OIG Report Highlights Emergency Preparedness Challenges for Nursing Homes

A report released by the United States Department of Health and Human Services, Office of Inspector General (“OIG”) on September 1, 2023, details key emergency preparedness challenges reported by nursing homes situated in areas the Federal Emergency Management Agency (“FEMA”) rates as having a very high or relatively high risk for natural hazards. The OIG says 77% of such nursing homes reported experiencing challenges with emergency preparedness activities. There’s just one hitch: The report is based entirely on the responses of 168 facilities to a survey and extrapolated to 3,097 facilities situated in FEMA high risk regions. Still, nearly 85% of the facilities surveyed by OIG were motivated enough to respond to the survey.¹ Thus, their responses are instructive in highlighting the practical challenges faced by nursing homes in planning for emergencies even if their specific experiences are not necessarily shared by all 3,097 facilities in the high-risk areas.

OIG surveyed facilities about 49 preparedness activities in seven categories, plus a catch-all category for other activities that did not fit within the seven topical categories. OIG admits that the activities are not delineated in CMS’s emergency preparedness requirements. In fact, although 77% of respondents stated that at least one of the activities constituted a challenge, only 24% received a deficiency for violation of the federal requirements during their most recent survey. Yet, OIG estimated that on average, homes that reported having challenges had issues with 14 of the 49 activities.

The categories and, within those categories, the activities that respondents cited the most are:

1. Ensuring proper staffing (62%)
   1. Receiving commitment from enough staff to assist with evacuations (both traveling to evacuation sites and caring for residents once there).
   2. Addressing staff burnout during an emergency.
   3. Broader staffing issues (e.g., reliance on staffing agencies).
2. Transporting residents during evacuations (50%)
   1. Difficulty establishing agreements with transportation companies and ensuring that they are not “double-booked.” This is especially problematic in rural areas.
   2. Insufficient number of vehicles and/or vehicles lacking in equipment necessary to transport residents with special needs.
3. Maintaining a comprehensive communication plan (45%)
   1. Ensuring alternative means for communicating during an emergency when there are likely to be disruptions in conventional communication modalities.
   2. Maintaining up-to-date emergency contact information for community partners.
4. Infection control and quarantine (44%)
   1. Difficulty developing protocols and preparing to isolate contagious residents during transport or at the receiving facility.
   2. Tracking resident exposures to contagious infections during an emergency.
5. Securing commitments from receiving facilities for residents and staff evacuations (39%)
   1. Finding receiving facilities with adequate capacity and facilities to temporarily house residents.
   2. Ensuring reimbursement for the care of evacuated residents.
6. Collaborating with community partners (35%)
   1. Infrequent collaboration on community-wide activities such as drills.
   2. Difficulty coordinating with community partners that often don’t include nursing homes in their drills.
   3. Finding supplemental staffing and volunteers to engage in community-based drills.
7. Managing medical records (29%)
   1. Institutional obstacles to sharing medical records across care networks.
8. Other (38%)
   1. Establishing procedures to address physical and mental trauma to residents during emergencies.
   2. Adequately planning for a range of emergency events contemplated by a home’s risk assessment.

Almost as an afterthought, OIG provided the following recommendations for addressing the challenges reported by nursing homes in two paragraphs at the end of the report narrative:

• Re­examine current nursing staff requirements and revise them as necessary²; and
• Target nursing homes most in need of infection control intervention and provide enhanced oversight and technical assistance to these facilities as appropriate.
• Actively participate in a Health Care Coalition (“HCC”). HCCs are regional organizations designed to incentivize diverse and often competitive healthcare organizations with differing priorities to work together on emergency preparedness and can assist homes in identifying potential gaps in their emergency preparedness efforts.

Although the OIG report adequately describes the challenges faced by nursing homes that responded to the survey, the extrapolation of the experiences of roughly 5% of the potential number of homes in the FEMA high-risk zones casts a wide net that may or may not be accurate. Further, OIG should have included questions designed to elicit recommendations from the respondents regarding how best to respond to the very real challenges faced by nursing homes in keeping residents safe during natural disasters and other emergency situations. The problem is real; however, like so many issues facing the long-term care industry, the solutions are in short supply.

[1] OIG surveyed 199 nursing homes out of a possible 3,097 rated by FEMA as having a very high or relatively high risk for natural hazards and received responses from 168.

[2] CMS proposed minimum staffing standards for nursing homes on September 1, 2023.