How Hurricane Irma Tested Emergency Preparedness Policy for Medically Vulnerable Patients

By | September 22, 2017

Hurricane Irma was the first major hurricane to hit Florida in over a decade, causing catastrophic damage in many areas. The human impact of the hurricane was also devastating, with reports of more than 50 deaths in the state. Among these deaths were ten residents of a nursing home in Hollywood Hills that lost power and air conditioning for several days.

In response to this tragedy, the state suspended the facility’s license, preventing the nursing home from admitting any new patients or billing Medicaid. Florida’s governor also implemented an emergency rule to require all nursing homes and assisted-living facilities to have generators in place within 90 days. These measures are all responses to what appears to be a failure to protect nursing home residents during times of disasters. However, local, state, and national efforts have been in place for many years to address emergency preparedness for medically vulnerable populations.

Nursing Home Residents Among the Most Vulnerable during Disasters

Over four million people in the United States are served by long-term care (LTC) providers, such as nursing homes and personal care and home health agencies. The elderly patients served by these providers are fragile and often have complex health conditions, which makes them extremely vulnerable to disruptions in medical care, food, and shelter during emergencies and large-scale disasters. These disasters often require evacuation or shelter-in place procedures, which have been shown to be challenging for LTC providers, emergency management officials, and public health agencies. As documented in previous major disasters, a lack of communication between these essential stakeholders can be detrimental to the health of the elderly, especially long-term care residents.

Local and State Emergency Preparedness Resources for Medically Vulnerable Populations

Many local and state emergency preparedness resources are available to providers of medically vulnerable populations. State health care provider associations are important organizations that conduct member training and education regarding emergency preparedness. The Florida Health Care Association (FHCA) has served nursing home and assisted living providers since 1954, and emergency preparedness has been one of its most central initiatives. The organization hosts a website ( dedicated to emergency preparedness planning whereby online planning tools and information regarding emergency preparedness policies are available.

FHCA also hosts regular webinars and conferences, including the Nursing Home Emergency Preparedness Summit. Health care coalitions also offer providers of medically vulnerable populations the opportunity to engage in community-based emergency preparedness planning. While sustained through federal funds, health care coalitions are organized regionally and “ensure that local providers and other health care partners plan collaboratively for the risks facing the health care community and identify available local resources.” In Florida, there are 10 regional health care coalitions.

CMS Emergency Preparedness Rule for Long Term Care (LTC) Providers

In September 2016, the Centers for Medicare and Medicaid Services (CMS) issued an Emergency Preparedness Final Rule. This purpose of this rule was “to establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional and local emergency preparedness systems.” Skilled nursing providers are among the 17 different types of Medicare and Medicaid participating providers that must implement these emergency preparedness requirements by November 15, 2017. Specifically, providers must:

  1. develop a disaster plan that is based on a thorough risk assessment of their patients and facilities;
  2. develop policies and procedures based on the risk assessment and disaster plan;
  3. develop a communications plan that complies with state and federal laws;
  4. develop and maintain emergency preparedness training programs, including participate in a full scale community-wide evacuation drill; and
  5. share their disaster plans with residents and their families.

Assessment of Emergency Preparedness Planning Policies and Capabilities of LTC Providers in Florida

Emory University researchers examined the emergency preparedness planning policies and capabilities of nursing homes in Florida and Georgia. With funding from the Centers for Disease Control and Prevention (CDC), the study included surveys and follow up interviews with nursing home administrators and senior staff.

Findings from Florida reveal that almost all nursing homes have disaster plans in place and most develop these plans based on thorough risk assessments of their patients’ health care needs. Results suggest that a majority of nursing centers have plans in place to transfer their residents when emergencies occur. In the case of an evacuation, 96% indicated they would transfer their residents to health care facilities. Eighty-three percent have plans to transfer patients to sister nursing centers, 53% to a non-sister nursing center, and 20% to a hospital. A large majority of nursing home participants (83%) also indicated that they have entered into mutual aid agreements with health centers to transfer their residents in cases of emergencies.

Communication about preparedness policy is also quite strong, according to survey results. Almost all (94%) of respondents indicated that they regularly communicate with local emergency management agencies to discuss emergency preparedness. Most also discuss emergency preparedness with their residents (88%) and residents’ families (85%).

In terms of emergency power, 63% of nursing centers who participated in the survey have the technical capacity to quickly connect to generators. Nursing home providers reported being aware of the new CMS emergency preparedness rule and working quickly to implement all provisions. The biggest challenge appears to be the requirement to conduct a full-scale exercise, which requires the participation of multiple emergency management agencies and health care providers.

The Future of Long-Term Care Emergency Preparedness

Much of Florida faces a long road to recovery in the wake of Hurricane Irma. Providers of medically vulnerable populations, including the elderly, must take special care to use the many available emergency preparedness resources on local, state, and national levels. Disaster plans are important, but they are not enough. Providers must actively engage and collaborate with emergency management officials, public health agencies, and other health care providers to ensure the safety of their patients.

Furthermore, there is a real need to integrate and coordinate emergency preparedness efforts across health care providers and across the health care continuum. To date, health care preparedness planning efforts have focused on hospital and emergency responder preparedness. It is time to prioritize long-term care patients and their providers in these efforts.

Sarah Blake
Sarah C. Blake, PhD, MA is an assistant professor in the Department of Health Policy & Management at the Emory University Rollins School of Public Health. She has over 20 years of health services research experience in the fields of women's health and aging. Dr. Blake evaluates local, state, and federal health care programs that address health care for the medically vulnerable. She also teaches graduate public health students at Emory University.
Sarah Blake

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