Federal Regulations Mandate Emergency Plans
All nursing homes certified by the Centers for Medicare & Medicaid Services (CMS) must meet federal emergency preparedness standards. This regulation outlines four core elements that every facility's program must include:
- Emergency Plan: Based on a facility-specific and community-based risk assessment, this plan must address a range of potential emergencies, from natural disasters like hurricanes and earthquakes to man-made incidents.
- Policies and Procedures: These must cover a wide array of actions, including resident tracking during and after an evacuation, arrangements for transportation, and managing medical supplies.
- Communication Plan: Facilities must have a system for communicating with staff, residents, residents' families, and local emergency officials during a crisis.
- Training and Testing: Staff must be regularly trained on emergency procedures and participate in drills to test the plan's effectiveness.
Beyond these federal rules, many states, like New York and California, impose additional specific requirements on top of CMS regulations to further enhance disaster readiness.
Evacuation versus Sheltering in Place
One of the most critical decisions during an emergency is whether to evacuate residents or have them shelter in place. Evacuation is not always the safest option, as relocating frail residents can cause significant stress and lead to negative health outcomes. The decision depends heavily on the type and severity of the threat.
When is evacuation necessary?
An evacuation is the organized withdrawal from a dangerous area. It is most likely for immediate, life-threatening dangers where the building is no longer safe. Common triggers include:
- Internal Fire: The single most common reason for nursing home evacuation, alongside hurricanes.
- Flooding or Storm Surge: Water-related events, including hurricanes, are a primary cause of natural disaster-related evacuations.
- Structural Damage: Earthquakes, tornadoes, or other events that compromise the building's integrity may necessitate an evacuation.
- Chemical Spill or Other External Hazards: A hazardous materials event in the surrounding area could force a move.
When is sheltering in place the safer option?
Sheltering in place involves staying inside the facility to separate individuals from an external threat. This may be preferable if the risk of relocation is greater than the risk of staying put, especially for events like a tornado warning or a widespread power outage where the facility has a strong backup power system. Plans for sheltering in place require facilities to have adequate supplies of food, water, and medical equipment on hand to sustain residents for an extended period.
Comparison of Evacuation vs. Sheltering-in-Place
| Feature | Evacuation | Sheltering-in-Place |
|---|---|---|
| Decision Trigger | Immediate threat to life, uninhabitable building, or ordered by authorities. | Temporary, less immediate threat, such as a severe storm or power outage. |
| Resident Risk | Increased risk of mortality, anxiety, and post-traumatic stress from relocation and environmental disruption. | Lower risk from relocation, but potential danger from loss of power, heat, or exposure to external hazard. |
| Logistical Challenge | Extremely complex, requiring pre-arranged transportation, alternate sites, and resident tracking. | Less complex logistically, focused on securing the facility and managing on-site resources. |
| Facility Needs | Transportation, formal agreements with alternate care sites, and secure transfer of medical records. | Backup power systems, stockpiled food, water, and medical supplies, and robust internal security protocols. |
| Staff Roles | Clearly defined roles for transportation, resident assistance, and coordination with external agencies. | Focus on maintaining operations, providing comfort, and monitoring residents during the event. |
The Evacuation Process for Nursing Homes
For facilities that do evacuate, the process is detailed and multi-faceted. The plan starts well before a crisis occurs with meticulous preparation and formal agreements.
- Preparation and Agreements: Facilities must establish formal agreements with designated evacuation sites, which could be other nursing homes, hospitals, or large venues like schools. These agreements specify the resources and support available at the alternate location. Transport contracts with ambulance services or other providers are also secured in advance.
- Activating the Plan: The decision to evacuate is based on a pre-determined risk assessment and is typically made by the facility administrator in consultation with local emergency management officials.
- Communication: The facility's communication plan goes into effect, notifying staff, residents' families, and relevant state and local agencies. Keeping families informed is a crucial, though sometimes challenging, part of a chaotic evacuation.
- Resident Tracking: A system is implemented to track every resident to ensure no one is left behind. Modern systems may use barcode bracelets, while others rely on detailed checklists and staff accountability. Medical records must be securely transported to ensure continuity of care.
- Transportation: Residents are moved based on their medical and mobility needs. This requires a range of transport, from buses for ambulatory residents to ambulances for those who are bed-bound or require specialized medical equipment.
- Relocation and Care: At the new location, the facility's staff, or staff from the host facility, continue to provide care. Staffing may be challenged, especially if the disaster affects a large area.
- Return to the Facility: After the event passes and the facility is deemed safe, a planned return is organized. This process also requires careful coordination to minimize disruption.
Conclusion
The question of "Do nursing homes evacuate?" has a clear answer: yes, but only when a comprehensive risk assessment determines it is the safest course of action. Federal regulations require all certified facilities to have detailed emergency preparedness plans that account for both evacuation and sheltering-in-place scenarios. For families, understanding their loved one's facility's specific plan, including communication protocols and designated evacuation sites, is a critical step in preparing for any emergency. While the process is complex and not without risks, mandatory planning ensures facilities are equipped to make the best possible decisions to protect their residents when a disaster strikes.
How can families prepare for a nursing home evacuation?
Families can take proactive steps to prepare for a loved one's evacuation by reviewing the facility's plan, keeping contact information up to date, and having their own emergency plan in place. Staying informed and being ready to provide emotional support can significantly aid in a smooth transition during and after a crisis.
