A 75-page investigative report entitled “Sheltering in Danger: How Poor Emergency Planning and Response Put Nursing Homes Residents at Risk During Hurricanes Harvey and Irma,” was released Nov. 2 by the Democratic minority staff of the Senate Finance Committee, which oversees Medicare and Medicaid matters. The report called for increased nursing home disaster preparedness standards.
The report investigated the Centers for Medicare and Medicaid Services (CMS), a federal agency in the Department of Health and Human Services that administers Medicare and partners with states to administer Medicaid and other programs. More than half of all payments to non-hospital-based nursing facilities comes from Medicare and Medicaid.
The report noted that while the majority of nursing home disaster preparedness performed adequately during Harvey and Irma, there were notable and tragic exceptions which “resulted from inadequate regulation and oversight, ineffective planning and communications protocols, and questionable decision-making by facility administrators,” according to a November 2 New York Times article quote from the report.
The investigation was requested by Senators Marco Rubio (R-FL) and Bill Nelson (D-FL) in response to the deaths of twelve residents at The Rehabilitation Center at Hollywood Hills, Florida, during Hurricane Irma, when the nursing home lost power to its air conditioner, according to Politico. Hurricane Irma made landfall on the lower Florida Keys as a category 4 storm on September 17, 2017. It’s the strongest storm on record in the open Atlantic Ocean and did $50 billion of damage.
Exactly a month before Hurricane Irma, Hurricane Harvey made landfall in Texas on August 17, 2017 and caused extreme rainfall-induced flooding in Houston and surrounding areas. Harvey caused $125 billion in damage, second only to Hurricane Katrina, in 2005, the nation’s most costly natural disaster. Residents of Houston area nursing homes and assisted living facilities were left stranded as waters rose. It was only after a now-famous photo of wheelchair-bound frail elderly in waist-high water was tweeted out that La Vita Bella nursing home residents in Dickinson, Texas, were evacuated.
In 2016, new CMS rules were put in place which mandated minimum nursing home disaster preparedness standards for healthcare providers who participate in Medicare and Medicaid. The rules weren’t implemented until November, 2017, after Hurricanes Harvey and Irma did their damage. The rules were at least in part a response to the heightened awareness about the issue that was raised by the more than 200 nursing homes deaths during Katrina, and the more than 4,000 nursing home resident evacuations under chaotic and flooded conditions during Hurricane Sandy in 2012.
The Senate report found these 2016 standards dangerously inadequate. The report’s number one recommendation was that comfort standards go beyond sole reliance on temperature and start referencing the heat index, also known as the “apparent temperature,” which is a measurement of the combined effect of heat and humidity on the human body.
The report urged that all nursing home emergency plans receive approval from knowledgeable regulators, which is not currently the practice in all states, and that better processes be developed for nursing homes to determine in advance of storms whether to evacuate or shelter in place.
There was plenty for investigators to be concerned about. The post-storm investigations of almost all Florida and Texas nursing home disaster preparedness found that more than 25 percent were out of compliance with federal requirements.
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