The right move

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The right move
The right move
When Hurricanes Katrina and Rita hit the Gulf Coast two-and-a-half years ago, reality also struck for the nursing home community. The long-term care field not only learned about the devastating impact of natural disasters, it also confronted its vulnerabilities in those situations. The realization that nursing homes, and nursing homes alone, need to be responsible for their own evacuation transportation was a major take-away.  

“The lesson learned is not to rely on other people – neither the government nor contracts,” said Scott Crabtree, executive director of Lambeth House, a continuing care retirement community located in New Orleans. 

That realization, painful as it is, has actually led to some positive developments. For one, it has mobilized the long-term care community to sharpen its emergency preparedness protocols. Providers' complaints about the current system also have forced the federal government to take notice of an industry that previously lurked under the emergency preparedness radar. 

“We know so much more than we knew in 2005,” said LuMarie Polivka-West of the Florida Health Care Association, a key national preparedness leader. “At the same time, we are respectful of the fact that there are never enough resources to get what you need.” 

National attention

One hallmark of the industry's maturity regarding emergency preparedness occurred in October when representatives from long-term care, the Department of Health and Human Services and the transportation industry met in Boston to discuss how to improve coordination of transportation services. 

It was the first time the national transportation industry and the long-term care industry met on this issue, noted Victor S. Parra, president and chief executive officer of the United Motorcoach Association.  

“That was an important first step,” Parra said. “What it's going to take is a relationship and an understanding – a relationship in terms of making sure equipment is available and an understanding of what the unique needs are of nursing home and assisted living patients.” 

Much of the meeting involved information gathering from both sides. Nursing homes, for their part, learned that the transportation business, not unlike the long-term care field, operates on narrow margins. Facilities, therefore, cannot expect to establish an agreement with a bus company in the event of a disaster and expect the company to keep its buses on hold until a facility needs them. Transportation company-facility agreements were a discussion point during the meeting. 

Noted prominent attendee, Peter J. Pantuso, president and CEO of the American Bus Association: “We will try to work together as the long-term care and motor coach industry to devise a sample agreement to put into place the things we learned from each other and the things that both sides have to deal with on a daily basis.”   

State action

As providers are working on the national scene, several states also have done their due diligence. Louisiana, where transportation plans most obviously ran amok, established legislation that outlines the rules regarding evacuations and a nursing home's role. 

Some of the new protocols:
• A facility evacuates if the parish orders a mandatory evacuation.
• The Department of Health and Hospitals must review facilities plans.
• The parish and state will step in to assist if bus agreement collapse. 

“I think we're about as well prepared as we can be,” said Joseph Donchess of the Louisiana Nursing Home Association. “Nursing homes have agreements with bus companies. The only question is how will it function in a real-world situation.”

Playing a part

Like states, transportation companies also are getting up to speed, though some told McKnight's they are not running their businesses differently as a result of nursing homes' emergency preparedness needs.

“When they tell us we want a certain number of buses at a particular location, we'll get them there,” said spokesman George Graveley of Dallas-based Coach America, the largest tour, charter and contract bus company and a key contractor with the Federal Emergency Management Agency (FEMA).

South Grafton, MA-based Atlantic Turtle Top said it also is also doing its part. It has told its customers they can list Turtle Top as a resource for assistance in the event of an emergency. It always has vehicles in stock, noted Vice President Bill Flynn.

“This is a family business,” Flynn said. “It would probably be me behind the wheel or my father or my brother.”

Roadblocks ahead

Despite progress on the planning front, there is palpable frustration among the long-term care provider community about ongoing concerns, largely the seemingly insurmountable problem of limited resources. While facilities may have contracts with transportation companies, those companies likely have contracts with other customers, and long-term care facilities may be left out of the loop.

“Transportation really is an Achilles' heel because there really aren't enough assets,” says Janice Zalen, director of special programs for the American Health Care Association. 

Another point of contention is the nursing community's previous exclusion from national preparedness efforts. The national response plan so far has not included nursing homes. As a result, facilities have been left to rely on their own fleet – typically one or two medically-equipped vans. 

Thanks to the transportation summit in October and the work of a national workgroup, which includes Polivka-West, however, there is more understanding of how facilities can improve their chances of securing transportation. These include scouting out the proper contract companies and establishing relationships with their local governments. (See  sidebar on previous page.)

“The challenges are still the same, but at the same time, there is now a recognition that there is more of a sense of responsibility in the federal, state and regional network for the special needs population,” Polivka-West said. 

Katrina's impact

There is no question that Hurricane Katrina left an indelible impression on long-term care and the transportation industry. 

“It pains me as an individual and even more as a transportation professional,” said Jack Burkert, a consultant and veteran of the passenger transportation industry. “In some ways, I think people thought they had a system in place and they didn't look really hard at it.” 

The transportation fiasco amounted to a “total communication breakdown,” said Pantuso of the American Bus Association.  I think in the wake of that, it has been rectified and fixed.”

Providers such as Lambeth House's Crabtree, who endured an evacuation and criminal activity, are not prepared to wait and see.

He has two evacuation sites in Baton Rouge at the ready. He has his own vehicles. And if worse comes to worst, he has an agreement with an ambulance company, and access to a school bus. 
Beyond his transportation plans, he has no shortage of supplies. These include a generator that is 13 feet above sea level and can run 10 days without refueling. Preparedness also includes food for 30 days. If he has learned anything, it is not to take much for granted: “After Katrina, you don't know anything for sure,” he said.

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Evacuation 101

Tips for lining up transportation in advance of a disaster

 -Know your residents. Identify their acuity levels. That will help determine the type of transportation you will need.
 -Be a partner with the local emergency preparedness department. Once you establish contracts with transportation providers, run those contracts by the department for review. It should find out if the company will be able to accommodate your needs or is already overly committed. 
 -Establish a relationship with a local transportation association. 
 -Keep costs in mind. Decide what you are willing to spend for an evacuation contract with a transportation company. Talk to state transportation association about reasonable amounts.
  Consider talking to local churches or schools about using their means of transportation if necessary.

Source: McKnight's interviews with transportation and long-term care experts, 2007„

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Planes, trains & automobiles

Transportation options to consider in the event of an evacuation

Cars: Make use of staff vehicles, if possible. Families may be able to pick up residents. 

Buses: Contract with a local bus company – but make sure the company is viable and has your interests at heart. Consult with the local emergency preparedness agency about the company. To find out about ratings of bus companies, go to the Department of Transportation's Web site, http://www.dot.gov. 

Vans: For nursing homes that own vans, make sure maintenance is up to date, that proper equipment is in place and licensed drivers are available.

Trains: Facilities near passenger train stops, such as Amtrak, could arrange for transport via train, according to experts at a hurricane summit that took place in May in Florida.

Planes: Chartering might not be out of the question – for fully functional residents.  

Source: McKnight's interviews with transportation and long-term care experts, 2007
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