More than half of nursing homes lack plan for pandemic flu

ANN ARBOR, Mich. — If an influenza pandemic hits the United States, acute care hospitals are likely to be overwhelmed. Nursing homes may then be expected to assist with the patient overflow, but a new study in the Journal of the American Medical Association suggests that many are not prepared for such a task.
Of the more than 400 nursing homes in the study, just 23 percent had a specific pandemic influenza plan. Another quarter of the nursing homes had a pandemic response incorporated into an overall disaster response plan. And more than half – 52 percent – did not have any pandemic plan.

“If nursing homes are called upon to serve as alternative care centers for patients who can’t be treated in overcrowded hospitals, the impact on the nursing homes could be vast. Nursing homes serve a vulnerable population prone to dire consequences from an emergency,” says lead author Philip W. Smith, M.D., professor and chief, Section of Infectious Diseases, University of Nebraska Medical Center. “While most facilities felt that nursing homes were being counted on to take hospital overflow patients in a pandemic, in reality few homes would be able to do so.”

“Nursing homes may not be equipped to handle an influx of influenza as well as non-influenza patients. They may also be unwilling to accept overflow patients, if it means displacing their current residents,” adds senior author Lona Mody, M.D., M.Sc, assistant professor of internal medicine at the University of Michigan Health System and research scientist, Geriatric Research, Education and Clinical Center at the Veterans Affairs Ann Arbor Healthcare System. “Nursing homes run a high occupancy rate, making it logistically difficult to accept a lot of patients if there is a time crunch.”

“Specific areas for improvement,” Mody says, “include communication with nearby health departments and hospitals at planning stage and exercising formulated plans. Planning for staff shortages is also critical.”

Half of the nursing homes in the study had stockpiled some commonly used supplies such as gloves and hand hygiene products. Less than half had provided pandemic education to staff members. Just 6 percent had conducted pandemic influenza outbreak exercises.

In more optimistic findings, more than three-quarters – 77 percent – of all Michigan and Nebraska nursing homes had a person or staff position designated as being responsible for pandemic preparedness. Access to laboratory facilities for the detection of influenza was available at 84 percent of these nursing homes. Another 71 percent provide mental health and/or faith-based services.

A pandemic is an outbreak of a disease on a global scale. Typically, a pandemic is lengthy and would create a strain on traditional health care institutions, infectious disease experts say. To relieve some of that burden, additional sites known as Acute Care Centers and Neighborhood Emergency Help Centers would be set up at places such as schools, armories, shopping malls and nursing homes.

Methodology: The researchers sent a questionnaire to all 656 state health department or Centers for Medicare and Medicaid-registered nursing homes in Nebraska and Michigan to assess their preparedness. The response rate was 69 percent.

Authors: In addition to Smith and Mody, authors of the paper are Valerie Shostrom, MS, and Al Smith, BA, from University of Nebraska Medical Center and Michael Kaufmann, BS, who was doing a research rotation at the University of Michigan.

Funding: National Institute on Aging, the Association of Specialty Professors/American Geriatric Society T. Franklin Williams Research Scholarship, and Student Research Training in Aging for Medical Students.

Reference: Journal of the American Medical Association, July 23, 2008, Vol. 300 No. 4.