title: Nursing Home Self-assessment of Implementation of Emergency Preparedness Standards.
abstract: Introduction Disasters often overwhelm a community's capacity to respond and recover, creating a gap between the needs of the community and the resources available to provide services. In the wake of multiple disasters affecting nursing homes in the last decade, increased focus has shifted to this vital component of the health care system. However, the long-term care sector has often fallen through the cracks in both planning and response. Problem Two recent reports (2006 and 2012) published by the US Department of Health and Human Services (DHHS), Office of Inspector General (OIG), elucidate the need for improvements in nursing homes' comprehensive emergency preparedness and response. The Center for Medicare and Medicaid Services (CMS) has developed an emergency preparedness checklist as a guidance tool and proposed emergency preparedness regulations. The purpose of this study was to evaluate the progress made in nursing home preparedness by determining the level of completion of the 70 tasks noted on the checklist. The study objectives were to: (1) determine the preparedness levels of nursing homes in North and South Carolina (USA), and (2) compare these findings with the 2012 OIG's report on nursing home preparedness to identify current gaps.
  
  
  METHODS
  A survey developed from the checklist of items was emailed to 418 North Carolina and 193 South Carolina nursing home administrators during 2014. One hundred seventeen were returned/"bounced back" as not received. Follow-up emails and phone calls were made to encourage participation. Sixty-three completed surveys and 32 partial surveys were received. Responses were compared to data obtained in a 2010 study to determine progress.
  
  
  RESULTS
  Progress had been made in many of the overall planning and sheltering-in-place tasks, such as having contact information of local emergency managers as well as specifications for availability of potable water. Yet, gaps still persisted, especially in evacuation standards, interfacing with emergency management officials, establishing back-up evacuation sites and evacuation routes, identification of resident care items, and obtaining copies of state and local emergency planning regulations.
  
  
  CONCLUSIONS
  Nursing homes have made progress in preparedness tasks, however, gaps persist. Compliance may prove challenging for some nursing homes, but closer integration with emergency management officials certainly is a step in the right direction. Further research that guides evacuation or shelter-in-place decision making is needed in light of persistent challenges in completing these tasks. Lane SJ , McGrady E . Nursing home self-assessment of implementation of emergency preparedness standards. Prehosp Disaster Med. 2016;31(4):422-431.
authors.affiliation: Nutrition and Health Care Management,Appalachian State University,College of Health Sciences,Boone,North CarolinaUSA.
authors.forename: Sandi J
authors.initials: SJ
authors.lastname: Lane
authors.affiliation: Nutrition and Health Care Management,Appalachian State University,College of Health Sciences,Boone,North CarolinaUSA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McGrady
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards* / Q000706:statistics & numerical data; D057189:Checklist; D004189:Disaster Planning / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D009657:North Carolina; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D013022:South Carolina; D014481:United States
keywords: CMS Center for Medicare and Medicaid Services; COOP Continuity of Operations Plan; DHHS Department of Health and Human Services; ESF-8 Emergency Support Function-8; OIG Office of Inspector General; checklist; disaster planning; disaster preparedness; long-term care; nursing home