Nursing Home Disaster Plans Found Lacking

Evacuation was not necessarily the right decision for Gulf Coast nursing homes that faced a hurricane. A new report shows they experienced a range of problems, including transportation agreements that fell through, long trips, and a lack of food, water and medicine.

Meanwhile, nursing home administrators who decided not to move residents reported fewer problems, particularly when it came to the health of the residents, according to the report by the inspector general for the U.S. Department of Health and Human Services.

The report called on the federal government to strengthen certification standards for nursing homes' emergency planning.

The inspector general reviewed 20 nursing homes along the Gulf Coast in areas where hurricanes struck in the past few years. Thirteen evacuated. Seven did not. The report did not identify the homes by name or location.

Although the IG found fewer health problems when nursing homes did not evacuate, it is clear that the homes' administrators faced a difficult decision. Not addressed in the IG's report are 56 deaths at two Louisiana nursing homes that failed to carry out evacuation plans during Hurricane Katrina.

While Hurricane Katrina was the most devastating of recent hurricanes, the IG's investigators also included Hurricanes Ivan, Rita and Wilma in their review.

The nightmarish experience of one nursing home went like this:

The company that had contracted with the nursing home to provide transportation was unavailable. Less than a quarter of the nursing home's employees were able to evacuate with the residents. Staff members and borrowed cars were used to cobble together a nine-vehicle convoy. Roads were clogged, and two vans broke down. Water, food and medicine were scarce during what was supposed to be a two-hour trip.

"Residents arrived at the camp after 19 hours in transit. All survived, but several were treated for cuts and bedsores resulting from the trip," the report said.

Federal law requires that nursing homes receiving Medicare and Medicaid funds have written plans to meet potential emergencies. The homes also must provide training to employees in emergency preparedness.

Nationally, 6 percent of the 16,125 nursing homes surveyed in 2004 and 2005 were cited for planning deficiencies. Twenty percent were cited for training deficiencies.

All of the 20 homes reviewed had been listed as meeting federal requirements on their most recent state survey, but a closer inspection by the investigators showed numerous planning weaknesses. Six of the 20 did not have instructions for evacuating to an alternative site, and nine did not have criteria for making the decision to evacuate or stay. Also, 15 did not have information about the specific needs of residents that would allow the staff to modify plans according to those medical needs.

The Centers for Medicare and Medicaid Services (CMS), which oversees nursing home certification, agreed with the need to strengthen certification requirements, and a review of guidelines had begun before the investigators issued their report.

"The OIG report is extremely helpful as we complete this review," CMS Administrator Mark McClellan said.

The investigators also recommended that state and local governments be encouraged to collaborate more when it comes to emergency planning for nursing homes.

-- Associated Press