A nurse gave a local resident a tetanus injection in the lobby of Hancock Medical Center in Bay St. Louis, Miss., after Hurricane Katrina in 2005.

Denis Paquin • Associated Press,

Sweeping disaster preparations proposed for health facilities

  • Article by: Sheri Fink
  • New York Times
  • March 11, 2014 - 11:05 PM

Federal officials are proposing sweeping new requirements for U.S. health care facilities — from large hospitals to small group homes for the mentally disabled — intended to ensure their readiness to care for patients during disasters.

Describing emergency preparedness as an “urgent public health issue,” the proposal by the Department of Health and Human Services offers regulations aimed at preventing the severe disruptions to health care that followed Hurricane Katrina and Hurricane Sandy.

More than 68,000 institutions would be affected, including large hospital chains, nursing homes, home health agencies, rural health clinics, organ transplant procurement organizations, outpatient surgery sites, psychiatric hospitals for youths and kidney dialysis centers.

The proposed rule, open for comment until later this month, has met resistance from industry officials, who question the first-year cost of $225 million. Some complained that could be “draconian.”

The American Hospital Association said in a member advisory that officials “may have significantly underestimated the burden and cost associated with complying.”

Emergency backup systems

The regulations would require hospitals, nursing facilities and group homes to have plans to maintain emergency lighting, fire safety systems, and sewage and waste disposal during power losses, and to keep temperatures at a safe level for patients. Those inpatient facilities would also be expected to track displaced patients, provide care at alternate sites and handle volunteers.

Home health care agencies would be required to help patients create personalized disaster plans. Hospices and others caring for frail, homebound patients would need procedures to help rescuers locate them. And health care employees would have to conduct disaster drills, while administrators might have to coordinate drills and response plans with local business competitors.

“It’s a big step,” said Susan C. Waltman, an executive vice president of the Greater New York Hospital Association, which is urging substantive changes. “It will be a resource-intensive process for many providers.”

Others said they were already struggling with Medicare and Medicaid reimbursement cuts and regulatory changes related to health reform.

One of the most contested of the requirements calls for hospitals and nursing homes to test backup generators for extended periods at least yearly, rather than once every three years, as is currently recommended.

Making generators reliable

The generators have sometimes failed catastrophically during prolonged power losses. The four-hour, full-load tests could involve significant fuel and labor costs. Critics question whether more frequent testing would improve safety.

The proposal is unusual because it applies to 17 types of providers that together serve an estimated 9 million fee-for-service patients each month, as well as other patients covered by Medicare Advantage and Medicaid. Federal officials said this broad approach was needed to ensure that the health care system pulls together and that poorly prepared institutions do not stress others during a crisis.

Government officials will have three years to finalize the rule. Their calculations suggest a relatively modest financial effect: $8,000 on average for hospitals the year the rule takes effect and about $1,262 each year for skilled nursing facilities.

But some facilities would be required to spend much more. Upgrading emergency power systems to run air conditioning alone could cost from tens of thousands to millions of dollars, according to hospital engineering specialists.

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