Function and response of nursing facilities during community disaster.

OBJECTIVES We sought to describe the role and function of nursing facilities after disaster. METHODS We surveyed administrators at 144 widely dispersed nursing facilities after the Los Angeles Northridge earthquake. RESULTS Of the 113 (78%) nursing facilities that responded (11 365 beds), 23 sustained severe damage, 5 closed (625 beds), and 72 lost vital services. Of 87 nursing facilities implementing disaster plans, 56 cited problems that plans did not adequately address, including absent staff, communication problems, and insufficient water and generator fuel. Fifty-nine (52%) reported disaster-related admissions from hospitals, nursing facilities, and community residences. Nursing facilities received limited postdisaster assistance. Five months after the earthquake, only half of inadequate nursing facility disaster plans had been revised. CONCLUSIONS Despite considerable disaster-related stresses, nursing facilities met important community needs. To optimize disaster response, community-wide disaster plans should incorporate nursing facilities.

[1]  F. Burkle,et al.  Telecommunications systems in support of disaster medicine: applications of basic information pathways. , 1999, Annals of emergency medicine.

[2]  T. Drabek,et al.  Assessing long-term impacts of a natural disaster: a focus on the elderly. , 1979, The Gerontologist.

[3]  A. Milsten,et al.  Hospital Responses to Acute-Onset Disasters: A Review , 2000, Prehospital and Disaster Medicine.

[4]  G. S. Wunderlich,et al.  Improving the Quality of Long-Term Care , 2001 .

[5]  J. Leor,et al.  Sudden Cardiac Death Triggered by an Earthquake , 1996 .

[6]  D Draper,et al.  Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. , 1990, JAMA.

[7]  J Martchenke,et al.  The 1989 Loma Prieta Earthquake: Issues in Medical Control , 1993, Prehospital and Disaster Medicine.

[8]  J. Kayser-Jones,et al.  Factors Contributing to Dehydration in Nursing Homes: Inadequate Staffing and Lack of Professional Supervision , 1999, Journal of the American Geriatrics Society.

[9]  C. Gabrel Characteristics of elderly nursing home current residents and discharges: data from the 1997 National Nursing Home Survey. , 2000, Advance data.

[10]  M F Lechat,et al.  Accident and disaster epidemiology. , 1993, Public health reviews.

[11]  F. Sabatino Stories of survival. Hurricane Andrew. South Florida hospitals shared resources and energy to cope with the storm's devastation. , 1992, Hospitals.

[12]  C. Saunders,et al.  The 1989 Loma Prieta earthquake: impact on hospital patient care. , 1992, Annals of emergency medicine.

[13]  J S Klein,et al.  Disaster Management: Lessons Learned , 1991 .

[14]  L B Bourque,et al.  Risk factors associated with moderate and serious injuries attributable to the 1994 Northridge Earthquake, Los Angeles, California. , 2001, Annals of epidemiology.

[15]  E Friedman Coping with calamity. How well does health care disaster planning work? , 1994, JAMA.

[16]  G. Koehler,et al.  Medical response to catastrophic events: California's planning and the Loma Prieta earthquake. , 1992, Annals of emergency medicine.

[17]  N Tanida,et al.  What happened to elderly people in the great Hanshin earthquake , 1996, BMJ.

[18]  A. Kramer,et al.  The increased needs of patients in nursing homes and patients receiving home health care. , 1990, The New England journal of medicine.

[19]  D. Meier,et al.  The inaccessibility of advance directives on transfer from ambulatory to acute care settings. , 1995, JAMA.

[20]  Jagbir Singh Disaster Management , 2000 .

[21]  Reuben Eldar,et al.  The Needs of Elderly Persons in Natural Disasters: Observations and Recommendations , 1992 .

[22]  K. Kario,et al.  Increased Coronary Heart Disease Mortality After the Hanshin‐Awaji Earthquake Among the Older Community on Awaji Island , 1997, Journal of the American Geriatrics Society.

[23]  J. Logue,et al.  Research issues and directions in the epidemiology of health effects of disasters. , 1981, Epidemiologic reviews.

[24]  M. Weston,et al.  Lessons Learned From Hurricane Andrew: Recommendations for Care of the Elderly in Long-Term Care Facilities , 1995, Southern medical journal.

[25]  C. Schultz,et al.  A medical disaster response to reduce immediate mortality after an earthquake. , 1996, The New England journal of medicine.

[26]  P. Katz,et al.  Medical Practice with Nursing Home Residents: Results from the National Physician Professional Activities Census , 1997, Journal of the American Geriatrics Society.

[27]  F H Norris,et al.  The impact of natural disaster on the health of older adults: a multiwave prospective study. , 1988, Journal of health and social behavior.

[28]  C. Kovner,et al.  Experts recommend minimum nurse staffing standards for nursing facilities in the United States. , 2000, The Gerontologist.

[29]  R. Verrier,et al.  Triggering of sudden death--lessons from an earthquake. , 1996, The New England journal of medicine.

[30]  J. Ouslander,et al.  Inappropriate Hospitalization of Nursing Facility Residents: A Symptom of a Sick System of Care for Frail Older People , 2000, Journal of the American Geriatrics Society.

[31]  J. Logue Disasters, the environment, and public health: improving our response. , 1996, American journal of public health.

[32]  A. Kurtz,et al.  Planning for disasters: sheltering persons with special health needs. , 1990, American journal of public health.

[33]  W. Greaves,et al.  The amateur Radio Emergency Service (ARES) and the National Disaster Medical System (NDMS). , 1993, Military medicine.

[34]  R. Kington,et al.  Appropriateness of the Decision to Transfer Nursing Facility Residents to the Hospital , 2000, Journal of the American Geriatrics Society.

[35]  R Bolin,et al.  The Northridge earthquake: community-based approaches to unmet recovery needs. , 1998, Disasters.

[36]  N. Miller,et al.  Predicting state Medicaid home and community based waiver participants and expenditures, 1992-1997. , 2000, The Gerontologist.

[37]  W L Kenney,et al.  Heat Tolerance, Thermoregulation and Ageing , 1987, Sports medicine.

[38]  W. Mangum,et al.  Hurricane Elena and Pinellas County, Florida: some lessons learned from the largest evacuation of nursing home patients in history. , 1989, The Gerontologist.

[39]  R. Hamer,et al.  Psychiatric consultation in the nursing home. A survey of six states. , 1998, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[40]  P. Kemper,et al.  Lifetime use of nursing home care. , 1991, The New England journal of medicine.