Senators Blast Nursing Home Operators, CMS

November 4, 2018, Alex Spanko, Skilled Nursing News - Members of the prominent Senate Committee on Finance released on Friday a scathing report on emergency preparedness in the nation’s nursing homes, accusing both operators and the federal government of failing residents during storms and other disasters.

Compiled by the Democratic members of the Senate Committee, the report — titled “Sheltering in Danger” — specifically looked at operators’ responses to Hurricanes Harvey and Irma in 2017; the latter storm claimed a dozen victims at a nursing home in Hollywood Hills, Fla. after a power outage sent inside temperatures soaring.

“This investigation cataloged a series of missteps, poor emergency planning, and faulty communication strategies that contributed to the misery and the preventable deaths of nursing home residents,” the senators wrote.  “The investigation identified gaps in nursing home emergency preparedness and response, particularly when their vulnerable residents are sheltered-in-place.”

The New York Times first reported on the results of the senators’ investigation, with Sen. Ron Wyden of Oregon telling the paper that “too many [operators] are not equipped to handle matters of basic safety in disasters.”

Wyden expanded on that idea in a statement issued along with the report.

“This is a failure of responsible governing from top to bottom.  Federal rules must be more robust and clear, while communication and planning among state and local officials and nursing homes must be dramatically improved,” Wyden said in the statement.  “Until changes are made, seniors in America’s nursing homes will continue to be at risk when disaster strikes.”

The report acknowledges that the 2017 storms occurred before the Centers for Medicare & Medicaid Services (CMS) instituted new emergency preparedness rules, which took effect in November of last year.  But in light of those storms, the minority members of the Senate Finance Committee claim that the regulations don’t go far enough to avoid repeats of the Hollywood Hills incident.

For instance, the senators note that while Florida recently required all providers to install backup generators, no such rule exists on the federal level — and CMS guidelines regarding the proper temperature that providers must maintain, 71 to 81 degrees, don’t take into consideration factors such as humidity and the heat index.

“Senior citizens are uniquely vulnerable to irreversible health consequences and death related to heat stress,” the report states.  “CMS should make this risk visible by instituting requirements and guidance that require facilities caring for senior citizens to specifically prepare for heat emergencies, particularly those located in regions of the country where they are likely to occur.”

As the title suggests, the report also takes a deep dive into the question of whether operators should have residents “shelter in place” during a storm or evacuate.  The decision is a difficult one, as moving frail and vulnerable elderly people could end up being more dangerous than waiting out a storm, but the senators argue that providers may have become too averse to evacuations when circumstances might require such a move. 

Research into the safety of long-term care evacuations has historically focused on actions taken before storms, rather than during and after, the senators point out, and they call on CMS to develop more detailed protocols for weighing the decision.

“The Minority staff does not expect that CMS rules will be specific about when a facility must evacuate.  However, the rules should be specific about the need to have procedures in place that ensure that shelter-in-place and evacuation decisions will be made by qualified personnel in a methodical way that will protect residents, not just an expectation that somehow they will,” they wrote.

In addition, the senators ask CMS to require more stringent approval processes for each facility’s required emergency plans, a task that currently falls to state and local authorities.  The existing emergency plan for the Hollywood Hills facility, for instance, discussed the use of a nearby hospital as a resource in the event of a terrorist attack — but did not consider the same eventuality for the much likelier event of a hurricane and power outage in South Florida.

“If these emergency plans are to be effective, then a more thorough review-and-approval process is needed,” the report stated.  “Local emergency officials did not appear to identify the major gaps and flaws in these emergency plans, even though CMS and state agencies relied on them to review plans for adequacy.”

Mark Parkinson, president and CEO of the American Health Care Association, pushed back on some of the senators’ findings, pointing out that Hollywood Hills and the other incidents mentioned in the report — primarily two difficult evacuations in Texas during Hurricane Harvey — were exceptions to the generally adequate care provided across the country.

“The safety of residents and staff is the top priority for nursing homes and assisted living communities.  The reality is that the vast majority of long term care facilities successfully implement their emergency plans and the heroic actions of caregivers and staff help ensure the safety and well-being of thousands of people,” Parkinson said in a statement e-mailed to SNN.  “Unfortunately, this report largely focuses on isolated incidents with tragic outcomes where existing regulations were ignored.”

He also emphasized the need for power companies to prioritize senior housing and care facilities in storms, which has been an area of lobbying for the trade group.

“First and foremost, nursing homes and assisted living communities must be a priority for power restoration and supplies for resource delivery in emergency situations.  Tragedies like those mentioned in this report could have been avoided if long-term care were prioritized like hospitals,” Parkinson said.  “We also need to develop systems and better criteria to allow us to work more closely with local authorities who are the one who provide guidance about sheltering in place or evacuating that nursing homes and assisted living communities follow.”

Katie Smith Sloan, president and CEO of LeadingAge — a trade group that represents non-profit senior housing and care providers — asked the federal government to allow time for the new CMS requirements to take hold.

“As we said in written testimony to the Committee in September, the deaths at Hollywood Hills should never have happened.  Had outside witnesses been invited to testify in early September, LeadingAge would have pointed out that the new CMS emergency preparedness rules outline very detailed specifications for emergency plans that address all potential hazards,” Sloan said in a statement provided to SNN.

Sloan also suggested Congress incorporate input from top-performing providers that kept residents safe during recent storms before instituting new regulations regarding emergency prep.

“Regarding the Committee’s recommendations, we propose that, prior to adding more regulations — and risk complicating the decision process administrators and nursing home staff follow when assessing whether to stay or go — the Committee members speak to administrators and staff whose deep experience in managing disaster situations has yielded success,” Sloan said. 

“As the report introduction notes, ‘most of the facilities weathered [Hurricanes Harvey and Irma] without incident.’  We believe that while clear requirements are essential, room must be allowed for human judgment in emergency and disaster situations.”