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What we know about disaster management in nursing homes: A meta-analysis

Dr. Annette M. Lane Dr. Sandra P. Hirst Linda Shorting, RN, MA. What we know about disaster management in nursing homes: A meta-analysis. Background. Older adults residing in nursing homes are a vulnerable population – often the frailest and most cognitively impaired

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What we know about disaster management in nursing homes: A meta-analysis

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  1. Dr. Annette M. Lane Dr. Sandra P. Hirst Linda Shorting, RN, MA What we know about disaster management in nursing homes: A meta-analysis

  2. Background • Older adults residing in nursing homes are a vulnerable population – often the frailest and most cognitively impaired • Older adults in nursing homes particularly vulnerable in disasters (e.g. over 100 older adults in NHs in Louisiana died following Katrina) (Hyer et al., 2010)

  3. There is a small, but growing research base examining disaster management • Question: What do we know about disaster preparedness and emergency management within nursing homes?

  4. Method – Thematic Analysis • Searched CINAHL, MedLine and Social Work Abstracts data bases (1995 present) • Search terms: - “nursing homes” and “disaster preparedness” - “nursing homes” and “emergency management”

  5. Findings • Limited number of research studies and articles related to disaster preparedness/emergency management in nursing homes • Located 31 articles/research studies pertaining to this topic

  6. Findings (cont’d) • Secured 10 research studies regarding disaster preparedness and nursing homes • Studies largely retrospective and focused upon disaster preparedness of nursing homes for Gulf Coast hurricanes (e.g. Katrina, Rita and Gustav) (Blanchard & Dosa, 2009; Castro , Persson, Bergstrom & Cron, 2008; Covan & Fugate-Whitlock, 2010; Hyer et al., 2010; Laditka et al., 2009; Laditka et al., 2007; O’Brien, Selod & Lamb, 2009; Thomas et al., 2010)

  7. 1 study examined disaster preparedness related to bioterrorism (Helget & Smith, 2002) • 1 study examined the role of function of nursing homes post disaster (Saliba, Buchanan & Kington, 2004)

  8. What are the research questions being asked? • Are nursing homes prepared for large scale disasters? (e.g. a pandemic such as the Avian flu) • What comprises a comprehensive disaster plan for nursing homes? • Why are nursing homes not included in local disaster management plans for some cities/areas?

  9. Decisions to evacuate – who should make these decisions and who should be evacuated first? (frailest or healthiest)? • How can comprehensive disaster plans be converted into effective actions in the event of a disaster (ie. a plan can be in place, but significant issues can remain in enacting the plan – (Blanchard & Dosa, 2009).

  10. What themes are emerging? • Many nursing homes are not prepared for disasters. • Even if nursing homes reported being satisfied with how they handled a disaster (e.g. hurricane), other issues emerged: - challenges with evacuation - transportation - staffing - supplies (Blanchard & Dosa, 2009; Laditka et al., 2009)

  11. Importance of nursing homes communicating with local and national disaster management agencies (Hyer et al., 2010). • Problems associated with receiving evacuees from other nursing homes

  12. What are the gaps in our understanding? • Little research in how nursing homes prepare for disasters that are non hurricane/earthquake related (e.g. pandemics, bioterrorism, nuclear power plants) • Few studies located that examined disaster preparedness in other locations that in the southern USA

  13. Gaps in our understanding (cont’d) • No studies found that deem influenza /GI outbreaks as disasters – what constitutes a disaster? Are numbers (the degree of impact) necessary to define a disaster?

  14. What are the implications of such gaps? • Much more research needs to be conducted on disaster preparedness in nursing homes • More research on the impact of disasters upon residents/nursing home staff, as well as comparative studies of disasters (e.g. Blanchard & Dosa compared disaster responses of 16 nursing homes who experienced Katrina (2005) and then Gustav (2008) )

  15. Implications of gaps (cont’d) • Need research on outcomes comparing evacuation versus “shelter in place” (evacuation can lead to increased morbidity and mortality) • Philosophical considerations: What constitutes a disaster (what about increased deaths from influenza)?

  16. Implications for Policy Makers • National policies that mandate disaster plans to be in place in all nursing homes • Plans need to include varied categories of disaster, especially those that are common to the region

  17. Policy Implications (cont’d) • Policies need to include phone numbers of emergency agencies • Policies within nursing homes should stipulate regular review of plans, regular “drills” and consistent checks of emergency supplies

  18. Policy Implications (cont’d) • Importance of policies/procedures to include mental health care follow up for staff and residents in nursing homes

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