Massive power failures and widespread evacuations caused by severe weather should be taken as a “warning sign” that US nursing homes remain unprepared for emergencies and the coming effects of climate change, a new Congressional report says.

Senate Finance Committee Chair Ron Wyden (D-OR) and Senate Special Committee on Aging Chair Bob Casey (D-PA) on Thursday issued a 130-page investigative report examining emergency preparedness in long-term care facilities during a February 2021 winter storm that hit Texas and the Central Plains. That storm led to major electrical grid failure, water outages, the evacuation of at least 1,400 long-term care residents and the deaths of two assisted living residents.

“As the climate crisis continues to cause an increase in severe weather events, greater strain is going to be placed on those that care for the most vulnerable,” Wyden said. “This report is a case study of just one in an increasing number of circumstances where elderly or infirm Americans are subjected to difficult conditions due to severe weather. Whether it’s a winter storm, hurricane or wildfire, more must be done to ensure long-term care facilities are adequately prepared to handle these events and care for their residents.”

The Congressional report identifies weather-related long-term care evacuations in 17 states since 2018, highlighting emergency preparedness shortfalls in those events and gathering the findings of multiple audits in the same time period. It joins a growing body of evidence that shows more nursing homes and healthcare facilities are in danger zones as climate change leads to more erratic and dangerous weather, often in areas seen as sheltered in years past.

“This report should serve as a warning sign — as we experience more frequent and catastrophic climate disasters, long-term care facilities must be better prepared to protect residents living there,” Casey said. 

Among the report’s recommendations are:

  • Improving nursing home staffing: Senators used the findings as another rationale for a federal minimum staffing standard for nursing homes. But their summary also called on Congress to use provisions in the Nursing Home Improvement and Accountability Act of 2021 to use federal Medicaid resources to increase worker wages.
  • Adding inspection staff: The report called for increased federal funding for survey and certification activities “to ensure that nursing homes comply with federal quality and safety requirements, including emergency preparedness rules. States should ensure their survey agencies, which oversee federally certified health care providers, are able to offer competitive wages to recruit and retain inspectors.”
  • Increasing transparency: Senators called for a requirement that would grant families copies of a facility’s emergency preparedness plan and access to those plans on Care Compare.
  • Making planning more inclusive: “Federal, state and local governments should ensure older adults, people with disabilities and residents of long-term care facilities are substantially involved in emergency planning, response, mitigation, management, and recovery,” the report said, calling on Congress to pass the Real Emergency Access for Aging and Disability Inclusion for Disasters Act introduced last year.
  • Recognizing climate change risks: CMS should consider requiring nursing homes to incorporate climate change risks, such as the increasing incidence of extreme weather events, into emergency preparedness planning.
  • Ensuring equity in planning: The report said CMS should study factors including payer mix, racial and ethnic makeup and climate change risk to evaluate if emergency preparedness can be improved for people of color, people living in poverty, and people with disabilities who live in nursing homes.
  • Adding emergency power contingencies: The report noted that backup power is still not required by federal regulators. It said CMS should require emergency power capacity be capable of maintaining a “safe and comfortable temperature standard.” It also called for the incorporation of renewable energy resources.

LeadingAge President and CEO Katie Smith Sloan said the report builds on research her group has already conducted. 

“The report findings released today provide further support for an already well-documented truth, as our LeadingAge LTSS Center research on the impact of climate change attests: older adults are more vulnerable to, and are at greater risk for the consequences of, climate change,” Sloan said.

“The increase in natural disasters highlights the need for and importance of proactive emergency preparedness – which includes sufficient staff, well-trained to execute plans that can save lives,” she added, also assigning responsibilities back to lawmakers and the White House. “We urge Congress and the Administration to address persistent workforce shortages and provide the funding needed to recruit, hire, train, and retain staff across the aging services sector.”