ORLANDO, FL — How well-prepared is your nursing home in the event that a disaster strikes — be it an active shooter, hurricane, cybersecurity attack or outbreak of Legionnaires disease? One recent report says the healthcare field is much more equipped than five years ago for such circumstances. But long-term care is far from where it needs to be, field experts emphasized Monday.

Just last week, the Robert Wood Johnson Foundation released its National Health Security Preparedness Index, which measures the nation’s day-to-day readiness for addressing a health emergency. Researchers found that the U.S. scored a 7.1 on a 10-point scale. That represents a 3% uptick from last year, and almost 11% over the past five years.

But recent disasters, such as 2017’s Hurricane Irma and a deadly bacteria outbreak at one Illinois facility, show that long-term care still has a ways to go, said Mary Helen McSweeney-Feld, an associate professor of healthcare management at Towson (MD) University. The noted expert in long-term care emergency preparedness spoke Monday during a packed session at the American College of Health Care Administrators’ 52nd Annual Convocation and Exposition.

Too many, including her home state, are still just viewing this as a hospital-centric issue, she said.

“We have all of these wonderful resources now, but, folks, this is paper preparedness,” she said. “I’m not saying it’s bad, but it’s a whole different ball game from ever experiencing an event where you have to evacuate and then bring your residents back to your organization.”

The resources McSweeney-Feld referenced include the Centers for Medicare & Medicaid Services’ emergency preparedness requirements, which went into effect in November 2017, along with the corresponding checklist, and the “ASPR TRACIE” vulnerability assessment tools.

But Mother Nature, for one, has added new wrinkles to preparedness in recent months, McSweeney-Feld pointed out. In the wake of hurricanes Irma and Maria, Florida passed its own generator law for nursing homes and assisted living last month, which requires such providers to have an alternate power source in play. The estimated cost of compliance for Florida nursing homes alone over the next five years, she noted, is more than $121 million, with $22 million borne by Medicaid. Oklahoma is pursuing similar legislation for long-term care facilities.

Those hurricanes also compelled the evacuation of long-term care facilities in Texas, Florida, Georgia and the Carolinas. Despite the comprehensiveness of CMS guidelines, they still might not leave providers prepared for all of the events that can occur during an evacuation, said Philip DuBois, an author, consultant and speaker on long-term care administration issues.

He ticked off numerous instances in the past where a well-intentioned exodus can go bad, such as a nursing home evacuation after Hurricane Rita. Exacerbated by residents’ oxygen tanks, a bus fire and explosion killed dozens. Nursing home administrators must carefully weigh all factors when considering an evacuation — including emergency power sources, timing, safety of the evacuation route, transportation, number of residents, instructions from emergency management, and memorandums of understanding with partner agencies.

The bottom line, he said, is to let the type and scale of incident determine your evacuation response. Be aware of the gaps in risk management and let your plans evolve over time, and be alert to the possible negative impacts of evacuation on frail residents. DuBois pointed to research in Florida and other states showing that individuals with dementia have showed significant declines in condition following an evacuation.

In addition, don’t forget to practice, practice and practice some more, the experts urged about emergency procedures.

“Drill, drill, drill,” he said. “And after you’ve had a drill or a natural event, once the dust settles, go back to your emergency plan with a pencil and eraser and figure out what you need to update because, inevitably, there will be something that you can learn through that process. And it’s not just the management team that has learned those lessons. Debrief with your staff at large — everybody who had a role in it.”

The ACHCA convocation concludes Tuesday.