Residents of Assisted Living Facilities rely on their caregivers for their daily needs and can be especially vulnerable during natural disasters and emergencies. Times of crisis can lead to stock depletion, staff shortages, and stress on caregivers. When planning unforeseen events, Assisted Living Facilities of any size must assess the many potential hazards and events that could affect their residents. These can include floods, earthquakes, tsunamis, forest fires, radiation emissions, power outages, chemical exposure, seasonal and pandemic influenza, and terrorist attacks. On such occasions, comprehensive preparedness planning can go a long way in helping communities using Assisted Living Facilities to meet the needs of their clients during natural disasters or other emergencies.
In Assisted Living Facilities, a powerful tool used in contingency planning is the emergency plan. Federal law requires that ALF certified by Medicare and Medicaid had written emergency plans. In all cases, when a facility does not meet government standards, a deficiency citation is issued. According to Public Health (2019), the facility must have detailed written plans and procedures for all potential emergencies and disasters. Moreover, the facility must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures”. Several mechanisms are available to the government when facilities do not meet minimum standards. If the Medicare or Medicaid screening and certification process determines that Assisted Living Facilities do not have appropriate written evacuation plans, they will be subject to fines and other penalties, including disenrollment from Medicare and Medicaid. Therefore, the purpose of overseeing emergency plans for ALF is to monitor and ensure the quality of care.
The need for proper emergency preparedness in Assisted Living Facilities is fixed in Florida regulations such as the Florida Statutes (Chapter 408, Part II) and the Florida Administrative Code (Chapter 59A-36). According to National Center for Assisted Living (2019), effective March 26, 2018, as a regulatory update, each Assisted Living Facilities is required to prepare a detailed evacuation plan to complement its Comprehensive Emergency Management Plan. The plan should include aspects such as an analysis of potential hazards in the facility that could disrupt the regular operation of the facility, emergency management rules, and emergency response procedures to assess the situation; protect residents, staff, volunteers, visitors, equipment, and drugs. Furthermore, the Agency for Health Care Administration prepared a report that Agency Regulated Health Care Providers, including ALF, need to consider the impact of a public health emergency related to COVID-19 on their preparedness plans for hurricanes and other disasters.
However, while there is emergency management legislation in Assisted Living Facilities, current Florida laws and regulations do not provide complete oversight. According to Koh (2018, January 21), Brian Lee, head of a long-term care residents’ advocacy group, claims that the enforcement in this area is poor, and the assessment of the plans is rather controversial. It is because in most states, checking emergency plans is little more than a paper check that confirms the plan meets the requirements. Moreover, Koh (2018, January 21) asserts that the emergency management division does not have enough staff to quality check all Assisted Living Facilities’ plans against all criteria.
Inspection data analysis, oversight reports, and interviews with ombudspersons and lawyers indicate that many Assisted Living Facilities do not comply with requirements. Kennedy et al. (2021) assert that since November 2017, when the so-called “all hazards rule” came into force, inspectors have found more than 24,000 deficiencies in emergency plans for Assisted Living Facilities. Violations occurred in 6,599 institutions, which is about 43% of ALF in the United States. Furthermore, Kennedy et al. (2021) note that in 2019 and 2020, the HHS inspector general found that inspectors in at least five states, including California, New York, Florida, Texas, and Missouri, did not properly comply with the new emergency preparedness rule.
The oversight of the emergency plans for the ALF should be organized at a high level. According to Furlow (2020, May 29), CMS said it would expand state oversight of the law. Inspectors who check whether Assisted Living Facilities meet emergency preparedness standards should read the plan to ensure it is up to date and take into account potential hazards. They must also confirm that the ALF has trained its staff in the contingency plan and ensure that the facility is prepared to communicate and delegate authority in an emergency. In its turn, Furlow (2020, May 29) claims that the most frequently cited issue of nursing home preparedness for emergencies is the inability to rehearse their plans in a community-based exercise, usually organized by the local emergency management or hospital-led health care coalition. To successfully overcome the consequences of an emergency, effective training should be organized for both personnel and residents of Assisted Living Facilities, as well as regular training sessions should be scheduled to teach how to act in an emergency.
Quality problems in nursing homes have been around for decades. Notably, the COVID-19 pandemic has drawn attention to the quality of Assisted Living Facilities and the oversight of their emergency plans at the federal and state levels. The current focus is on the challenges facing ALF and state research agencies in responding to the pandemic. Therefore, policymakers should reconsider whether federal requirements for Medicare and Medicaid should be adjusted to improve oversight and whether additional funding is needed to support providers and agencies to ensure adequate capacity. These issues are likely to continue to be the subject of political discussion and debate.
Thus, understanding the emergency plans used by Assisted Living Facilities can lead to the development of advanced evacuation techniques. This research has implications for responding to future hurricanes and other natural disasters, such as floods and earthquakes, that occur periodically in the United States and may require the evacuation of ALF residents. Plans should outline how facilities will respond to the emergency, indicating how nursing homes will decide whether to grant in situ or evacuate and how they will provide residents with food, water, medicine, and electricity. At the same time, current laws and regulations of most states do not provide appropriate oversight of emergency plans for ALF and require further detailed consideration and improvement, taking into account contemporary social trends.
References
Furlow, B. (2020). Nursing homes fought federal emergency plan requirements for years. Now, they’re coronavirus hot spots. ProPublica. Web.
Kennedy, K., Hua, C., & Nelson, I. (2021) A Comparison of emergency preparedness policies by long-term care setting type in Ohio: Assisted living settings to lag behind nursing homes in key areas. Journal of Applied Gerontology, 40(4), 377-386. Web.
Koh, E. (2018). Nursing homes need improved emergency plans, but who will verify them? Miami Herald. Web.
National Center for Assisted Living (2019). 2019 assisted living: State regulatory review [PDF document]. Web.
Public Health, 42 C.F.R. §483.73 (2019). Web.