvements in how nursing homes like Seven Acres prepare for emergencies.
Central to this evolution is the recognition of the importance of well-written plans, said Goldstein, emphasizing that having a detailed evacuation strategy is essential, especially in Texas.
During Hurricane Ike, for instance, a slow evacuation order from Galveston left many facilities stranded as the storm approached, he said. It highlighted a crucial gap in coordination between nursing homes and local authorities, which has improved now, he said.
Staff training and leadership
Goldstein’s organization now prioritizes training staff and conducting regular drills to ensure everyone knows their role in an emergency. These “tabletop exercises” simulate real-world scenarios, helping teams practice communication and logistics in preparation for potential disasters.
“If you know a hurricane is coming, you need to take action days in advance,” he said, highlighting the importance of timely decision-making.
Moreover, effective communication between nursing homes and local emergency services is another pillar of Goldstein’s successful approach.
With initiatives promoted by the SouthEast Texas Regional Advisory Council (SETRAC), facilities are now able to coordinate with public health, EMS agencies, home health and hospitals and other organizations. This collaborative framework has transformed how nursing homes respond to emergencies.
“We’ve built a consortium that runs drills to identify weaknesses in our disaster plans, and fix gaps at each of the facilities based on the action report, and to get their staff involved,” Goldstein said.
Such steps make facilities far more resilient to climate change and extreme weather mishaps. They are able to address important issues related to infrastructure.
Nursing homes should also be aware that they need to invest in backup power systems, transportation and communication systems during evacuation, and practical needs such as stocking up on enough fuel and supplies to ensure they can operate during emergencies, Goldstein said.
“We’ve just had organized drills related to power loss and floods,” he said. “[We asked:] ‘How can we improve? What do we need to do?’ And if I say, ‘I didn’t have a vendor to refuel,’ then the plan wouldn’t work. Then, I know I need to get one before the actual disaster happens.”
For Seven Acres, current emergency preparedness plans include having a dedicated generator and adequate emergency supplies stocked well beyond the minimum requirements.
In addition to physical preparations, Goldstein highlights the importance of fostering a culture of leadership at all levels.
“A leader doesn’t need a title,” said Goldstein. “There may be a nurse aide who understands command and control, and who could separate noise from the mission at hand.”
In the end, this mindset encourages every staff member to contribute to disaster readiness, reinforcing a collective responsibility toward residents’ safety.
And while Goldstein is optimistic about the progress made since the dangerous hurricanes of the past, he acknowledges the reality of climate change presents unpredictability and ongoing challenges. Each year brings new lessons, and as weather patterns shift, nursing homes must adapt continuously, he said.
As nursing homes brace for the set of next storms, features of an emergency preparedness plan facilities should consider including are risk assessment of the facilities, warning communications, sheltering arrangements, resource management, adequate medical supplies and training and education of staff, he said.
And, one feature often overlooked in disaster plans, but ultimately most important, is to not only have a strong leadership on the ground, but a way to acknowledge their effort, Goldstein said.
“Disaster plans talk about the eight essential parts. I would say there is a ninth one, and it is to reward your staff. Because if you don’t reward your staff, why would they do it next time?”
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