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 7% of nursing homes JCAHO-accredited
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. Methods and Response Rate
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= )
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. Results – Post-Katrina Survey
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. Grant #U90-424245-02 in conjunction with the
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 #U in conjunction with the
Association of Schools of Public Health
Arnold School of Public Health
Office for the Study of Aging