Many nursing homes lack pandemic plan

Jul 25, 2008 (CIDRAP News) – A recent survey of nursing homes in two states found that fewer than half had a plan for coping with pandemic influenza, according to a report in this week's Journal of the American Medical Association.

Although nursing homes house vulnerable people and may be called on to take overflow patients from hospitals in a pandemic, the survey of 451 nursing homes in Nebraska and Michigan revealed that only 23% had a specific pandemic plan.

Another 26% had included pandemic response in their general disaster response plan, while 52% had no pandemic plan, says the report by Philip W. Smith, MD, of the University of Nebraska Medical Center in Omaha, and colleagues from Nebraska and Michigan.

On the other hand, most of the facilities had designated a staff member to oversee pandemic planning, and about half had stockpiled some supplies in preparation for a pandemic.

A pandemic planning checklist from the Department of Health Human Services (HHS) advises nursing homes to anticipate requests to accept patients from hospitals that need to make room for seriously ill flu patients. HHS suggests that nursing homes negotiate agreements with hospitals, identify space for extra beds, and notify local and regional planning contacts.

"If nursing homes are called upon to serve as alternative care centers for patients who can't be treated in overcrowded hospitals, the impact on the nursing homes could be vast," said Smith in a University of Nebraska news release. "While most facilities felt that nursing homes were being counted on to take hospital overflow patients in a pandemic, in reality few homes would be able to do so."

The researchers mailed a questionnaire about pandemic planning to all 656 registered nursing homes in Michigan and Nebraska. Overall, 69% (451) of the facilities responded, including

74% (171 of 231) in Nebraska and 66% (280 of 425) in Michigan.

Besides the findings mentioned above, the survey showed that:

  • 77% of the facilities had named someone to take charge of pandemic planning, most often an infection control professional (45%) or administrator (21%)
  • 62% had referred to the HHS pandemic planning checklist for nursing homes
  • 50% had stockpiled some supplies, including gloves (38%), alcohol rub (35%), food (18%), and N-95 respirators (11%)
  • 46% had given staff members some basic education on pandemics
  • 84% had access to laboratory facilities for influenza detection
  • 58% had plans to "prioritize staff and residents for vaccine and antiviral distribution"
  • 53% had plans to brief family members, visitors, and vendors on pandemic issues
  • 6% had conducted a pandemic outbreak exercise

Forty-five percent of the nursing homes said they had established communication lines with nearby hospitals, and 53% said they had done the same with state and local public health agencies.

More than half of the facilities (57%) said they thought nursing homes would be called on to take extra patients because of full hospitals. In further findings on that subject:

  • 37% of the facilities said they could make some beds available
  • 38% said they would accept hospital overflow flu patients needing a low level of care
  • 58% would accept non-flu patients needing low-level care
  • Only 4%would accept patients on ventilators

HHS's pandemic vaccine allocation guidance, released this week, puts nursing-home healthcare workers in the first tier (priority group) for vaccination. The plan estimates their number at 1.6 million. Other healthcare groups in the first tier are public health workers (300,000), inpatient providers (3.2 million), and outpatient and home healthcare providers (2.5 million).

Smith PW, Shostrom V, Smith A, et al. Preparedness for pandemic influenza in nursing homes: a 2-state survey. (Letter) JAMA 2008 Jul 23/30;300(4):392-4 [Extract]

See also:

Jul 22 University of Nebraska Medical Center news release

HHS pandemic planning checklist for long-term care and other residential facilities

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