Nursing Home Emergency Preparedness for Extreme Weather
The public was aghast at a viral photo of Texas nursing home residents sitting in waist-deep water after Hurricane Harvey. While the elderly residents were eventually rescued — and the nursing home had followed the instructions of local authorities to shelter in place — the image reminded all of us that surviving a storm is only the first step. Nursing home emergency preparedness for the days and weeks following an extreme weather event requires just as much forethought and effort as weathering the storm itself.
This fact was tragically illustrated in the aftermath of Hurricane Irma a few weeks later, when Florida nursing home residents who had survived winds and floods died from heat caused by a lack of air conditioning in the days after the storm. Nursing homes and other long-term care (LTC) and skilled nursing facilities must use the lessons from the 2017 hurricane season to ensure that their patients, staff and facilities are better prepared, during and after a disaster.
A study of the healthcare emergency preparedness and response after Hurricane Sandy revealed that 89 percent of hospitals reported challenges with resource allocation, community collaboration and power failures. While not every negative outcome can be avoided, healthcare facilities can review and improve emergency preparedness plans.
Nursing home emergency preparedness: Sheltering in place
It’s easy for social media onlookers to ask “Why didn’t they evacuate?” Those responsible for emergency management in nursing homes understand that the choice to evacuate or shelter in place is a difficult one given the fragility of some of nursing home residents and their substantial dependence on medical hardware, prescription medicines, and treatment of critical conditions. Limited transportation or hazardous conditions can also prevent evacuation.
The Centers for Medicare and Medicaid (CMS) emergency preparedness rule notes that many Gulf State facilities lacked the provisions to meet the needs of those taking shelter there for an extended period after Hurricane Katrina. Following a careful risk assessment, some nursing homes, senior and elder care facilities, continuing care retirement communities (CCRs) and other long-term care facilities may decide that they must be prepared for the subsistence needs of staff and patients through a storm and for several days following. In addition to documenting inventory, nursing homes should be aware of what additional support can be provided by local, state or regional agencies, and have multiple solutions for contacting them.
Few nursing homes can store all necessary resources for an extended period of sheltering in place, but all facilities should have a clear plan for where they will get resources and how to reallocate them as conditions change.
Nursing home emergency preparedness: Plan for power
The problems created by an ongoing lack of electricity in a nursing home are extensive. Apart from the medical support devices powered by electricity, basic needs like lighting to prevent accidents, refrigeration for supplies and medicines, elevators for transporting non-ambulatory patients, and heating and air conditioning to maintain safe temperatures are threatened by power outages.
Most healthcare facilities have some form of alternate power source, such as one or more generators. While CMS removed its enhanced generator testing requirement from its emergency preparedness final rule (as well as the proposed requirement to keep an onsite fuel supply), maintaining and testing alternate power sources will be crucial to minimizing risks. In addition, nursing homes may want to re-evaluate the facility’s emergency power needs during annual updates to its emergency plan, to ensure that alternate power sources can match current usage levels.
Nursing home emergency preparedness: Collaborating with community partners
Creating an emergency preparedness plan for sheltering in place that ensures adequate resources and alternate sources of power will depend heavily on a facility’s location and surrounding community. Even in the same geographic region, a nursing home in a heavily populated area will have different needs than a facility in a distant exurb or rural area. To a large extent, a nursing home’s emergency preparedness needs will depend on the availability and proximity of community partners.
Prioritizing the ability to collaborate — for example, through robust communication tools and full-scale and table top drills with other healthcare facilities and emergency management agencies — is a crucial next step for many nursing homes, senior and elder care facilities, continuing care retirement communities and other long-term care facilities. Once the worst of the storm has passed, a nursing home’s ability to reach out and request or offer assistance will determine how a facility endures an extended period of reduced operations.
Nursing home emergency preparedness: Trying to anticipate the unexpected
Severe weather events can be catastrophic because it is impossible to predict the impact they will have and how long that impact will last. Healthcare facilities such as nursing homes, senior and elder care facilities, continuing care retirement communities and other long-term care facilities must prepare for the problems they can anticipate, and develop emergency preparedness plans so that communication, collaboration and training will mitigate the damage from the inevitable occurrence of the unexpected.
- CMS Emergency Preparedness for Nursing Homes and Long-Term Care
- More blog posts about how to improve emergency and everyday communications in long-term care, including nursing homes, continuing care retirement communities (CCRCs, extended care, institutional care, and senior/eldercare facilities.
- Demo: Streamline Emergency and Everyday Communications for Long-Term Care
- Webinar series: CMS Emergency Preparedness for Long-Term Care
- Take the self-assessment quiz now.