Nursing home evacuation plans

Objectives. I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes cited for deficiencies in their evacuation plans.Methods. Evacuation plans were assessed according to criteria developed by an expert panel funded by the Office of the Inspector General. Deficiency citations came from the Online Survey, Certification, and Recording database, collected from 1997 to 2005. Four specific citations, for written emergency plans, staff training, written evacuation plans, and fire drills, were examined with multivariate logistic regression.Results. Most plans had water supply provisions (96%). Only 31% specified an evacuation route. The rate of citations was relatively stable throughout the study period: each year approximately 0.6% of facilities were found to be deficient in written emergency plans, 2.1% in staff training, 1.2% in written evacuation plans, and 7.9% in fire drills.Conclusions. Some nursing homes need more specific evacuation plans. Water supply was the most and evacuation routes were the least well-addressed areas.The US Department of Health and Human Services recently reported that administrators from 5 of 13 nursing homes evacuated as part of Hurricane Katrina described negative effects on residents’ health, such as dehydration, depression, and skin tears. The report further stated that “problems can be tied to a lack of effective emergency planning.”1^(pii)In nursing homes, an important tool used as part of emergency planning is the evacuation plan. Federal law requires that Medicare-and Medicaid-certified nursing homes have written plans for evacuation. Nursing homes are subject to deficiency citations (and fines) if the Medicare or Medicaid survey and certification process determines that they do not have adequate written evacuation plans.State Medicaid programs are responsible for approximately 50% of all nursing home expenditures, and Medicaid recipients consume 70% of all bed days. Because the federal government is such a dominant purchaser of nursing home care, it is also the dominant overseer of care quality. This oversight primarily occurs via the certification process. Titles XVIII and XIX of the Social Security Act require that all nursing homes accepting Medicare or Medicaid residents must be certified. Specific minimum standards were established for this certification, and surveyors inspect facilities for compliance.2 The standards require facilities to have “detailed written plans and procedures to meet all potential emergencies and disasters.”3^(p19) In addition, facilities must “train employees in emergency procedures when they begin work in the facility, periodically review procedures, and carry out unannounced staff drills.”3^(p19)The intent of the survey and certification process is to monitor and ensure quality of care. Several mechanisms are available to the government when facilities fail to meet certification minimum standards. These include varying levels of fines (≤ $10000/day) and termination from the Medicare and Medicaid programs. In all cases, however, when a facility does not meet government standards, a deficiency citation is issued. The deficiency citations (commonly called F-tags) for evacuation planning are F-517 and F-518. F-517 states, “The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather and missing residents.”4^(p32) F-518 states,

The facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.4^(p32)

In addition, incorporated into survey and certification regulations are Life Safety Code requirements (commonly called K-tags). These regulations focus mainly on fire safety but also include evacuation planning procedures, such as K-48 and K-50. K-48 states, “There is a written plan for the protection of all patients and for their evacuation in the event of an emergency.”5^(p42) K-50 states,

Fire drills are held at unexpected times under varying conditions, at least quarterly on each shift. Staff are familiar with procedures and aware that drills are an established routine. Responsibility for planning/conducting drills is assigned only to competent persons who are qualified to exercise leadership.5^(p42)

To my knowledge, the report from the Department of Health and Human Services is the only published document addressing evacuation plans used by nursing homes.1 The authors of the report interviewed 20 nursing home top managers involved with facility evacuation and examined deficiency citations given nationally in 2004 for having no plans or deficient plans for evacuation (codes F-517, F-518, K-48, and K-50). They found that nationwide, 94% of nursing homes met federal standards for emergency plans and 80% had sufficient emergency training. They also found substantial variation in the content of evaluation plans used by the 20 nursing homes examined.I examined evacuation plans from 2134 nursing homes and analyzed national data to determine the types of nursing homes (such as for-profit or nonprofit) that received deficiency citations for inadequate plans. My analysis extends the previous research by (1) examining evacuation plans from a large sample (n = 2134) of nursing homes and (2) analyzing longitudinal panel data (1997–2005) from nursing homes (n = 121 779) to determine the types of nursing homes that received deficiency citations for inadequate evacuation plans.