Medicare Compliance & Reimbursement

Upcoming GAO report could make a push for emergency SNF evacuations.

Skilled nursing facilities that assume "shelter in place" is the way to go in most emergencies could be endangering residents and inviting the wrath of federal regulators.

In a preliminary report the Government Accountability Office released on Feb. 16, the GAO admits that nursing homes don't have it easy when making the call to evacuate. Special challenges nursing home administrators face include residents having no other home to go to and the problem of finding receiving facilities that can accommodate residents for a long time, the report states.

The reality is that SNF providers are often isolated in making the call about whether or not to evacuate. They aren't bound legally to evacuate when state and local governments order evacuations during emergencies, adds the report.

GAO researchers conducting the preliminary investigation found that hospital and nursing home administrators generally evacuate only as a last resort and that facilities' emergency plans primarily aim to "shelter in place."

SNFs Must Identify Tripping Points Early

To evacuate residents when necessary, SNFs should concern themselves with the preliminary report's following essential considerations:

• Adequate resources to shelter in place. Key questions: Is the emergency power system reliable? Did the facility test it recently? Will the facility have access to critical supplies? How will the facility keep lines of communication open with family? Has the facility planned for staff support activities, such as housing, transportation and counseling?

• Determining the risk to patients. Key question: Is making the call early and having more time to evacuate safer, or can the facility reduce risk by delaying the decision?

• The availability of transportation to move patients. Key questions: Are the facility's transportation agreements up to date? Has the facility coordinated its plans with neighboring health care facilities?

• Receiving facilities' ability to accept patients. Key questions: Has the facility kept agreements with receiving facilities current? Does the SNF know whom to contact locally for assistance in the event of an emergency evacuation?

The full report, which is due this summer, could call attention to nursing homes' particular vulnerabilities during disasters. That, in turn, could encourage more assistance at the federal and state levels, says LuMarie Polivka-West of the Florida Health Care Association.

During the last hurricane season, hospitals--but not nursing homes--received patient evacuation assistance from the National Disaster Medical System, a partnership between the Department of Defense, the Department of Health and Human Services, Department of Homeland Security and the Department of Veteran Affairs. In the future, NDMS may assist nursing homes as well.

The report, "Disaster Preparedness: Preliminary Observations on the Evacuation of Hospitals and Nursing Homes Due to Hurricanes" (GAO-06-443R), is available online at www.gao.gov/new.items/d06443r.pdf.