Congressional investigation sounds alarm on nursing homes’ emergency readiness 

As the latest onslaught of extreme weather affects much of the U.S., Senate Democrats on Thursday released an investigation finding shortcomings in long-term care facilities’ emergency preparedness. 

The report, by the majority staff of the Senate Finance Committee and the Senate Special Committee on Aging, examined the impact of the February 2021 winter storm that caused blackouts across Texas. The report cites MarketWatch reporting on the aftermath of that storm, finding that residents had little defense against frigid temperatures in some nursing homes and assisted-living facilities that lacked backup power for their heating systems. 

Nearly half of the 1,200 nursing homes in Texas reported power or water outages, evacuations or other emergencies to state regulators during the 2021 storm, which struck in the midst of the COVID-19 pandemic, the committees’ investigation found. At least 1,400 nursing-home and assisted-living residents were evacuated, and two residents died, according to the report. 

Since 2018, extreme weather events in 17 states have forced long-term-care facility evacuations or led to resident injuries and deaths, the report said. “This report should serve as a warning sign — as we experience more frequent and catastrophic climate disasters, long-term care facilities must be better prepared to protect residents living there,” Sen. Bob Casey, the Pennsylvania Democrat who chairs the Senate Special Committee on Aging, said in a statement. 

New rules are needed to ensure the safety of long-term-care residents, the report said, calling on federal regulators to require that nursing homes have emergency power capable of maintaining safe temperatures and urging federal, state and local officials to coordinate with electricity providers to ensure that nursing homes get higher priority for power restoration during emergencies, among other measures.   

The early 2021 storm, known as Winter Storm Uri, underscored longstanding gaps in long-term-care facilities’ emergency preparedness. During on-site inspections of 154 nursing homes in eight states conducted in 2018 and 2019, the Health and Human Services Department’s inspector general found violations of life safety and emergency preparedness requirements at almost all of the facilities, according to a report released last year. “As a result, residents, visitors, and staff at the nursing homes were at increased risk of injury or death during a fire or other emergency,” the report said. 

Some facilities had no generators, insufficient emergency water supplies, fire exit doors that would not open, inadequate backup power for fire alarms, or lacked carbon-monoxide detectors, among other issues, according to the inspector general’s report. 

Past natural disasters have also taken a heavy toll on vulnerable patients, due to blackouts, staffing shortages, botched evacuations and other issues. A 2020 study by researchers at Brown University and the University of South Florida found more than 430 excess deaths among nursing-home residents exposed to Hurricane Irma, which hit Florida in 2017. A 2006 report on Hurricane Katrina by the Senate Committee on Homeland Security and Governmental Affairs noted that many New Orleans–area nursing homes lacked adequate evacuation plans and that 235 people had died in Louisiana nursing homes and hospitals.  

Long-term-care-industry trade group American Health Care Association/National Center for Assisted Living said in a statement that “the vast majority of long term care facilities successfully implement their emergency plans, and the heroic actions of staff help ensure the safety and well-being of countless lives when such events occur.” Nursing homes are already subject to extensive federal emergency-preparedness regulations, with additional state rules applying to nursing homes and assisted-living facilities, the group said, adding that “long term care facilities should be prioritized by local, state, and federal agencies for power and water restoration, resources, and supplies.” 

In facilities affected by Storm Uri that lacked power or backup generators, “the common solution was to pile on blankets and stay in bed,” Texas state long-term-care ombudsman Patty Ducayet wrote in a January 2022 letter to Casey and fellow Senate Democrat Ron Wyden of Oregon, who chairs the Senate Finance Committee. “This may have been the best we could do at the time, but it should sound alarm bells about the vulnerability of emergency response within facilities and the health risks that residents face in extreme weather events.” 

Neither federal nor Texas state regulations require long-term-care facilities to supply HVAC systems with backup power, Ducayet wrote in the letter, although nursing facilities are required to maintain safe temperatures and power fire alarms, emergency lighting and other emergency systems. 

“Long-term-care facilities should have generators that can power their heating and cooling and other essential services that will fail with power loss,” Ducayet told MarketWatch. “It must be a requirement, and it must be enforced.” 

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