Week 3 Project Assignment Due June 22 at 11:59 PM Supporting Lectures:Review the following lecture: Human Resource in HealthcareProjectThe project assignment provides a forum for analyzing and eval

CASE 53

Is Whispering Willows Nursing Home Prepared for a Disaster?

Sharon B. Buchbinder

Bob Freundlich is a Nursing Home Administrator at Whispering Willows Nursing Home (WWNH). He runs a 200-bed facility in a rust belt town on the banks of a river that flooded 10 years ago during a hurricane. The WWNH residents are primarily on Medicaid and their lower income families have been hard hit by the latest downturn in the economy. WWNH is located one small town away from a 72,500-acre military garrison that stockpiles and tests biological, chemical, and other hazardous materials. In addition, terrorist experts now are concerned about attacks on “soft targets” such as schools, shopping malls, and health care facilities (Blair, 2005). With the history of the town, this report, and the nearby base, Bob has good reason to be concerned about a disaster (FEMA, 2012).

Bob has set up a meeting with his team of administrators and asked for their input on a test of their All Hazards Continuity of Operations Plan. Bob believes there is no substitute for experiential learning and wants to have a real-time scenario, acting out an All Hazards Disaster. Bob begins his meeting by sharing the recent Office of Inspector General (OIG) report that identified “gaps in nursing home emergency preparedness and response during disasters” (OIG, 2012). The authors found that although every facility had a written plan on hand, when it came down to operationalizing the plan, over 70% of the institutions fell down on the following items on the CMS Emergency Preparedness for Every Emergency checklist (CMS, 2009):

•    “Pre-disaster planning had little input from outside agencies, such as emergency planning officials, fire departments and public health;

•    When drills took place, they were primarily fire drills, table top exercises, or county level exercises;

•    Family members are expected to take residents in time of disasters; less family involvement was found in facilities with lower income families;

•    Transportation contracts with bus and ambulance companies were in place, however, there were issues related to these vehicles being commandeered by the county during a disaster” (Howard & Blake, 2012, slides 16–18).

Bob has invited the head of the county emergency planning agency, John Spotte, to today’s meeting. He goes around the room, introduces everyone, and asks his key administrators for a status report on their part of the plan, noting gaps, to address gaps, and their perspectives.

•    The facility manager, Red Foxx reports, “I’ve looked at the CMS checklist and I have everything ready to shelter in place for seven days. However, I’m worried that our five-year-old back-up generator, which has tested fine for short power outages, may not be able to take the strain of a week’s worth of work, especially if we’re to continue running the laundry facilities. There are some newer generators on the market that run on propane. I took the liberty of obtaining three bids to purchase, install, and maintain five generators that would power our entire facility for a week. They are a large investment and would need to go into our capital budget.”

•    The dietary manager, Kathy Gold, reports, “Like Red, I used the checklist and have enough food and water on hand for seven days. My only concern is keeping a fresh inventory. Most of the goods are canned, but even they have an expiration date. My dietary aides are already overworked, so I’m checking the inventory on a regular basis.I found a software program that we could use to scan the barcodes and dates. It will alert us to when the inventory needs to be refreshed. It’s cheaper than Red’s generators, but it still requires an investment of money and the labor to do the initial data input. If we could get a health care management intern from a local university, that would be the first thing I’d assign to the student.”

•    The transportation manager shakes his head. “You guys are in much better shape than I am. If we have to evacuate our residents anytime soon, we’re in trouble. I’ve been working on contract negotiation with a bus company and an ambulance company for transporting patients out of harm’s way in case of a disaster. Neither company has responded to my concerns about the ability of the company to handle disabled or ill residents. And, they won’t promise to provide services if the county commandeers their vehicles. We would also need to transport food, water, medications, and specialized equipment. If we could afford to buy a large container truck, two buses, and two ambulances, I think we could work the rest out with the WWNH vans and staff vehicles.”

Bob’s head is spinning. His disaster planning meeting is turning into a disaster. His administrators are identifying more issues and more potential expenses than he thought possible. Hoping to hear some good news, he turns to the Ombudsman.

•    Peter Peacemaker reports, “The good news is, I identified and have a list of shelters that would take us in, if we need to evacuate. Per CMS, they are at least 50 miles away from our facilities, and the potential disaster. They are a little spread out, but the director of each shelter has assured me in writing that they will have grief counselors and mental health counselors there at the time of the incident. The bad news is I met with as many family members as I could find to set up an emergency evacuation plan. Out of the 200 families, I could only track down 100 who still lived in the state. Many have moved out of state to find jobs because the industries they once worked in no longer exist here. The other half is in state, but has challenges. In the event of an evacuation, I could get about 50 families to commit to come here in a disaster and pick up their loved ones. So, that leaves us with 150 residents to move in a safe and compassionate manner.”

The migraine that was lurking has now blossomed in Bob’s right eye. He turns to the Director of Nursing (DON) and with a pleading tone of voice says, “Sally Feelgood, do you have any optimistic news for us?”

•    The DON crosses her arms over her chest and says, “If there is a smallpox outbreak, we are out of luck. We have 50 employees who have never been immunized against smallpox. We do require them to have the flu vaccine every year. We made that mandatory for continued employment last year. And we fired two people who refused to get the shots, despite ample warnings. However, I’m not sure what the legality of requiring a smallpox vaccination is vis-à-vis a health care provider. I looked at the CDC website, and the side effects can vary from redness, swelling, and blisters at the injection site to inflammation of the heart or a heart attack. If I didn’t already have this smallpox vaccination scar on my arm, I don’t know if I’d do it. In addition, when I asked the staff if they’d be willing to remain during an All Hazards lockdown, half of them said absolutely not, they would go home. We have to provide care for our residents 24/7. I think we need to get some legal counsel and coordinate with HR on this issue. I don’t want to overstep any laws if I order people to stay during a disaster.”

Bob thanks everyone for their time and effort, asks them to e-mail their reports and recommendations to him. After he pops two aspirin, Bob asks John Spotte if he can stay for a while so he can ask him some questions.

Discussion Questions

1.    What is going on in this case?

2.    What is the nature of the organizational problem?

3.    Has Bob shown good leadership in addressing this All Hazard Disaster? Should he have invited John Spotte to this meeting? What kind of questions should Bob be asking John? Is it reasonable for Bob to want to act out an All Hazard Disaster?

4.    Given the financial realities of running WWNH, what purchases, if any, do you think Bob should authorize from the list his team provided to him?

5.    Hurricane Katrina revealed significant weaknesses in the emergency planning system for nursing homes and hospitals. Hospitals can order nurses to remain on duty during a blizzard when other personnel cannot get to work. Is it legal to require health care professionals to stay during a flood that endangers their lives? What about a biohazard? Is it ethical?

6.    Have you ever been involved in a disaster? Provide your reflections and personal opinions as well as your recommendations for addressing this problem.

ADDITIONAL RESOURCES

American College of Healthcare Executives (ACHE). (2009, November 16). Healthcare executives’ role in emergency preparedness: Policy statement. Retrieved from http://www.ache.org/policy/emergency_preparedness.cfm

Blair, J. D. (2005, September). Is the healthcare industry prepared for terrorism? All-hazards “HVA” for non-federal healthcare CBRNE readiness: A level playing field? Inside Homeland Security. Retrieved from http://www.jblairassociates.com/article/article01.pdf

Borkowski, N. (2011). Organizational behavior in health care (2nd ed.). Sudbury, MA:Jones and Bartlett.

Buchbinder, S. B., & Shanks, N. H. (Eds.). (2012). Introduction to health care management (2nd ed.). Burlington, MA: Jones & Bartlett.

Centers for Disease Control and Prevention (CDC). (2012, May 29). Emergency preparedness and response. Planning resources by setting. Retrieved from http://www.cdc.gov/phpr/healthcare/planning2.htm

Centers for Disease Control and Prevention (CDC). (2012, May 29). Emergency preparedness and response. Smallpox. Retrieved from http://www.bt.cdc.gov/agent/smallpox/

Centers for Medicare and Medicaid Services (CMS). (2009, September). Survey & certification: Emergency preparedness for every emergency. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/SandC_EPChecklist_Provider.pdf

Federal Emergency Management Agency (FEMA). (2012, January 19). National preparedness directorate. National training and education. Retrieved from http://training.fema.gov/

Howard, D., & Blake, S. (2012, May 8). Improving disaster planning in nursing homes and home health agencies. Centers for Disease Control and Prevention (CDC). Retrieved from http://emergency.cdc.gov/coca/ppt/2012/05_08_12_HomeHealth_FIN.pdf

Merchant, R. M., Leigh, J. E., & Lurie, N. (2010, February 24). Health care volunteers and disaster response—First, be prepared. The New England Journal of Medicine, 362, 1–3.

Morrison, E. E. (2011). Ethics in health administration: A practical approach for decision makers (2nd ed.). Sudbury, MA: Jones and Bartlett.

Office of Inspector General (OIG). (2012, April). Gaps continue to exist in nursing home emergency preparedness and response during disasters: 2007–2010. Retrieved from http://oig.hhs.gov/oei/reports/oei-06-09-00270.pdf

Office of Minority Health. (2001). National standards for culturally and linguistically appropriate services in health care: Final report. Washington, DC: U.S. Department of Health and Human Services.

Okie, S. (2008, January 3). Dr. Pou and the hurricane. The New England Journal of Medicine, 358, 1–5.

Udden, S. G., Barnett, D. J., Parker, C. L., Links, J. M., & Alexander, M. (2008). Emergency preparedness: Addressing a residency training gap. Academic Medicine, 83, 298–304.

Weiner, E., Irwin, M., Trangenstein, P., & Gordon, J. (2005). Emergency preparedness curriculum in nursing schools in the United States. Nursing Education Perspectives, 26, 334–339.