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Disaster Planning in Nursing Homes: The Questions to Ask Your Loved One’s Facility

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This guide is part of our Older and Overlooked series on the danger wildfires pose to California's older population, especially during COVID-19.

Speaker 1: 00:00 Fast moving wildfires are burning right now in Northern California, forcing people to flee their homes. KQBD has been investigating the risk that wildfires pose to medically frail Californians who live in skilled nursing facilities. They found that a quarter of nursing homes are in parts of the state at heightened risk for wildfire. Many of those homes were unprepared for the Corona virus and are not ready for yet another looming disaster. At the same time, KQBD science reporter. Molly Peterson continues our series older and overlooked by examining the regulations that are supposed to protect these patients.

Speaker 2: 00:34 Last October, a brush fire was fast coming toward the nursing home, where Bob Hannah's wife

Speaker 3: 00:39 And the smoke and the wind was blowing really bad.

Speaker 2: 00:43 Crystal Ridge care center is a top of Hill in rural grass Valley staffers. We're bringing patients to the parking lot. And Bob started to wonder how they were going to get everyone out.

Speaker 3: 00:52 Cause they had one van that was, you know, they might've gotten a few people in, but not enough to take care of everybody that was out in the parking lot

Speaker 2: 01:00 In a wildfire. The first plan at crystal Ridge is to shelter in place. If that isn't safe, staff would shuttle residents to a sister facility nearby. They asked visitors like Bob to leave. And as he did, he thought of his wife, Laura Lee.

Speaker 3: 01:14 I wanted to make sure that she was out. You know, no problem.

Speaker 2: 01:17 Bob is 80. Still play softball. Laura Lee can't walk independently. She's got ms. Before the pandemic, Bob would pick her up for day trip.

Speaker 3: 01:26 Well, I have a van that has a ramp on it.

Speaker 2: 01:28 So he turned back to pitching as more brush caught, flame crews put that fire out quickly. Federal regulations now demand that skilled nursing facilities prepare and practice for hazards. Exactly like this one wildfires hurricanes and yes, pandemics part of why is climate change? Water flooded into st. Rita's nursing home, outside new Orleans drowning 35 residents on after hurricane Katrina in 2005, federal watchdogs recommended better emergency preparedness rules like identifying hazards and nursing home might face training knowing who to call for help and telling families about the plan.

Speaker 3: 02:06 Katrina was a wake up call for all of us.

Speaker 2: 02:08 Industry trade groups fought to weaken and delay those regulations. It was 12 years before they took effect. Meanwhile, natural disasters became more common over and over. Gulf coast storms have left wheelchairs piled up caked with mud after flooding. After the campfire in 2018 Bay area, paramedic Jimmy Pierson remembers a similar scene outside of paradise care, home

Speaker 3: 02:31 Seven or eight, just empty wheelchairs on the driveway. So you do what happened. There was, it was crap. Crap, crap,

Speaker 2: 02:39 California has over 1200 skilled nursing facilities. Only Texas is even close. The state department of public health oversees these nursing homes and inspects them using federal and state standards. KQBD investigated how ready they are for disasters. We found that over a two year period, 78% of these homes got caught violating regulations for emergency preparedness, big deal. You submit a plan of correction and that's just about it. Pat McGuinness directs the watchdog group, California advocates for nursing home reform. That's a problem because it's very seldom corrected. It repeats and repeats and repeats. And we see it every year and we see it with the same facilities. KQBD also looked at the severity of the violations. Just 6% of the time, evaluators considered deficiencies bad enough to require a followup visit in person. Again, it says, if you're missing an emergency plan, that's not even labeled in actual harm.

Speaker 2: 03:32 We really need to have an oversight agency that gets out there tries to find problems in advance of the tragedies. You know, how serious is this? How many residents could potentially be affected by this and how severe is this violation? And of course we don't do that. Last fall. Federal auditors criticized California for its oversight of emergency preparedness at nursing homes. They said the state should offer more training and inspectors should visit facilities more often. The California department of public health rejected those recommendations saying it doesn't have enough staff or resources. CDPH denied our request for a taped interview and did not respond to written quiz.

Speaker 4: 04:13 You picked a good day to come out. Good morning. How are you, sir? Okay.

Speaker 2: 04:20 In February I met Ray Baldwin when at the sequoias in Portola Valley, it's part of a small group of care homes. Bowen is the director of facilities and former fireman Botto and says, it's rare to get through inspections with zero problems, but being without a comprehensive emergency plan.

Speaker 4: 04:37 Yeah, I think that that's pretty serious. If you don't have any emergency plan, I don't really understand how you could even get licensed.

Speaker 2: 04:44 Being prepared is a huge capital investment. He says, especially now Bowen's plan is so big. It has cheat sheets and color.

Speaker 4: 04:53 For example, you know, we have code silver for active shooter, code yellow for bomb, threat code pink missing resident, which is always an issue. They're going to have code beige, which is for mountain lion.

Speaker 2: 05:04 Pandemic is in there too. He says the three facilities he oversees have been in an emergency for months. They use the same management style police and firefighters do one commander with clear responsibilities for everyone below,

Speaker 4: 05:17 You can see the body language from the staff they're worn out. I mean, this has been an active situation since late February. It's, it's kind of like a war. You know, it doesn't go away.

Speaker 2: 05:28 None of his facilities have yet found COVID-19 among patients. I am still knocking on wood, but if fires come Boto and says, the pandemic will complicate evacuations, smaller groups and force them to be more spread out, it'd be more of a campground style. But Owen says he might have to move residents as much as a hundred miles away from home.

Speaker 4: 05:48 I have to worry about air quality. The residents may have a compromised immune system. They may have respiratory issues, cardiac issues. So we've got to get them in safe. So the

Speaker 2: 05:58 Trade group representing most nursing homes in the state, the California association of health care facilities offers training and templates for emergency plans. But the state has suspended routine inspections during the pandemic and critics say state and federal policies do little to encourage preparedness. You need to be able to hit them where it hurts. Pat McGuinness argues the state should levy more fines and even block nursing homes from admitting patients. That's not going to be in their hearts. That's going to be in their wallets violations. Almost never cost a facility money. The California department of public health, rarely issues, fines when they do facilities can appeal. I think the regulatory structure in nursing homes desperately needs to be changed. That's Mike Wasserman, a gerontologist who used to run a company overseeing 70 nursing homes. Now he leads a reform minded group, California association for longterm care medicine Wassermann says issuing fines.

Speaker 2: 06:54 Doesn't touch the actual problem. Nursing home real estate owners are today's today. He argues that owners limit their financial liability with webs of corporations, different companies for property, for operations, for management, that makes fines just a small cost of doing business. You can just ask yourself where that's gonna end up from a quality perspective where that's going to end up. If there's a fire where that's going to end up and we're seeing the results he says, the state should demand more transparency about corporate ownership. Without it, the people who suffer are the patients and their families. COVID-19 outbreaks are overwhelmingly common in California nursing homes, where they're at risk for fire. More than half of skilled nursing facilities have reported cases of the virus to they include Randy Odette's 96 year old mother who is recovering from COVID-19.

Speaker 5: 07:46 He's just like 80 pounds. And I'm just sleeping.

Speaker 2: 07:51 Sure. The facility where Betty Odette lives, a story in nursing and rehab center has reported over 140 cases of the Corona virus. 25 people have died.

Speaker 5: 08:00 Infection control, infection control. These are all separate companies.

Speaker 2: 08:04 Randy reads a list of active and proven complaints. Since the pandemic began this year,

Speaker 5: 08:09 Ability, staffing, pressure, sores, extra controlled practices, not followed that last man.

Speaker 2: 08:15 Randy took care of her mom for a decade before finding a story on the edge of the San Fernando Valley. Now she lives in an RV parked on a wide street near the same steep hillsides that threatened the facility. She was born and raised here. She knows fire comes without warning,

Speaker 5: 08:31 The dry Britney dry up there, but that's kind of cool.

Speaker 2: 08:36 Randy asked the administrator about a story as emergency plan. He's supposed to let her see it. He pointed her to a sign on the wall, like what you'd see at a motel six, showing where the emergency exits are.

Speaker 5: 08:46 The state has got to be responsible for these homes.

Speaker 2: 08:49 Now she's scared and a little angry.

Speaker 5: 08:51 I mean, they can't help themselves. The patients. And it's really up to the staff.

Speaker 2: 08:57 Odette believes the staff at a story. I didn't pay attention to COVID-19 until it was too late. She fears the same will be true. When a wildfire comes, nursing homes are obligated to protect their residents from disasters, no matter how frequent they are or how often they overlap right now, we can't really be sure they're all doing that for KQBD news. I'm Molly Peterson in Los Angeles.

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Maureen Cavanaugh and Jade Hindmon host KPBS Midday Edition, a daily radio news magazine keeping San Diego in the know on everything from politics to the arts.