Arnold School of Public Health

1
Ready or Not? Perceptions about Preparedness in
Nursing Homes Before and After Hurricane Katrina
Sarah B. Laditka, Ph.D. Health Services Policy
and Management Co-authors, alphabetical order
Carol B. Cornman, RN/PA, Courtney B. Davis, MHA,
James N. Laditka, D.A., Ph.D., Jane V.E.
Richter, Dr.PH., RN, Sudha Xirasagar, MBBS,
Ph.D.
Arnold School of Public Health Office for the
Study of Aging
2
Preparedness Research Team
Carol Cornman Jim
Laditka Jane Richter
Marcia Lane Courtney Davis Sarah
Laditka Sudha Xirasagar
Arnold School of Public Health
3
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

Arnold School of Public Health
4
Background II

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

• 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

Arnold School of Public Health
5
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
6
Study Design

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

• Baseline survey mailed to licensed nursing homes
  (N192), in July 2005
• Post-Katrina survey distributed to all nursing
  homes, mid-September, to see if preparedness
  views were influenced by Hurricane

Arnold School of Public Health
7
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)

8
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

Arnold School of Public Health
9
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)

Arnold School of Public Health
10
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

Arnold School of Public Health
11
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

Arnold School of Public Health
12
Results Qualitative

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

• 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)

Arnold School of Public Health
13
Arnold School of Public Health
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)

14
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 Health
15
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 Health Office for the
Study of Aging
16
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 Health Office for the
Study of Aging
17
Ready or Not? Perceptions about Preparedness in
Nursing 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
Arnold School of Public Health Office for the
Study of Aging