Flirting with disaster

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
Having once slept through a 6.7-magnitude earthquake, driven blithely through snowstorms and regularly horrified my Kansas-born husband with my lack of knowledge about tornadoes, I am far from an expert on natural disaster planning.

But I do know it's a topic that long-term care operators need to spend some more time on.

(As a quick disaster-planning aside, I can tell you that I don't advise doing what one manager did before a snowstorm hit a hospital where I once worked: At a planning meeting, she mentioned the likelihood of having to put doctors “to sleep.” I briefly thought we were going to have to euthanize some of our docs if things got tough, not just mandate naps. Oh, I also don't recommend making Wizard of Oz-related jokes to people from Kansas. They apparently have heard them all.)

On Monday, a disturbing report from the Department of Health and Human Services' Office of the Inspector General was released. It indicates that there's a reason to perk up your ears when it comes to emergency plans.

When OIG inspectors showed up at 24 nursing homes — all of which HAD ALREADY BEEN AFFECTED BY AT LEAST ONE DISASTER, such as a hurricane, flood or wildfire — what they found was deeply troubling.

Technically, the majority had met federal requirements for written emergency plans. But these plans — one of which was written on a legal pad, according to the widely disseminated Associated Press report — took a casual approach to what is mentioned on the Center for Medicare & Medicaid Services' emergency preparedness checklist.

For example, 22 out of 24 plans did not include backup plans for staff unable to report to work during the disaster. A third did not specify methods for identifying residents after evacuation, i.e. using wristbands or name tags. Eleven plans did not specify what personal information must accompany residents during an evacuation. Almost all didn't have a transportation plan.

Let's put aside the fact that common sense would tell us that even a mild weather event could knock out critical staff members' ability to show up. Or that cognitively impaired residents might not be able to tell anyone who they are in a disaster's aftermath. Or that figuring out how to transport a resident in a wheelchair out of harm's way might be worthwhile.

But it gets worse: How does one explain that not one of the plan authors had calculated the amount of water needed to ensure sufficient supply for a week, as is mandated? Or that 22 facilities had no plan for how to get extra medical supplies or equipment?

It can seem like a waste of time to plan for a “what-if.” And the inspectors acknowledged they were looking at a small sample. This isn't meant to slam an entire profession. Certainly one Dallas nursing home has received justifiable praise in saving the majority of the residents from injury during a recent tornado. The majority of the time, however, no one hands out awards for creating a comprehensive emergency plan.

But the bottom line is, as noted by the OIG, not much has changed since a 2006 report after Hurricane Katrina, where dozens of nursing home residents died, 35 of them at one facility alone.

CMS and the Administration on Aging have said they're going to review and update emergency checklists, and that they plan to develop model policies that protect residents.

In the meantime, I'm afraid, it's up to you to plan your emergency work and work your emergency plan.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.