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Report (OEI-06-09-00270)

Gaps Continue To Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010

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Federal regulations require that Medicare- and Medicaid-certified nursing homes have written emergency plans and provide employees with emergency preparedness training. In a 2006 report about nursing homes that experienced hurricanes, we found that emergency plans lacked many provisions recommended by experts. In response, CMS issued guidance checklists for emergency planning of health care facilities, long-term care (LTC) ombudsman programs, and State survey agencies (SA). We conducted this study to assess emergency preparedness and response of nursing homes that experienced more recent disasters.


For this study, we analyzed national survey data to determine compliance with Federal regulations. We also conducted site visits to 24 selected nursing homes that experienced floods, hurricanes, and wildfires in 2007-2010. We interviewed nursing home administrators and staff, local emergency managers, and representatives from State LTC ombudsman programs and SAs. We also compared the emergency plans of each selected nursing home to the CMS checklist for health care facilities.


Most nursing homes nationwide met Federal requirements for written emergency plans and preparedness training. However, we identified many of the same gaps in nursing home preparedness and response that we found in our 2006 report. Emergency plans lacked relevant information-including only about half of the tasks on the CMS checklist. Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems. LTC ombudsmen were often unable to support nursing home residents during disasters; most had no contact with residents until after the disasters. SAs reported making some efforts to assist nursing homes during disasters, mostly related to nursing home compliance issues and ad hoc needs.


We made three recommendations to CMS and one recommendation to AoA. CMS agreed with our recommendations to revise Federal regulations to include specific requirements for emergency plans and training, update the State Operations Manual to provide detailed guidance for SAs on nursing home compliance with emergency plans and training, and promote use of the checklists. AoA agreed with our recommendation to develop model policies and procedures for LTC ombudsmen to protect residents during and after disasters. Finally, in a memorandum report (OEI-06-09-00271), we outline guidance that CMS can consider when revising the checklist for health care facilities.

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