Arnold School of Public Health Office for the Study of Aging

1. Ready or Not? Perceptions about Preparedness in Nursing Homes Before and After Hurricane Katrina Sarah B. Laditka, Ph.D. Health Services Policy and Management Co-authors, alphabetical order: Carol B. Cornman, RN/PA, Courtney B. Davis, MHA, James N. Laditka, D.A., Ph.D., Jane V.E. Richter, Dr.PH., RN, Sudha Xirasagar, MBBS, Ph.D. Arnold School of Public Health Office for the Study of Aging

2. Preparedness Research Team Carol Cornman Jim Laditka Jane Richter Marcia Lane Courtney Davis Sarah Laditka Sudha Xirasagar Arnold School of Public Health

3. Background I • 3 million older Americans reside in 18,000 nursing homes • Few studies have examined nursing home preparedness • Identified problems: transportation, communication, lack of water, food, medical and hygiene supplies, staff shortages • Nursing homes receive much less support than hospitals during/after emergencies Arnold School of Public Health

4. Background II • JCAHO (Joint Commission on Accreditation of Healthcare Organizations) requires HCO to have comprehensive emergency plans • 7% of nursing homes JCAHO-accredited • CMS delegates oversight to states • State oversight focuses on checklists, documentation of a plan, regular review with staff and drills, without feedback from public officials or risk managers Arnold School of Public Health

5. Research Objectives • Examine nursing home preparedness in the absence of an immediate emergency or disaster • Investigate administrators’ views about preparedness change in response to a large disaster • Suggest ways to enhance preparedness Arnold School of Public Health

6. Study Design • Designed mailed “baseline” survey after talking with emergency management officials, nursing home administrators, reviewing guidelines • Baseline survey mailed to licensed nursing homes (N=192), in July 2005 • Post-Katrina survey distributed to all nursing homes, mid-September, to see if preparedness views were influenced by Hurricane Arnold School of Public Health

7. Arnold School of Public Health Methods and Response Rate • Quantitative data: standard descriptive statistics, t-test, chi-square statistics, correlation coefficients • Qualitative data: coded independently by 3 researchers using grounded theory • 112 baseline surveys; 50 post-Katrina surveys (response rate: 58.3%; 25%)

8. Results –Respondent Characteristics • 90% were administrators • 60% worked in facility more than 5 years; average 15 years of nursing home administrative experience • Less than 20% were in metropolitan areas • 14% located in “coastal” regions Arnold School of Public Health

9. Results – Satisfaction with Preparedness • 1. 82% satisfied with sheltering arrangements if evacuation needed • 2. 68% satisfied with their ability to shelter • 3. 59% satisfied with transportation resources • 4. 55% satisfied with off-duty staff ability to care for evacuees • 5. 93% satisfied with “overall” ability to protect • Overall satisfaction with preparedness (5) modestly correlated with 1-4 (r range=.25-.33) Arnold School of Public Health

10. Results – Communication Plans • Asked participants, “all communications methods you plan to use …” • More than 80% would rely on cell phones, computers if landline phone service was disrupted • Only 5 mentioned use of HAM radio operators; HAMS use low tech, reliable equipment to establish communication when landline systems are disrupted Arnold School of Public Health

11. Results – Emergencies in last 3 Years • Total of 55.4% experienced some type of disaster: loss of power (40.2%); ice storm (35.7%); hurricane (11.6%); tornado (8%); fire (7.1%); chemical spill (2.7%) • Asked about experience with first responders to these emergencies; experience was good – but, these were generally not widespread disasters Arnold School of Public Health

12. Results – Qualitative • How can county or state help?: provide more resources (39%); provide education (30%); improve communications (19%) • Strengths?: well trained, dedicated staff (52%); strong community support (30%) • Weaknesses?: high turnover (13%); need more training (12%); lack of transportation resources (12%); lack of generators and communication systems (12%) Arnold School of Public Health

13. Arnold School of Public Health Results – Post-Katrina Survey • Katrina changed views about preparedness (54%): rethinking evacuation/transportation (32%); updating plans (30%), rethinking supplies (14%); rethinking staff (12%) • Katrina did not change views about preparedness (36%): feel well prepared (30%); SC is better prepared because of hurricane experience (6%)

14. SC Study - Conclusions • Overall satisfaction with preparedness not highly correlated with specific preparedness domains • Most would rely on cell phones and/or computers if landline phone service were disrupted • Most did not acknowledge capacity problems with transportation in a widespread disaster, and the need for backup arrangements • Findings suggest several domains important to consider for emergency preparedness in nursing homes: communication, transportation, and ability to shelter residents from other nursing homes Arnold School of Public Health

15. Policy Recommendations I • Develop stronger linkages with local emergency preparedness system (EPS) to help access resources, e.g., gasoline, power • Work with local EPS to tap into HAM network to improve communication systems • Identify backup transportation resources Arnold School of Public Health Office for the Study of Aging

16. Policy Recommendations II National Level: • Professional associations should hire risk managers to serve as consultants Federal Level: • Centers for Medicare and Medicaid Services should require nursing homes to have disaster plans reviewed by professional risk managers • FEMA should assist nursing homes with evacuation following widespread disaster Arnold School of Public Health Office for the Study of Aging

17. Ready or Not? Perceptions about Preparedness in Nursing Homes Before and After Hurricane Katrina~ Thank You ~ This research was funded by the Centers for Disease Control and Prevention, Grant #U90-424245-02 in conjunction with the Association of Schools of Public Health Arnold School of Public Health Office for the Study of Aging