Assessment of Regional Nursing Home Preparedness for and Regulatory Responsiveness to Wildfire Risk in the Western US

Abstract

ImportanceIt is uncertain whether emergency preparedness and regulatory oversight for US nursing homes are aligned with local wildfire risk.ObjectiveTo evaluate the likelihood that nursing homes at elevated risk of wildfire exposure meet US Centers for Medicare & Medicaid Services (CMS) emergency preparedness standards and to compare the time to reinspection by exposure status.Design, Setting, and ParticipantsThis cross-sectional study of nursing homes in the continental western US from January 1, 2017, through December 31, 2019, was conducted using cross-sectional and survival analyses. The prevalence of high-risk facilities within 5 km of areas at or exceeding the 85th percentile of nationalized wildfire risk across areas overseen by 4 CMS regional offices (New Mexico, Mountain West, Pacific/Southwest, and Pacific Northwest) was determined. Critical emergency preparedness deficiencies cited during CMS Life Safety Code Inspections were identified. Data analysis was performed from October 10 to December 12, 2022.Main Outcomes and MeasuresThe primary outcome classified whether facilities were cited for at least 1 critical emergency preparedness deficiency during the observation window. Regionally stratified generalized estimating equations were used to evaluate associations between risk status and the presence and number of deficiencies, adjusted for nursing home characteristics. For the subset of facilities with deficiencies, differences in restricted mean survival time to reinspection were evaluated.ResultsOf the 2218 nursing homes in this study, 1219 (55.0%) were exposed to elevated wildfire risk. The Pacific/Southwest had the highest percentage of both exposed (680 of 870 [78.2%]) and unexposed (359 of 486 [73.9%]) facilities with 1 or more deficiencies. The Mountain West had the largest difference in the percentage of exposed (87 of 215 [40.5%]) vs unexposed (47 of 193 [24.4%]) facilities with 1 or more deficiencies. Exposed facilities in the Pacific Northwest had the greatest mean (SD) number of deficiencies (4.3 [5.4]). Exposure was associated with the presence of deficiencies in the Mountain West (odds ratio [OR], 2.12 [95% CI, 1.50-3.01]) and the presence (OR, 1.84 [95% CI, 1.55-2.18]) and number (rate ratio, 1.39 [95% CI, 1.06-1.83]) of deficiencies in the Pacific Northwest. Exposed Mountain West facilities with deficiencies were reinspected later, on average, than unexposed facilities (adjusted restricted mean survival time difference, 91.2 days [95% CI, 30.6-151.8 days]).Conclusions and RelevanceIn this cross-sectional study, regional heterogeneity in nursing home emergency preparedness for and regulatory responsiveness to local wildfire risk was observed. These findings suggest that there may be opportunities to improve the responsiveness of nursing homes to and regulatory oversight of surrounding wildfire risk.

A Mixed Method Study to Explore How Maintenance Personnel Can Enhance Wildfire Smoke Resilience at Long-Term Care Facilities in the US Mountain West

“…This report demonstrates that LTCFs most at risk for wildfire impacts were often the least prepared, evidenced by the number of critical emergency preparedness deficiencies cited during CMS inspections. Compared to other regions, facilities in the Mountain West had the strongest association between wildfire risk and number of emergency preparedness deficiencies, highlighting the need for improved responses in the target area of our study [39].…”

“…There is a substantial quantity of works in the literature describing the associations between air pollution exposure and older adults [30][31][32][33][34][35][36][37][38], as well as a growing body of literature on the impacts of wildfires on older adults. In response to the increasing threat of wildfires in the Mountain West, the Journal of the American Medical Association recently published an assessment on nursing home preparedness and responsiveness to wildfires [39][40][41]. This report demonstrates that LTCFs most at risk for wildfire impacts were often the least prepared, evidenced by the number of critical emergency preparedness deficiencies cited during CMS inspections.…”

Enhancing the quality and reproducibility of research: How to work effectively with medical and data librarians

“…In the second dyad, the data librarian was embedded in the research process from the outset of a series of projects, first advising the clinician‐investigator on data sourcing and later managing most aspects of data processing, including data retrieval and management, and writing Python code to clean, merge, and restructure data for statistical analyses conducted by the clinician‐investigator. To date, this ongoing collaboration has led to publication of three original research reports 18–20 …”