TABLE 3—

Eight Domains of Disaster Preparedness for Nursing Homes Based on Discussions With Administrators and Staff in Nursing Homes Sheltering Hurricane Katrina Evacuees: Gulf Coast, 2005–2006

Domain	Preparedness
Incorporating the needs of nursing homes into disaster plans	Disaster preparedness coordinators need to include the needs of frail older people who reside in nursing homes in their planning. Nursing homes should be in an emergency priority category similar to that of hospitals to facilitate having lifelines restored (such as critical utilities) and access to ambulances and other emergency vehicles for evacuation.
Using nursing homes as community resources during a disaster	Nursing homes have important resources, including health care professionals, medical resources, and supplies. Thus, they can contribute to community recovery after a disaster.
Ensuring that core functions are maintained in a disaster	Preparedness requires nursing homes to continue to carry out normal daily operations, with adequate supplies. Training is needed to maintain adequate stockpiles of supplies and staffing levels. Additional supplies are needed for staff and family members of the evacuating and sheltering nursing homes. Nursing homes should have back-up vendor arrangements.
Incorporating care approaches responsive to the needs of diverse stakeholders	Nursing homes will serve an increasingly diverse group of older people in terms of race and ethnicity. Nursing homes should develop processes to ensure that care is sensitive to residents with diverse backgrounds.
Developing geriatric-specific protocols for managing across the continuum of care	Nursing homes should have established triage and care procedures that address special needs of older people. Nursing homes must ensure that medical information, medications, and medical supplies accompany evacuated residents. Nursing homes need plans to receive evacuees.
Developing strategies to maintain mental health	Nursing homes need to address mental health needs of residents, evacuees, and staff. Frail older people are more susceptible to depression following a disaster because of relocation and loss of family. Staff may experience long-term stress associated with extra workload in the facility and also with the need to address personal and family losses from the disaster.
Coordinating and planning for transportation	Nursing homes need adequate evacuation plans that accommodate wheelchairs and provide adequate heating, cooling, food, water, and medications during travel.
Ensuring communications	Nursing homes must have back-up systems to communicate with local law authorities and families of residents; land line phones, cell phones, and Internet service may be disrupted for several weeks.

Note. Six education and training, clinical practice, policy, and research areas for nursing home preparedness were developed (domains 3–8). Two additional domains (1 and 2) that address practice and policy needs of the public health preparedness system were identified as being particularly relevant for nursing homes.

Source. Adapted from Johnson A, Howe JL, McBride MR, et al.3