Nursing Home Emergency Preparedness: Preliminary Project Report

Transcription

1 Nursing Home Emergency Preparedness: Preliminary Project Report James Kendra, Ph.D., CEM Disaster Research Center and School of Public Policy and Administration University of Delaware

2 Project Concept Hurricane Irene A near miss for Delaware; extensive damage especially from flooding in states to the north One Delaware nursing home evacuated residents Question: What if the storm had taken a different path? Or had been stronger?

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4 Project Concept Collaborative project between the Department of Health and Social Services, Delaware Emergency Management Agency, University of Delaware (Disaster Research Center, and the School of Nursing in the College of Health Sciences)

5 About the College of Health Sciences School of Nursing and Departments of Behavioral Health & Nutrition, Department of Kinesiology and Applied Physiology, Department of Medical Technology (changing to Department of Medical Laboratory Sciences on July 1), Department of Physical Therapy Graduate focus areas include: M.S. degrees in exercise science, nursing, health services administration; Ph.D. in nursing science; clinical doctorate degree in physical therapy

6 About the Disaster Research Center Founded in 1963; oldest in the world 700 post-disaster field studies (recent studies include 9/11, Indian Ocean tsunami, Hurricane Katrina, Haiti earthquake, Tohoku earthquake) and many larger research projects Social science and engineering emphases

7 Project Question What is our situation in Delaware; what can we do to bolster emergency preparedness for long-term care/nursing home/assisted living facilities?

8 Method Literature review Focus groups and interviews

9 Overall Findings Emergency preparedness must be seen in a systems context Threats, community context, behavior, social processes, consequences of preparedness (Dobalian, Claver, and Fickel (2010: 582, Figure 1). Facilities dependent on utilities, roads, other facilities, contractors, suppliers (Menoni et al, 2000)

10 Decisions Shelter in place overwhelmingly the preferred option; its success depends on durability of infrastructure and emergency substitutes; care of staff and staff families Evacuation decisions weigh resident health; transport risk; available destinations (Dobalian et al, 2010: 586). Mandatory evacuations are often not seen as mandatory by facility managers (Dobalian et al, 2010: 586)

11 Effects on Evacuees Evacuation is harrowing Injuries, transfer trauma, death through worsening of physical condition or in accidents Not evacuating can also be harrowing; 70 nursing home residents died in Hurricane Katrina (Laditka et al, 2009: 55)

12 Office of the Inspector General, (2006:10) transportation contracts were not always honored, evacuation travel took longer than expected, medication needs complicated travel, host facilities were unavailable or inadequately prepared, facilities could not maintain adequate staff, food and water shortages occurred or were narrowly averted, and prompt return of residents to facilities was difficult

13 Office of the Inspector General, (2006: iii) Lack of collaboration across all sectors. generally, nursing homes managed evacuation or sheltering in place without guidance or evacuation assistance from State and local emergency entities. Evacuation assistance came primarily from parent corporations, sister facilities, and resident and staff family members.

14 Staff experiences (Laditka et al, 2009: 59) evacuees were in poor physical condition and extremely anxious Staff provided emotional and physical support Staff saw event positively: caring viewed as a blessing ; bonded more closely with staff and residents

15 Local findings widely varying expectations amongst the nursing homes and others of the roles of the various agencies, including of the National Guard and the Air Force Need clarity on use of DNG; some facilities assumed that DNG will be activated and will be made available (and capable of) helping evacuate facilities Need clarity on what a State of Emergency means in terms of resources available Need time requirements for requesting resources from DEMA Need clarity on state s role in finding space for displaced residents, and other state services.

16 Most use snow storm experiences as a point of reference for their actions, and consider snow storms to be a bigger threat than hurricanes Participants largely believed that their facilities could withstand the wind forces of the hurricane, and overall thought they would fare well in hurricanes. The main threat they associated with hurricanes was flooding. Specifically in the case of the nursing home that evacuated, it was flooding, not wind speeds, that drove the evacuation.

17 Local findings, continued The default is to shelter in place. Evacuation is a last resort

18 Local findings, continued Another concern brought up by more than one facility was that of a rogue shooter in the facility All facilities engaged in some kinds of preparedness activity, although the extent of or specificity of this activity varied across nursing homes. In addition, nursing homes that are a part of larger networks seem more capable of absorbing shocks to the system than facilities in smaller networks or stand alone nursing homes

19 Putting it Together What does it mean for us: A need to clarify roles and expectations A need to look inward at our own capabilities in our facilities A need to look outward, and to take a systems or network perspective

20 A different case Boat evacuation of Manhattan on 9/11 300, ,000 people evacuated by boat Unplanned; spontaneous Self-organized and coordinated

21 What made it work Strong ethos toward rescue Strong norm of coping and resilience Strong community knowledge Longstanding routine interactions Formal and informal partnerships Willingness to break some rules Smooth integration of Coast Guard and official agencies

22 Emergency Preparedness Needs Well-articulated plans Strong level of familiarity amongst participants Strong networks Robust and candid dialogue Flexibility and improvisation

23 References Dobalian, A., Claver, M., and Fickel, J.J Hurricanes Katrina and Rita and the Department of Veterans Affairs: a conceptual model for understanding the evacuation of nursing homes. Gerontology 2010: 56(6) Laditka, S.B., Laditka, J.N., Cornman, C.B., Davis, C.B., Richter, J.V.E. Resilience and challenges among staff of Gulf Coast nursing homes sheltering frail evacuees following Hurricane Katrina, 2005: Implications for planning and training. Prehospital and Disaster Medicine 24(1): Menoni, SM, Meroni, F., Pergalani, F., Petrini, V., Luzi, L., and Zonno, G Measuring the seismic vulnerability of strategic public facilities: response of the health-care system. Disaster Prevention and Management 9(1) Department of Health and Human Services. Office of Inspector General Nursing Home Emergency Preparedness and Response During Recent Hurricanes. OEI