As the Houston area approaches the heart of hurricane season, there are several lessons learned from our trying experiences with Rita and Ike. Chief among these lessons is that ensuring our most vulnerable citizens’ safety is a priority during a major storm. Although there has been progress working with state lawmakers on transportation issues, there remains room for improvement in terms of how we will improve access to buses and emergency vehicles to ensure residents reach safety as quickly as possible.
Beyond transportation concerns, we had extreme difficulty during Hurricane Ike ensuring that electrical power was restored to facilities throughout the area. No doubt it was an enormous undertaking to restore power to the three million individuals in the area. But it is essential to view nursing homes as a priority in the same manner hospitals are viewed as a priority. Our facilities provide complex care services as well as around-the-clock care. Unfortunately, however, nursing homes have typically been viewed as residential — in other words, not a paramount priority when it comes to restoring power. On policy grounds, there are no logical arguments to justify this difference in status.
Historically, nursing homes have been expected to take care of themselves when it comes to weather emergencies. The situation in Ike’s troubling aftermath was challenging, and truly heroic efforts were taken by nursing homes to ensure residents retained 24-hour access to care. Long-term care facilities along the vulnerable Gulf Coast have instituted important life-saving disaster contingency plans to ensure critical health care services are continually provided throughout the ordeal — regardless of whether the facility is completely evacuated out of harm’s way, or shelters in place. During Ike, for example, 86 of the state’s 1,144 nursing homes, affecting 20 counties, were evacuated — impacting approximately 7,000 elderly patients.
Nursing facilities generally evacuate 72 hours before a disaster strikes. Both buses and ambulances are necessary to transport patients beyond the storm’s reach. Other expenses incurred by evacuating facilities include lodging for additional staff and their families, overtime and emergency supplies. Likewise, facilities sheltering in place have additional expenses such as generators, fuel, ice, water, additional food for staff and their families and day care for staffers’ families. Costs simply to evacuate a single nursing home can run from $75,000 to $100,000.
When sheltering in place, the generators necessary to fully power a nursing home cost approximately $70,000 each, and burn 10 gallons of diesel fuel per hour to run air conditioning.
Therefore, as a result, both for-profit and nonprofit long-term care facilities urgently required immediate help with transportation and other disaster-related expenses. Yet, under the Stafford Act, for-profit long-term care facilities are not authorized to access federal assistance. Under current law, inexplicably, for-profit long-term care providers are precluded from accessing this funding. In Texas, only 14 percent of all nursing facilities are not for-profit. In short, current federal policy is ill conceived and merits immediate reform.
Disasters wreak havoc indiscriminately, damaging for-profit and non-profit facilities alike. In many localities, for-profit nursing facilities may be the only long-term care provider available in an entire community. They, too, should be provided with equal access to federal resources. Yet the unfortunate backdrop for this entire discussion is that long-term care facilities are already facing the significant challenges of a historic state and federal funding squeeze.
In addition to the fact Texas facilities are now being forced to absorb more than $1 billion in federal Medicare cuts over 10 years, state leaders in Austin are considering $25.6 million cuts to Medicaid-funded nursing home care.
It is clear we need to fine-tune the complicated state and federal disaster response process. We are pleased with progress to date working with state leaders, and will continue to work cooperatively to improve the overall process. However, in addition to improving access to federal disaster relief, funding stability from Austin and Washington in the context of Medicaid and Medicare funding, respectively, is a necessary prerequisite to progress in helping our residents and facilities in times of danger.
Graves is president of the Texas Health Care Association in Austin; Lentz is chair of THCA and president and CEO of Healthmark, operating eight facilities in the greater Houston area.
Nursing home evacuation is rare in most parts of the United States, but those of us that have participated in one know it is a big undertaking.
About the Author
During his career in human resources and recruiting, Tony Perry has been placing top long-term care talent in the healthcare industry for nearly 20 years. His firm, Executive Search Solutions, is one of nations leading senior care recruiting firms. Check out his BLOG and WEBSITE to secure the right candidate for critical open positions or for representation in your job search.