Arnold School of Public HealthOffice for the Study of Aging

Ready or Not? Perceptions about Ready or Not? Perceptions about Preparedness in Nursing Homes Before and Preparedness in Nursing Homes Before and

After Hurricane KatrinaAfter Hurricane Katrina

Sarah B. Laditka, Ph.D.Sarah B. Laditka, Ph.D.Health Services Policy and Management

Co-authors, alphabetical order: Carol B. Cornman, RN/PA,Co-authors, alphabetical order: Carol B. Cornman, RN/PA,

Courtney B. Davis, MHA, James N. Laditka, D.A., Ph.D., Courtney B. Davis, MHA, James N. Laditka, D.A., Ph.D.,

Jane V.E. Richter, Dr.PH., RN, Sudha Xirasagar, MBBS, Ph.D.Jane V.E. Richter, Dr.PH., RN, Sudha Xirasagar, MBBS, Ph.D.

Arnold School of Public Health

Preparedness Research Team

Carol Cornman Jim Laditka Jane Richter

Marcia Lane Courtney Davis Sarah Laditka Sudha Xirasagar

Arnold School of Public Health

Background I

3 million older Americans reside in 18,000 nursing homes

Few studies have examined nursing home preparedness

Identified problems: transportation, communication, lack of water, food, medical and hygiene supplies, staff shortages

Nursing homes receive much less support than hospitals during/after emergencies

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Background II

7% of nursing homes JCAHO-accredited CMS delegates oversight to states State oversight focuses on checklists,

documentation of a plan, regular review with staff and drills, without feedback from public officials or risk managers

JCAHO (Joint Commission on Accreditation of Healthcare Organizations) requires HCO to have comprehensive emergency plans

Arnold School of Public Health

Research Objectives

Examine nursing home preparedness in the absence of an immediate emergency or disaster

Investigate administrators’ views about preparedness change in response to a large disaster

Suggest ways to enhance preparedness

Arnold School of Public Health

Study Design

Baseline survey mailed to licensed nursing homes (N=192), in July 2005

Post-Katrina survey distributed to all nursing homes, mid-September, to see if preparedness views were influenced by Hurricane

Designed mailed “baseline” survey after talking with emergency management officials, nursing home administrators, reviewing guidelines

Arnold School of Public Health

Methods and Response Rate

Quantitative data: standard descriptive statistics, t-test, chi-square statistics, correlation coefficients

Qualitative data: coded independently by 3 researchers using grounded theory

112 baseline surveys; 50 post-Katrina surveys (response rate: 58.3%; 25%)

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Results –Respondent Characteristics

90% were administrators

60% worked in facility more than 5 years; average 15 years of nursing home administrative experience

Less than 20% were in metropolitan areas

14% located in “coastal” regions

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Results – Satisfaction with Preparedness

1. 82% satisfied with sheltering arrangements if evacuation needed

2. 68% satisfied with their ability to shelter

3. 59% satisfied with transportation resources

4. 55% satisfied with off-duty staff ability to care for evacuees

5. 93% satisfied with “overall” ability to protect

Overall satisfaction with preparedness (5) modestly correlated with 1-4 (r range=.25-.33)

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Results – Communication Plans

Asked participants, “all communications methods you plan to use …”

More than 80% would rely on cell phones, computers if landline phone service was disrupted

Only 5 mentioned use of HAM radio operators; HAMS use low tech, reliable equipment to establish communication when landline systems are disrupted

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Results – Emergencies in last 3 Years

Total of 55.4% experienced some type of disaster: loss of power (40.2%); ice storm (35.7%); hurricane (11.6%); tornado (8%); fire (7.1%); chemical spill (2.7%)

Asked about experience with first responders to these emergencies; experience was good – but, these were generally not widespread disasters

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Results – Qualitative

Strengths?: well trained, dedicated staff (52%); strong community support (30%)

Weaknesses?: high turnover (13%); need more training (12%); lack of transportation resources (12%); lack of generators and communication systems (12%)

How can county or state help?: provide more resources (39%); provide education (30%); improve communications (19%)

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Results – Post-Katrina Survey

Katrina changed views about preparedness (54%): rethinking evacuation/transportation (32%); updating plans (30%), rethinking supplies (14%); rethinking staff (12%)

Katrina did not change views about preparedness (36%): feel well prepared (30%); SC is better prepared because of hurricane experience (6%)

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SC Study - Conclusions

Overall satisfaction with preparedness not highly correlated with specific preparedness domains

Most would rely on cell phones and/or computers if landline phone service were disrupted

Most did not acknowledge capacity problems with transportation in a widespread disaster, and the need for backup arrangements

Findings suggest several domains important to consider for emergency preparedness in nursing homes: communication, transportation, and ability to shelter residents from other nursing homes

Arnold School of Public HealthOffice for the Study of Aging

Policy Recommendations I

Develop stronger linkages with local emergency preparedness system (EPS) to help access resources, e.g., gasoline, power

Work with local EPS to tap into HAM network to improve communication systems

Identify backup transportation resources

Arnold School of Public HealthOffice for the Study of Aging

Policy Recommendations II

National Level:

Professional associations should hire risk managers to serve as consultants

Federal Level:

Centers for Medicare and Medicaid Services should require nursing homes to have disaster plans reviewed by professional risk managers

FEMA should assist nursing homes with evacuation following widespread disaster

Arnold School of Public HealthOffice for the Study of Aging

Ready or Not? Perceptions about Preparedness in Ready or Not? Perceptions about Preparedness in Nursing Homes Before and After Hurricane KatrinaNursing Homes Before and After Hurricane Katrina

~ Thank You ~

This research was funded by the Centers for Disease Control and Prevention,

Grant #U90-424245-02 in conjunction with the

Association of Schools of Public Health