If disaster hits, elderly may suffer

Nursing homes' plans might be vague

Nursing home rules in North Carolina require each facility to have a disaster plan, but the facilities are not required to get the plan evaluated or file it routinely to emergency responders.

A move to draw attention to this regulatory gap gained urgency after Hurricane Katrina last fall, when inadequate preparations led to the deaths of nearly three dozen elderly nursing home residents in Louisiana.

That scenario has raised concerns in North Carolina among officials from some nursing homes, government and nonprofit groups. Worried that the lack of information could result in a repeat of Katrina's catastrophe, the groups have been working to improve plans and communication between nursing homes and emergency workers.

And legislators are studying whether -- and with what funding -- they can provide more inspectors.

"If the plans are really good, and they are well executed and there is consensus among state and county agencies, the upside would be getting the patients out effectively and the quality of care is maintained," said Holli Hoffman, hospital bioterrorism coordinator at the state division of facility services.

"The downside would be chaos."

During March, both a legislative subcommittee report on emergency preparedness and the working group defined the problem as a lack of oversight.

"Neither the Emergency Medical Department nor the Department of Health and Human Services has sufficient staff to review these plans or monitor these facilities during an evacuation," the subcommittee report said, "... nor is there a system to track and account for their residents when they are evacuated."

A draft bill was approved last week by the legislative group, seeking funding for emergency measures such as vaccines and a new public health lab. But language calling for more staff and oversight for nursing home emergency response was missing. Participants, however, said that language could be added to the bill after the session starts.

Heather Burkhardt, program consultant for the state Division of Aging and Adult Services, said the quality of nursing home emergency plans varies widely.

"What that plan is and the quality of that plan is not evaluated," Burkhardt said. "Some of these plans are, 'Call 911 in a disaster.' "

Most area nursing homes contacted by The N&O did not return calls or would not provide details of their disaster plans.

Jeff Horton, chief operating officer of the state's Division of Facility Services, has staff who survey nursing homes, but they don't check out the homes' disaster planning. If heavy weather threatens, staffers try to use forecasts and maps to call nursing homes in the path of danger and ask whether they have things under control.

"That's more reactive," Horton said. He said he would welcome adding oversight of emergency planning to his teams' purview to plug the gap in the regulations.

"The facility is possibly going to say, 'We'll use local EMS,' " Horton said. "But as far as the next step of finding out how this works out, they haven't done that. A lot of things have to be in place if you do mass evacuation -- transportation being the biggest one. If everybody thinks they're going to use the same hospital and the hospital has limited capacity, that's not going to work. What's the Plan B?"

State inspectors are well-qualified to examine the physical plant and resident care but aren't trained to evaluate and coordinate disaster plans, Horton said.

State Sen. John Snow, a Murphy Democrat, said some counties have liability concerns about moving frail elderly residents out of nursing homes.

County emergency management directors, who are often responsible for transporting nursing home residents in disasters, say they have never seen the plans for some facilities. There's no formal method for monitoring or collecting plans at the state level, either.

"What you found in New Orleans and what you find all over the place is that there's going to be a period where nobody does anything except the local people," Snow said. "All this stuff about evacuating and moving people out of nursing homes ... a lot of this has to go back to being locally prepared."

Stacy Flannery, director of legislative affairs for the N.C. Health Care Facilities Association, said the trade organization is part of the working group on improving planning.

"In most places throughout the state, they do not have a lot of experience in this," Flannery said. "If we had a Category 5 hurricane that was going to hit the East Coast and we had to evacuate 20 counties, we would be in a pickle. We've got to build that full plan using all of the expertise available from the provider side and the emergency management side."

Government, industry and nonprofit workers reached for this story voiced the same hope: that elderly North Carolinians never see a repeat of Katrina's ravages.

"The good thing is that it's on everybody's radar screen," Horton said. "Hopefully we'll have some positive action."