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After Katrina we were shocked at the disaster in some nursing homes in New Orleans. Florida nursing home residents may not have faired any better. Last month’s mandatory evacuation of the Florida Keys lashed by Hurricane Rita revealed critical flaws in the state’s elaborate emergency requirements for nursing homes.

In the afternath of Katrina we were shocked at the disaster in some nursing homes in New Orleans. The Palm Beach Post says Florida nursing home residents may not have faired any better. Why? “Last month’s mandatory evacuation of the Florida Keys lashed by Hurricane Rita revealed critical flaws in the state’s elaborate emergency requirements for nursing homes.”

Florida’s secretary of Health Care Administration, Alan Levine, confirmed that he personally stepped in to help rescue hundreds of nursing home patients in the Keys when the operator of three nursing homes failed to immediately heed state evacuation orders.

“The owner was going to evacuate his Key West facility to Marathon,” Levine said. “And he wanted to move people in his upper Keys facility to Sunrise. . . .

“That would not have gotten people out of harm’s way. His position was that it’s expensive to even move people to other homes he owned. But when it comes to patient safety, it’s nonnegotiable.”

Notified of the situation by the Monroe County Emergency Operations Center, Levine, who was working in Florida’s state-of-the-art EOC in Tallahassee, arranged for a National Guard plane equipped for medical emergencies to fly to Key West and bring the patients to Broward County.

Those with serious medical conditions, including some in need of kidney dialysis, were transferred to Broward hospitals. Levine personally arranged to have the rest transported by ambulance or bus to Palm Beach County nursing homes. All arrived unharmed.

“Time had run out,” Levine said. “We got fantastic cooperation . . . and were able to get the patients to safety.”

With the only highway out of the Keys underwater in some areas, and high winds blowing in roofs and windows in parts of the lower Keys, Florida easily could have faced a scenario like the Texas and Louisiana hurricane-driven nursing home tragedies. In one instance, a bus carrying patients and oxygen canisters caught fire on the Houston-to-Dallas highway, killing 24 Texas nursing home residents. Earlier, 34 elderly patients were found dead in a flooded nursing home outside New Orleans whose owners defied evacuation orders. A 35th victim was discovered Monday.

The Post article then itemizes some major problems:

• No one checks to see whether nursing homes actually have the staff, supplies and transportation contracts to provide what is written in their fairly elaborate and specific emergency plans filed annually. Those reports include provisions for evacuation, staffing, transportation, food, water and medicine. County emergency operations officials review and approve the plans or require revisions, but no government agency keeps a copy or verifies the information.

• Transportation contracts or “agreements” to move patients in a mandatory evacuation from nursing homes are required, but no one checks to see whether those who have agreed to transport the patients actually have the vehicles and staff to do so or whether they are double- or triple-booked for evacuations.

• Florida nursing homes are required to have only a 72-hour supply of food, water and medicine to care for evacuated patients. Hurricane Katrina proved that much larger stocks of supplies may be needed in the event of extensive damage.

• If a nursing home fails to evacuate its patients according to its EOC-approved plan, there is no agency with enforcement authority to penalize it.

State-mandated nursing home emergency plans

Florida state law requires that licensed nursing homeshave emergency plans approved by their respective county Emergency Operations Center to keep patients safe in the event of a hurricane or other disaster. The plans must include:
• A 72-hour supply of all essentials, including prescription medication, food and water.
• Written transportation contracts or mutual aid agreements for evacuating patients.
• Provisions for continuous 24-hour staffing.
• Arrangements for moving medical records, drugs, food, water and other necessities with the patients.
• Contracts with predetermined locations to which patients will be evacuated with special consideration for non-ambulatory and the most seriously ill patients.
• Identification of evacuation routes and alternate evacuation routes.
• Specific plans for communicating with patients’ relatives and guardians before evacuation and throughout the emergency.
• Accommodations for the families of critical staff members.
• Identification of the owner and administrator and 24-hour contact information; listing the facility’s chain of command in an emergency.
• Training of all workers in the execution of the disaster plan.
Sources: Emergency Management Planning Criteria for Nursing Homes, American Health Care Association; and Florida statutes

Why should nursing homes bear the expense of emergency evacuations? Many nursing homes argue that it is unfair that they must bear the expense of the evacuations, which can cost tens of thousands of dollars. But, that is part of the responsibilities, legal and fiscal, in operating a nursing home. Protecting the health and life of nursing home patients in an emergency is an obligation of the contract between the patients and the homes.

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