As the 2018 hurricane season nears its end, the need for adequate disaster preparedness at nursing homes continues to become more evident. News coverage highlights the plight of residents needing to evacuate and later returning to destroyed homes and possessions. This time last year, AARP pointed out how storms and inconsistent disaster preparedness surrounding these events lead to unnecessary deaths.

Even if flooding doesn’t occur, hurricanes and other types of natural disasters have far-reaching complications. In one instance during last year’s season, Hurricane Irma disabled a Florida nursing home’s air conditioning system for several days, exposing residents to extreme heat. Staff made no effort to move residents and 12 died of heat exposure. This past year, the U.S. Coast Guard assisted with evacuating residents from storm-related flooding in North Carolina and Florida.

Need for Change

lightning strike These incidents have been going on for years, rarely getting significant news coverage. According to a Department of Health and Human Services report, data indicated that, even post-Katrina, disaster preparedness isn’t uniform across facilities and nursing homes rarely prepare for the worst:

  • Even if a facility had an emergency plan, most instructions did not take a resident’s illness or treatment into account for evacuation.
  • In seven out of 24 plans, homes did not factor in how to identify residents.
  • For 15 out of 24 nursing facilities, emergency plans did not involve residents’ medication lists.
  • Of all the homes examined, none had a safe, seven-day supply of drinking water for residents having to shelter in place. Few had thought about transporting food, water and medications to evacuated residents.
  • Nearly all the homes surveyed had no backup plan if staff members couldn’t report for work during the disaster.
  • For 17 out of the 24 homes, there was no plan to work with local emergency shelter coordinators, regardless of whether residents had to be evacuated or were being sheltered in place.

As findings like this come to light, the Centers for Medicare & Medicaid Services has started requiring homes to put together emergency and disaster preparedness plans using specific guidelines. While the effort could lead to improved response, multiple elder care experts have pointed out loopholes:

  • The CMS and state agencies have yet to strongly enforce the new guidelines.
  • Testing, including practice drills, is not consistent across all homes. Simply putting a plan down on paper is often sufficient.
  • Staff don’t receive ongoing training to prepare for these incidents.

A recent review of federal records found that, over the past four years, nursing homes received 2,300 citations concerning emergency planning regulations and another 1,400 for inadequate emergency generator upkeep.

Where Emergency Preparation is Working

In one example from AARP’s report, Genesis, a nationwide chain of roughly 450 nursing homes, started buildings its emergency preparedness strategy after Katrina in 2005. Since then and refined with every major storm, the company has required:

  • Emergency preparedness plans at each facility, adjusted for the location’s common natural disasters.
  • Plans must cover everything from backup power and emergency supplies to staffing and medications. For instance, residents are provided with backpacks containing a multi-day supply of medication, copies of medical records and a change of clothing.
  • Homes must test their plans regularly with power outage drills.
  • Staff from regions outside the storm area help with evacuations and get residents to a safe area.

Disaster Issues Specific to Nursing Homes

When a storm is imminent, a nursing home often has a plan for sheltering in place, where residents stay put and staff members are trained to respond to the disaster and any complications. Successful planning requires that the home already have adequate resources, including backup power, and be ready to evacuate at a moment’s notice, all while keeping all residents safe. In an ideal situation, sheltering in place reduces stress on residents, allows them to continue receiving care and provides resources to get through the storm.

While a home may be physically designed to withstand the storm, a building is not enough when the flood waters are rising and the power shuts off; extraneous factors have just as great of an impact. For instance, communication with state and local emergency personnel influences how fast and smoothly evacuation occurs. Effective communication pathways are also vital to keep a home powered during and after a storm.

At the national level, the push for improving how nursing homes respond to natural disasters continues to grow. After the findings of the “Sheltering in Danger” report were released in November 2018, members of Congress called for more oversight, clear, stronger rules, better communication and emphasized prioritizing resources for nursing communities during a disaster. The report offers 18 recommendations for improved disaster preparation.

Between this report and previous studies, nursing home disaster preparedness strategies still need to consider the following.


According to one report from NPR, federal inspection records show that homes are rarely reprimanded when they violate the CMS’ emergency preparedness guidelines. In many cases, violations could jeopardize patient safety:

  • In one example, a home had no plan for evacuating wheelchair-bound residents.
  • During test drills, residents weren’t evacuated in the correct order and staff didn’t know the combination to unlock a courtyard gate.
  • A third of all homes did not inspect their generators weekly or test them monthly.

State-by-State Inconsistencies

State officials review facilities’ emergency plans and determine if a home has any safety violations. In NPR’s report, violations and inspection results weren’t uniform across all states. In some locations, a quarter to half of all homes received citations. Oregon, Mississippi and Indiana did not receive any citations over a four-year period.


The staff at nursing homes are already stretched thin, with facilities regularly understaffed. Based on one report from The Huffington Post, natural disasters may exacerbate this issue. Staff members can’t get to work and thus, there aren’t enough personnel to assist residents in a storm or help during an evacuation. A home might not even have adequate transportation to evacuate all residents, making communication with local emergency responders a life-or-death situation.
Power outages affecting residents’ health, inadequate evacuation and ignoring treatment plans all fall within the scope of nursing home negligence. If you found that your loved one’s safety and health were endangered in the aftermath of a storm, you don’t have to be silent. Work with Trantolo & Trantolo’s lawyers to hold the home and its staff accountable for their lack of preparation. To bring your claim to our attention, contact us today.