Effect of Hurricane Irma on daily direct‐care nurse staffing in nursing homes

Abstract

Objectives To examine the effect of Hurricane Irma on staff‐related financial expenditures and daily direct‐care nurse staffing levels. Design Retrospective cohort study. Setting September 3–24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. Participants Six hundred and fifty‐three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered‐in‐place. Measurements This study used data from Payroll‐Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct‐care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility‐level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed‐effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. Results Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3–24), an additional estimated $2.41 million was spent on direct‐care nurse staffing. In comparison to facilities that sheltered‐in‐place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered‐in‐place spent $76.10 on nurse staffing per resident. Conclusion NHs face unprecedented challenges during hurricanes, including maintaining adequate direct‐care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct‐care nurse staffing that was greater than that seen in NHs that sheltered‐in‐place.

Applying the age‐friendly‐health system 4M paradigm to reframe climate‐related disaster preparedness for nursing home populations

“…Prior work from Hurricane Irma in September 2017 suggests that NHs increase all types of direct‐care nurse staffing in preparation for major hurricanes, but that evacuating a facility requires an even greater staffing response 68 . Unfortunately, lower‐quality NHs increased their staffing levels the least and opted to retain fewer RNs compared to higher‐quality NHs during Hurricane Irma 69 . Because direct‐care staff implements the 4Ms (i.e., resident goal planning and fulfilling preferences/wishes, providing medications and identifying adverse drug‐related events, recognizing and managing cognitive and mental health disorders, assisting with transfer and mobility), it is crucial for NHs to maintain adequate staffing levels to meet the needs of residents during disasters.…”

“You Just Forge Ahead”: The Continuing Challenges of Disaster Preparedness and Response in Long-Term Care

“…Disasters increase staffing needs and costs, as suggested in a study of a one-time state of Florida effort to reimburse NHs for 2004–2005 hurricane expenses ( Thomas et al, 2010 ). Recent research found that Hurricane Irma also increased NH staffing costs, particularly for NHs that evacuated, suggesting the need for a renewed effort to help facilities pay for needed disaster staffing ( Jester et al, 2021 ).…”

“…After crossing the Florida Keys, it made landfall in southwest Florida as a Category 3 storm with a wind field that threatened the entire state as it travelled north ( Cangialosi et al, 2018 ). Among those at risk at the time were an estimated 71,000 residents of Florida’s 670 NHs and 85,000 residents of the 3,112 ALCs ( Jester et al, 2021 ; Peterson et al, 2020 ). In the present study, we conducted qualitative interviews and focus groups with owners and administrators of NHs and ALCs in Florida concerning their experiences related to Hurricane Irma, including actions they took to prepare for the hurricane and challenges they faced during and after the storm.…”

Association of Nursing Home Exposure to Hurricane-Related Inundation With Emergency Preparedness

“…6,7 The adverse outcomes incurred by nursing home residents following Hurricanes Katrina and Rita highlight this population's unique susceptibility to environmental exposures and the importance of adequate emergency preparedness. 8,9 Despite the risks borne by nursing home residents, variation in their exposure to potential environmental hazards is not well characterized. It is also uncertain whether nursing homes at increased risk of exposure are adequately prepared to safeguard residents upon encountering environmental hazards.…”

“…2,3,16 These preventable deficiencies heighten the risk of resident morbidity and mortality following exposure to severe weather events. [6][7][8]17 In this study, we estimate the prevalence of nursing homes that are subject to severe hurricanerelated inundation within Coastal Atlantic and Gulf Coast states. We then evaluate whether exposure status is associated with adherence to emergency preparedness standards by nursing homes across regulatory regions overseen by 5 CMS regional offices.…”