Public Health Emergency Preparedness
This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.
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This study can help fill gaps in our knowledge about the role nursing homes
could play in larger local or regional preparedness efforts. In addition,
the study reveals many concerns specific to nursing homes and the populations
they serve that should be addressed if these facilities are expected to provide
resources to the community during and after a public health emergency.
Based on our findings from the six focus groups, nursing homes have prepared
for natural disasters but have given very little thought to bioterrorism. Facilities
reported having disaster plans in place, some more comprehensive than others,
and reviewing these plans with nursing staff at orientation and during regular
in-service trainings. Disaster plans appeared to focus on the natural
disasters most prevalent in a region (e.g., wild fires, earthquakes, floods,
hurricanes). Only a few facilities reported including policies and
procedures specific to bioterrorism in their disaster plans.
facilities we spoke with reported quarterly fire drills and annual or semi-annual
disaster drills. These drills were held in accordance with State requirements,
suggesting that States may need to require more comprehensive drills that
address bioterrorism if this is deemed important. However, focus group
participants stressed that, if States do develop new requirements related
to bioterrorism, it will be important to provide resources, including guidance
documents, training, staff, and money, to their facilities so they could
develop viable plans.
Results from the focus groups also highlight the differing levels of local
coordination of disaster planning across States. Two States initiated
focus groups or forums to discuss local coordination to which nursing homes
and other long-term care facilities were invited. Participants reported
varying levels of success with these activities, but they indicate that some
States are actively trying to involve nursing homes in coordination efforts. Other
participants reported no success in trying to engage local emergency planning
agencies in disaster planning.
Most participants lacked a basic understanding
of State regulations that govern nursing homes during an emergency. While
a few participants (mostly those directly engaged in the local government)
were aware of bed licensure or staffing regulations in a state of emergency,
most were not. This lack of knowledge suggests that State nursing home
associations or other regulatory bodies may need to be more proactive in
informing nursing home facilities of changes in regulations during an emergency.
Focus group participants expressed a wide range of needs, some of which
were unique to nursing home facilities and some which would be problematic
to a variety of health facilities. Participants voiced concerns about
caring for special patient populations that require specialized equipment
or nursing care during an emergency. In particular, participants were
concerned about patients with Alzheimer's and other cognitive impairments. Many
facilities caring for these patients have locked facilities with high-tech
monitoring systems that could easily fail during power loss.
also were concerned about the logistical difficulties involved in moving
or evacuating patients with limited physical abilities. Focus group
participants stressed the importance of maintaining a calm, routine environment
to avoid undue stress on their elderly patients. Linked to these concerns
about patient care were concerns about staffing. Participants were
concerned about maintaining staffing levels since nursing staff would undoubtedly
want to care for their own families or may have difficulty getting to work.
Several concerns raised by focus group participants may be of concern to
the larger health care community. These include:
- Maintaining adequate pharmaceutical and medical supplies.
- The ability of generators to support an entire facility and the adequacy
of fuel supplies.
- Feeding the resident population and keeping them adequately hydrated.
Most participants reported that pharmaceuticals and medical supplies are
delivered on monthly cycles. Thus, the amount of time they could sustain
their resident population on existing medical supplies is highly dependent
on when the disaster occurred in relation to their last delivery. While
all nursing home facilities represented have generators to provide back-up
power, many participants were concerned that the generator would not be able
to power the entire facility. Nursing home populations are particularly
sensitive to heat and cold, so the environmental conditions regulated by
generators are particularly important.
Finally, the focus group results suggest a number of potential roles nursing
homes could play in the event of a public health emergency. Nearly
all participants reported they could accept transferred residents back from
area hospitals to free up bed space in those facilities. Most facilities
acknowledged the possibility of receiving additional patients from the community
and were willing to accommodate those patients if they could. In doing
so, however, they had two major concerns: patient acuity and staffing.
group participants agreed that their ability to accept transfers or patients
from the community depended on the patient's level of acuity. They
explained that many facilities specialize in caring for patients with certain
conditions. Thus, one facility might be able to take a transferred
ventilator patient while another could not. This suggests that area
hospitals wanting to transfer patients would need to know what the nursing
homes in their area were skilled in. Participants also stressed that
they would need staff with the knowledge and expertise in providing care
to higher acuity patients if they were to accept them.
Nursing homes could provide a variety of additional resources during an
emergency, including basic medical care and short term shelter. Participants
agreed that nursing staff had the skills to provide a certain level of medical
care to outside community members. They suggested staff could provide
vaccinations, basic first aid, or triage services. Many larger facilities
felt they could use their facilities' community spaces, such as dining
rooms and auditoriums, to provide short-term shelter. However, long-term
storage of equipment and stockpiled drugs was considered an inappropriate
use of facilities. Providing long-term storage would require nursing
homes to take space designated for specific activities away from the resident
Focus groups are valuable in that they provide very detailed information
about a small sample of nursing homes and have high face validity. However,
because of the relatively small number of nursing homes we talked with, our
data do not allow us to generalize these conclusions to all nursing homes
in the United States. We can, however, conclude that nursing homes
have special patient populations that require disaster plans that address
the needs of their residents. Nursing homes can also provide valuable
resources to their communities if they are included in local and regional
disaster planning activities.
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AHRQ Publication No. 07-0029-1
Current as of May 2007