Elderly/Long-term Care

Some U.S. nursing homes need more specific evacuation plans to better respond to natural or other disasters

In the wake of Hurricane Katrina, residents at 5 of 13 Louisiana nursing homes suffered adverse effects such as dehydration, depression, and skin tears, which were primarily attributed to lack of effective emergency planning. Indeed, some nursing homes lack a critical part of emergency planning—specific evacuation plans, concludes a new study. U.S. nursing homes are subject to citations and fines for care deficiencies if the Medicare or Medicaid survey and certification process determines that they do not have adequate written evacuation plans.

The University of Pittsburgh study analyzed national data from 1997 to 2005 on 2,134 nursing homes for 4 specific deficiency citations (written emergency plans, staff emergency training, written evacuation plans, and fire drills) to determine the types of nursing homes cited for deficiencies in their evacuation plans. They also surveyed nursing home administrators in 2006 about their evacuation plans.

In general, most nursing homes were well prepared to shelter in place. Most facilities (86 percent) had a hazard analysis plan to ensure water supply (96 percent) and had detailed evacuation procedures (92 percent). Fewer facilities had a procedure to meet specific resident needs (37 percent), a plan for serving as a host facility (63 percent), and an evacuation route (31 percent).

The rate of citations was relatively stable throughout the study period. Each year about 0.6 percent of facilities were found to be deficient in written emergency plans, 2.1 percent in staff training, 1.2 percent in written evacuation plans, and 7.9 percent in fire drills. Only 3 percent of nursing homes were compliant with all 25 evacuation plan requirements. For-profit nursing homes were more likely, and those with a higher average Medicaid census and with a high percentage of residents with dementia were less likely to be cited for evacuation plan deficiencies.

The study was supported in part by the Agency for Healthcare Research and Quality (HS16547).

See "Nursing home evacuation plans," by Nicholas G. Castle, Ph.D., M.H.A., A.G.S.F, in the July 2008 American Journal of Public Health 98(7), pp. 1235-1240.

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