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While most U.S. nursing homes have adequate written plans for managing natural disasters, many facilities have significant gaps in preparedness and response, a government report finds.

In its analysis of federal nursing home compliance data and interviews conducted during site visits, officials from the Department of Health and Human Services’ Office of the Inspector General noted that emergency plans lacked crucial information, including only about half of the tasks on the Centers for Medicare & Medicaid Services checklist. Investigators evaluated facilities’ response plans for natural disasters including hurricanes and wildfires.

“Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems,” the report states. “LTC ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters.”

The report provided CMS with three primary recommendations: it said the agency should revise federal regulations for emergency management and training; update the State Operations Manual with guidance for state surveys; and promote the use of emergency checklists.

Preparation was seen as the key to preventing deaths during a recent Texas tornado that hit a nursing home.

Click here to read the full report.