Are Nursing Homes Ready for the Next Natural Disaster?

“For the most part, providers are more prepared to deal with emergencies since Katrina, but what happened in Florida shows us that emergency preparedness plans need to be actionable and implemented effectively,” says Lori Smetanka, head of the National Consumer Voice for Quality Long-Term Care.

A recent review of federal records found that nursing home inspectors issued 2,300 violations of emergency-planning regulations over the past four years nationwide. Nearly 1,400 nursing facilities were cited for neglecting upkeep on emergency power generators.

Merely requiring elder-care operators to file emergency preparedness plans won’t change that, says David Marcozzi, M.D., former director of the federal government’s National Healthcare Preparedness Programs. He says there’s not enough oversight or enforcement to make sure the emergency preparedness will actually work. 

“At most nursing homes, emergency preparedness is an afterthought,” Marcozzi says. “It’s not woven into the fundamental construct of how they conduct business and assure the health and safety of their residents.”

From paper to practice 

Florida state Sen. Gary Farmer says he’ll push for tougher regulations, such as surprise on-site inspections to ensure emergency preparedness plans work. “Part of the problem is the actual execution of these plans,’’ Farmer says. “It’s great to put something on paper. But do you have the proper equipment and training? Let’s do a drill, and see how you react. There’s a lack of meaningful oversight.” 

Genesis, which operates more than 450 nursing centers and assisted/senior living communities in 30 states, says emergency preparedness is woven into the fabric of the company’s operations. It makes good business sense and offers more security for residents. 

Emergency plans are required of each facility, tailored to the locale. Each covers a host of variables, such as backup power equipment, emergency supplies, medical deliveries and staffing protocols. Regular testing is part of the plan, as well; Genesis’ Ocala facility had just run through a power outage drill two weeks before Irma inundated the state with its unprecedented rains. 

While Texas officials recommended a shelter-in-place for most area residents and businesses in Harvey’s path, Genesis made the decision to evacuate facilities in danger zones. “If you can, shelter-in-place is better,” Hager says. “But given the enormity of the storms, I’m glad we made the decision to evacuate.”  

Genesis knows the impact of close regulatory oversight. In June, the company agreed to pay $53.6 million to settle allegations that facilities it had bought in 2012 or obtained in a 2015 merger had submitted false claims. Genesis denied the allegations, noting that the matters arose prior to the transactions. 

The recent natural disasters ushered in an all-hands-on-deck mentality at Genesis. Executives from regions outside the storms served as drivers, shuttling residents from evacuated facilities to safe locations. Extra buses and U-Haul trucks were rented where needed. Genesis also provided evacuated Texas residents with backpacks filled with several days of their medications, copies of medical charts and a change of clothing. Dozens of staffers left their homes and families to accompany evacuated residents. 

When the situation finally settles down, Genesis will take the lessons learned from Harvey and Irma to refine its disaster preparedness plans yet again. 

“We came through this without incident. In hindsight, we could have deployed even more resources to support people,” says Hager, who spent six days in Florida and Texas speaking with local workers to hear what worked and to glean suggestions for improvements. 

But until more operators take emergency disaster planning seriously, Farmer says, older people living in nursing homes are still at risk. “It shouldn’t be a surprise if something like this happens again,” he says.