Ready or Not? Perceptions about
Preparedness in Nursing Homes Before and
After Hurricane Katrina
Preparedness Research Team
Sarah B. Laditka, Ph.D.
Health Services Policy and Management
CoCo-authors, alphabetical order: Carol B. Cornman,
Cornman, RN/PA,
Courtney B. Davis, MHA, James N. Laditka, D.A., Ph.D.,
Jane V.E. Richter, Dr.PH., RN, Sudha Xirasagar,
Xirasagar, MBBS, Ph.D.
Carol Cornman
Marcia Lane
Arnold School of Public Health
Office for the Study of Aging
Background I
¾ 3 million older Americans reside in 18,000
nursing homes
¾ Few studies have examined nursing home
preparedness
¾ Identified problems: transportation,
communication, lack of water, food, medical
and hygiene supplies, staff shortages
¾ Nursing homes receive much less support
than hospitals during/after emergencies
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Jim Laditka
Courtney Davis
Background II
¾ JCAHO (Joint Commission on
Accreditation of Healthcare
Organizations) requires HCO
to have comprehensive
emergency plans
¾ 7% of nursing homes JCAHO-accredited
¾ CMS delegates oversight to states
¾ State oversight focuses on checklists,
documentation of a plan, regular review
with staff and drills, without feedback
from public officials or risk managers
Arnold School of Public Health
Study Design
¾ Examine nursing home preparedness in the
¾ Designed mailed “baseline”
¾ Investigate administrators’ views about
preparedness change in response to a large
disaster
¾ Suggest ways to enhance preparedness
Sudha Xirasagar
Arnold School of Public Health
Research Objectives
absence of an immediate emergency or
disaster
Jane Richter
Sarah Laditka
survey after talking with
emergency management
officials, nursing home
administrators, reviewing
guidelines
¾ Baseline survey mailed to licensed nursing homes
(N=192), in July 2005
¾ Post-Katrina survey distributed to all nursing homes,
mid-September, to see if preparedness views were
influenced by Hurricane
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Methods and Response Rate
Results –
Respondent Characteristics
¾ Quantitative data: standard descriptive
statistics, t-test, chi-square statistics,
correlation coefficients
¾ Qualitative data: coded independently
by 3 researchers using grounded
theory
¾ 112 baseline surveys; 50
post-Katrina surveys
(response rate: 58.3%;
25%)
Results – Satisfaction with Preparedness
¾ 1. 82% satisfied with sheltering arrangements if
evacuation needed
¾ 2. 68% satisfied with their ability to shelter
¾ 3. 59% satisfied with transportation resources
¾ 4. 55% satisfied with off-duty staff ability to care for
evacuees
¾ 5. 93% satisfied with “overall” ability
to protect
¾ Overall satisfaction with
preparedness (5) modestly
correlated with 1-4 (r range=.25-.33)
Arnold School of Public Health
Results – Emergencies in last 3 Years
¾ Total of 55.4% experienced some type of
disaster: loss of power (40.2%); ice storm
(35.7%); hurricane (11.6%); tornado (8%);
fire (7.1%); chemical spill (2.7%)
¾ Asked about experience with first
responders to these emergencies;
experience was good – but, these were
generally not widespread disasters
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¾ 90% were administrators
¾ 60% worked in facility more than 5 years;
average 15 years of nursing home
administrative experience
¾ Less than 20% were in metropolitan areas
¾ 14% located in “coastal” regions
Arnold School of Public Health
Results – Communication Plans
¾ Asked participants, “all communications
methods you plan to use …”
¾ More than 80% would rely on cell phones,
computers if landline phone service was
disrupted
¾ Only 5 mentioned use of HAM radio
operators; HAMS use low tech, reliable
equipment to establish communication when
landline systems are disrupted
Arnold School of Public Health
Results – Qualitative
¾ How can county or state help?:
provide more resources (39%);
provide education (30%); improve
communications (19%)
¾ Strengths?: well trained, dedicated staff
(52%); strong community support (30%)
¾ Weaknesses?: high turnover (13%); need
more training (12%); lack of transportation
resources (12%); lack of generators and
communication systems (12%)
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Results – Post-Katrina Survey
SC Study - Conclusions
¾ Katrina changed views about preparedness
¾ Overall satisfaction with preparedness not highly
(54%): rethinking evacuation/transportation
(32%); updating plans (30%), rethinking
supplies (14%); rethinking staff (12%)
¾ Katrina did not change
views about preparedness
(36%): feel well prepared
(30%); SC is better
prepared because of
hurricane experience (6%)
correlated with specific preparedness domains
¾ Most would rely on cell phones and/or computers if
landline phone service were disrupted
¾ Most did not acknowledge capacity problems with
transportation in a widespread disaster, and the
need for backup arrangements
¾ Findings suggest several domains important to
consider for emergency preparedness in nursing
homes: communication, transportation, and ability to
shelter residents from other nursing homes
Arnold School of Public Health
Policy Recommendations I
Policy Recommendations II
¾ Develop stronger linkages with local emergency
National Level:
preparedness system (EPS) to help access
resources, e.g., gasoline, power
¾ Work with local EPS to tap into HAM network to
improve communication systems
¾ Identify backup transportation resources
¾ Professional associations should hire risk managers
to serve as consultants
Federal Level:
¾ Centers for Medicare and Medicaid Services should
require nursing homes to have disaster plans
reviewed by professional risk managers
¾ FEMA should assist nursing homes with evacuation
following widespread disaster
Arnold School of Public Health
Office for the Study of Aging
Arnold School of Public Health
Office for the Study of Aging
Ready or Not? Perceptions about Preparedness in
Nursing Homes Before and After Hurricane Katrina
~ Thank You ~
This research was funded by the Centers for Disease Control and Prevention,
Grant #U90-424245-02 in conjunction with the
Association of Schools of Public Health
Arnold School of Public Health
Office for the Study of Aging
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