Disaster preparation plans should not necessarily count on skilled nursing facilities to handle additional patients that hospitals cannot accommodate, according to newly published findings.
Emory University researchers analyzed SNF and hospital admission and discharge data from Hurricane Katrina and the Midwest floods of 2008. Skilled nursing facility discharge rates declined during both Katrina and the floods, the study authors determined by looking at Medicare data from facilities in the disaster zones. Hospitals discharged more people to other hospitals but not to SNFs during those events.
The Centers for Disease Control and Prevention and numerous states have disaster plans that list SNFs as “alternate care sites” that can “expand” the system by admitting hospital patient overflow, the authors noted. However, the admissions and discharge data show that this is not how skilled nursing facilities functioned in the “real world” disasters that they studied.
“Nursing homes face challenges providing care to their current residents during disasters,” they wrote. “They are probably reluctant to accept new patients, especially patients with complex medical conditions that require extra staff time and/or specialized medical equipment and supplies.”
Given this reality, disaster planning should not assume that hospitals can “free up bed space” by shifting patients to SNFs, particularly during emergencies that also compromise nursing homes’ ability to provide services, the investigators stated. Instead, planners should consider that SNF and hospital discharge rates are likely to go down during a disaster because fewer patients can go home and other facilities may not be willing to accept transfers.
To address the potential difficulties in caring for new patients during a disaster, planning needs to take a “systems perspective” that more closely examines how inter-facility transitions could occur, the researchers recommended. Highlighting that stakeholders too often overlook this issue, they cited prior research showing that only 20% of hospitals included long-term care facilities in mass casualty drills as of 2008.
Full findings are forthcoming in Health Systems and have been published online ahead of print
