As follow up to information previously released by the Louisiana Department of Health (LDH) regarding findings against seven nursing homes in Louisiana, on September 7, 2021, LDH officials alerted the nursing homes in question that had evacuated their residents to a warehouse ahead of Hurricane Ida that their licenses are being revoked and that their Medicaid provider agreements have been terminated. Six residents died, and the deaths were not considered storm-related.
Following two in-person site visits by Health Standards and an environmental health assessment by an Office of Public Health Sanitarian prior to hurricane landfall, it appeared that from a facility standpoint the minimum necessary components to provide a safe sheltering environment for up to 700 residents for a very short period of time were met. There were plans for staffing, food service and laundry, potable water, portable toilets, and a working generator appropriately sized for the facility.
Conditions at the warehouse, most importantly including care for the 843 residents transferred there, deteriorated significantly following the storm as backup generators failed, trash piled up, and care declined to very poor standards. An individual representing himself as the owner of these nursing homes failed to communicate the dire situation to the state and ask for help. When the Louisiana Department of Health (LDH) went on-site August 31 upon receiving concerning reports from third parties, the operator expelled LDH representatives from the property and prevented the completion of the site visit. In addition, over the course of the event, LDH team members were subject to intimidation.
On August 31, LDH began planning for the evacuation of all residents in the facility. On September 1 and 2, LDH, in collaboration with several state agencies and local officials, worked around the clock to get all 800-plus residents to immediate safety.
Since then, LDH’s Office of Aging and Adult Services has been fielding calls to help connect families to loved ones rescued from the warehouse facility. In addition, LDH has proactively contacted all family members for each nursing home resident remaining at designated medical special needs shelters.
The notice given to the seven nursing facilities by the LDH of the termination of their Medicaid agreement and revocation of the facility licenses states, “An emergency preparedness plan is more than just a form of paper compliance. The implementation must accomplish the goals it is designed to meet. Some of those goals include the delivery of essential care and services to residents, the procedures for ensuring that all residents have access to licensed nursing staff, and that services are provided during all phases of the evacuation, including transporting of residents. […] it is clear that the facility failed in this regard.”
The formal notice further states, “The situation at the site was clearly and rapidly deteriorating. While this was going on, the facility’s owner, rather than reaching out for help in regard to the situation from state regulators, was orchestrating a campaign with the goal of preventing a proper assessment of what the situation was at the site via threats, harassment, and intimidation. This type of conduct, while also possibly violating the right of the resident to receive adequate and appropriate healthcare and protective and support services, is clearly demonstrative of indifference to the welfare of the residents.”
Louisiana’s State Health Officer ordered that these seven facilities are prohibited from admitting or repatriating residents. LDH made appropriate referrals to the Office of the Attorney General, Office of Inspector General, Centers for Medicare & Medicaid Services, Louisiana State Police, East Baton Rouge Sheriff’s Office, and Baton Rouge Police Department.
Compliance Perspective
Issue
The time to review your emergency preparedness plan is not during an emergency. Advance review and preparation are essential. This should include a plan on how an evacuation would be implemented should it become necessary. If an emergency does happen in your facility, it is critical that all are prepared and ready to take appropriate and swift action. A satisfactory emergency preparedness plan can truly mean the difference between life and death for residents and staff.
Discussion Points
- Review your Emergency Preparedness Plan. Ensure that the Plan includes how an evacuation will be conducted if it becomes necessary. Compare your plan to the required Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Actions. Update your Emergency Preparedness Plan as needed.
- Train all staff on your Emergency Preparedness Plan. Conduct drills for the various disaster response plans to ensure staff competency with each. Document that these trainings and drills occurred and file the signed documents in each employee’s education file.
- Audit staff understanding to ensure that they are aware of their roles during an emergency per your Emergency Preparedness Plan.
FOR MORE INFORMATION ON THIS TOPIC VIEW: CMS – EMERGENCY PREPAREDNESS CHECKLIST and EMERGENCY PREPAREDNESS REQUIREMENTS FOR NURSING HOMES.
