Most health care preparedness planning efforts have focused on hospital and first responder preparedness. Both the needs and potential role of nursing homes, which house the particularly vulnerable elderly population, have emerged in local and national preparedness discussions, but very little information exists on the extent to which nursing homes have planned for and/or have been incorporated into regional planning efforts. The Agency for Healthcare Research and Quality (AHRQ) has called for research to identify ways to augment hospital bed capacity during public health emergencies. To better understand the role that nursing homes could play with respect to regional preparedness, RTI International (hereinafter referred to as RTI) examined the current status of nursing home disaster planning and response, elasticity of staff and licensed beds, space availability, and special needs. (RTI International is a trade name of Research Triangle Institute.)
Exploring the Special Needs and Potential Role of Nursing Homes in Surge Capacity for Bioterrorism and Other Public Health Emergencies is a task funded under a master task order to RTI's Integrated Delivery System Research Network (IDSRN) (Contract #290-00-0018, Task 10) by the Agency for Healthcare Research and Quality (AHRQ). RTI is a nonprofit research organization based in Research Triangle Park, North Carolina. The RTI IDSRN is a network of five health systems committed to high-quality, applied research. Four of these systems with hospital facilities in seven States were included in this project:
RTI conducted a cross-sectional study using mixed methods to address specific research questions. We drew on a series of secondary datasets to assess the location and capacity of nursing homes in the entire United States. Using these data, we more closely examined the policy, regulation, surge capacity, and response planning issues of nursing homes in the six States above. RTI conducted interviews with IDSRN partner representatives in these States. We then convened in-person focus groups with staff from nursing homes that have patient flows to our partner health systems in five of these States to ascertain special needs, planning, and capacity issues. We used the results of the interviews and focus groups and developed this report.
Emergency Preparedness Atlas: U.S. Nursing Home and Hospital Facilities combines findings from the interviews with information obtained through a larger environmental assessment to help explain the State-specific regulatory environment of nursing homes with respect to surge capacity and nursing home geographic distribution in the United States.
In conducting this environmental assessment, we used geographic information system (GIS) technology to synthesize and analyze the distribution of nursing home and hospital facilities across the United States. The Atlas presents these results as a series of six case studies for the States where our IDSRN partners are located. These case studies assess issues of regional planning concordance relevant to preparedness and response in disaster situations. In addition to the six case studies, we created maps for each of the 50 States and the District of Columbia examining the location of hospitals and nursing homes relative to the distribution of the elderly population.
Elisabeth D. Root, M.A.—Project Director
David Dosa, M.D., M.P.H.—Co-Investigator (Brown University Medicine Foundation)
Shulamit L. Bernard, R.N., Ph.D.—Senior Scientist
Sally Phillips, Ph.D.—AHRQ Project Officer
IDSRN Partners: Intermountain Health Care, Providence Health System, UNC Health Care, UPMC Health System