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PostPosted: Tue Sep 19, 2017 4:59 pm 
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From NPR: Many Nursing Homes Aren't Prepared For Even Basic Emergencies
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Many Nursing Homes Aren't Prepared For Even Basic Emergencies September 19, 2017 11:12 AM ET By Jordan Rau From Kaiser Health News

It does not take a hurricane to put nursing home residents at risk when disaster strikes.

Around the country, facilities have been caught unprepared for far more mundane emergencies than the hurricanes that struck Florida and Houston, according to an examination of federal inspection records. And these nursing homes rarely face severe reprimands, even when inspectors identify repeated lapses.

In some cases, nursing homes failed to prepare for even the most basic contingencies.

In one visit last May, inspectors found that an El Paso, Texas, nursing home had no plan for how to bring wheelchair-dependent people down the stairs in case of an evacuation. Inspectors in Colorado found a nursing home's courtyard gate locked and that employees did not know the combination, records show. During a fire at a Chicago facility, residents were evacuated in the wrong order, starting with the people farthest from the blaze.

Nursing home inspectors issued 2,300 violations of emergency-planning rules during the past four years. But they labeled only 20 so serious as to place residents in danger, the records show.

In addition, a third of U.S. nursing homes have been cited for failing to inspect their generators each week or to test them monthly. None of those violations was categorized as a major deficiency, even at 1,373 nursing facilities that were cited more than once for neglecting generator upkeep, the records show.

A lack of backup power is being investigated as a factor that could have contributed to the deaths of eight people on Sept. 13 at the Rehabilitation Center at Hollywood Hills, Fla., following Hurricane Irma.

"That's the essential problem with the regulatory system: It misses many issues, and even when it identifies them, it doesn't treat them seriously enough," says Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. "It's always the same story: We have some pretty good standards and we don't enforce them."

The deaths at the Rehabilitation Center have focused attention on new federal disaster-planning rules, with which nursing homes must comply by mid-November. Those rules were prompted by nursing home and hospital deaths during Hurricane Katrina in Louisiana in 2005.

Dr. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home industry group, says facilities have gotten better at handling disasters after each one. Most evacuations go smoothly, he says.

"After each one of these emergencies we've learned and gotten better," Gifford says.

But advocates for the elderly say enforcement of rules remains as great a concern, if not greater.

Dr. David Marcozzi, a former director of the federal emergency preparedness program for health care, says that inspectors — also known as surveyors — should observe nursing home staff demonstrating their emergency plans rather than just checking that they have been written down.

"If you have not implemented and exercised plans, they are paper tigers," says Marcozzi, now an associate professor at the University of Maryland School of Medicine. "The emphasis from the surveyor has to be 'Show me how you do this.' "

But Gifford says preplanning and drills, which are important, go only so far in chaotic events such as hurricanes.

"No matter what planning you might have, what we have learned from these emergencies is these plans don't always work," he says. Nursing homes take surveys seriously and face closure if they do not fix flaws inspectors identify, he added.

Inspection results vary widely by state, influenced sometimes by lax nursing homes or more assertive surveyors, or a combination, according to an analysis of emergency-planning deficiencies.

In California, 53 percent of nursing facilities have been cited for at least one of two deficiencies related to emergency preparation: training employees what to do in an emergency and carrying out unannounced staff drills; or having a detailed written plan for disasters and emergencies, such as fire, severe weather and missing residents. In Texas, one-quarter of nursing homes have been cited. No nursing home in Indiana, Mississippi or Oregon was issued violations for those deficiencies in the past four years.

The danger of high temperatures for elderly residents, which the Hollywood Hills case shows can be disastrous, has been well-known. In a heat wave in 2000, two nursing home residents in a Burlingame, Calif., facility died and six others suffered severe dehydration, heat stroke or exhaustion.

During the past four years, inspectors have cited 536 nursing homes for failing to maintain comfortable and safe temperature levels for residents. Inspectors deemed 15 violations as serious, including two where patients were harmed, records show.

"There is undoubtedly little, if any, enforcement of the laws since we see the same tragedies repeated time and again," says Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.

Asked to explain the rarity of severe citations for lapses in emergency preparation, the federal Centers for Medicare & Medicaid Services, which oversees inspections, referred a reporter to its emergency-preparedness mission statement on its website.

This story was produced as part of a partnership with Kaiser Health News, a nonprofit health newsroom and editorially independent part of the Kaiser Family Foundation.

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PostPosted: Wed Sep 20, 2017 1:00 am 
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Hell, most nursing homes aren't prepared for a medical emergency

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PostPosted: Wed Sep 20, 2017 1:21 am 
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The main problem with having a backup power supply in a flood is that someone will use it.

And electrocute someone in the water.


But having a bug out plan is something that should be in every nursing homes books. Plus it should be coordinated with a local hospital and the local city to use their buses and special transport vehicles.


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PostPosted: Wed Sep 20, 2017 6:23 am 
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Great post addition. It is something I am having to consider fairly soon with an in-law.

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PostPosted: Wed Sep 20, 2017 9:54 am 
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taipan821 wrote:
Hell, most nursing homes aren't prepared for a medical emergency


So true. It's sad that it is easy to find a bad nursing home than a good nursing home. I've worked at a good one. I've been to a bad one. Remember to research before letting anyone take control of a family member's well being.

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PostPosted: Wed Sep 20, 2017 6:35 pm 
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Here is the thing. There is no "a nursing home" per se. There are many different types of extended care facilities. These provide a wide variety of care levels.

Typically they range from independent living where in effect the people live independently albeit with access to assistance should they need it to full fledged hospices which provide skilled nursing care to chronically ill upon discharge from the hospital.

There are all manner of care levels in between:

There are assisted living facilities where basic living assistance is provided (3 meals a day and laundry, assistance with bathing etc.).

There are memory care units where people with memory issues like Alzheimer patients live.

There are rehabilitation facilities which care for people typically after hip and or knee surgery.

There are traditional "nursing homes" that provide some level of very long term nursing care.

The vast majority of these are regulated at the state level to a wide variety of standards that range in effectiveness.

As such as one would expect the quality of these facilities range from dismal to 5 star hotel quality. The prices range from affordable to 5 star hotel (London/NYC/Tokyo based) rates.

The deaths due to Irma was not surprising. In Katrina these facilities whether located in hospitals or as stand alone units had a horrible casualty rate.
http://www.washingtonpost.com/wp-dyn/co ... 02562.html

There were even charges that patients were euthanized.
http://www.thepublicdiscourse.com/2014/06/13261/

However, no one was convicted. If you want to read more about this. One of the people charged Dr. Anna Pou has a web site with her side of the story. It is an interesting and sobering read of what happened in her words.
http://www.drannapou.com/

I post this not to rehash these events but to simply provide insight into this issue.

However, here are my thoughts on the matter albeit at a 40,000 ft level.

If you have loved one in or about to enter a facility like this, you have both the right and duty to ask what plans they have in place to deal with common emergencies. Understand when you walk into admissions you are a customer. They see you as revenue and you should assume you are getting the sales talk. I am not disparaging anyone who works at such facilities, but I am saying you are getting a sale talk.

Forget zombies ask about:

What is the fire evacuation plan? Ask to see the SOP manual. If they cannot lay their hands on the manual quickly you have a pretty good idea about the quality of their planning.

If you face a risk like hurricanes, tornadoes or wild fire. Ask about the evacuation plan. Ask to the plan in the manual.

Walk around the place. Look at basic things. Do the fire extinguishers have current inspection tags, Is it clean. Does it smell like chemicals or god forbid human waste. Do the residents look clean. Are they huddled together, do they simply look dazed or do they seem engaged and happy. Look in trash cans are they full or empty. If they are full that indicates a less than routine emptying schedule.

Come back after 6pm or at 5am to see who is on duty.

Ask about the staff and their qualifications. Obviously the level of care needed dictates staffing but for instance in assisted living in LA &MS an RN is not required to be on staff. Do you need an RN?

In short it is up to you to ensure that quality care to the level you need is provided. Do some basic diligence.

I have faced this issue once with my mother and will face it shorty again with my in laws. It is difficult for all involved. My mother wanted to live and if possible die at home. She wanted independence and to live comfortably in her own home. She was remarkably healthy up until 4 months before her death so that was possible. She swam in her pool until she was 92 and became ill. We should all live and die as well as she did.

I was lucky, my sister was willing to live with her at my mother's house for those 4 months.

The facility I was going to use charged $250 a day at that time. Extra duty attendants were an additional $12/hour so another $288 a day so $16,140 per month. My sister took care of my mother with just a house keeper to help her 4 hours a day.

This brings me to the reason for so many of the short cuts noted.

The cost of providing the facility, the people, the equipment, insurance, utilities, etc. is tremendous. Some are for profit and others are not but very few of these facilities are cash cows. In fact I have been involved in a turnarounds for one such entity. This allowed me insight into the real cost of running these places and the difficulty in keeping the lights on day to day.
It is a tough business.
It is even tougher for one off entities and mom/pop type operations that cannot achieve efficiencies of scale for insurance and similar costs.

So in summary my $.02.

Due some basic diligence before you use such a facility.
If you have a loved one in such a facility make your own arrangements if you live in hurricane country.
If you can have your loved ones stay at home and get in home care that is really the cheapest and best way for all involved if the health condition permits it

That and stay healthy.

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Last edited by raptor on Thu Sep 21, 2017 3:10 pm, edited 1 time in total.

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PostPosted: Thu Sep 21, 2017 2:26 pm 
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MacAttack wrote:


But having a bug out plan is something that should be in every nursing homes books. Plus it should be coordinated with a local hospital and the local city to use their buses and special transport vehicles.


The Hollywood incident in Florida on the 13th is extra tragic due to the facility literally being RIGHT NEXT to a hospital.

I mean, even a very basic rudimentary plan could have saved those poor people.

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