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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.,

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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

slide2

Preparedness Research Team

Carol Cornman Jim Laditka Jane Richter

Marcia Lane Courtney Davis Sarah Laditka Sudha Xirasagar

Arnold School of Public Health

slide3

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

slide4

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

slide5

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

slide6

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

slide7

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%)
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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

slide9

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

slide10

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

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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

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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

slide13

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%)
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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

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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

slide16

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

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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