Louisiana officials propose secretive review process for nursing home hurricane plans
Reports on emergency response would not be released publicly
The Louisiana Department of Health removed nearly 850 nursing home residents from this warehouse in late August 2021 after nursing home owner Bob Dean transferred people there during Hurricane Ida. (Photo by Wesley Muller/Louisiana Illuminator)
The proposal from Gov. John Bel Edwards’ administration to tighten up rules for nursing home hurricane evacuations would prohibit state records about how well those plans are executed from being released publicly.
Officials who work under Edwards helped craft House Bill 933 in response to the horrific evacuation of seven southeast Louisiana nursing homes to an old pesticide warehouse for Hurricane Ida. The state health department was forced to rescue more than 800 elderly and medically vulnerable people from the warehouse in Tangipahoa Parish in September. Fifteen people died in the aftermath, with at least five deaths attributed to the evacuation.
The bill, carried by Rep. Joe Stagni, R-Kenner, aims to create more accountability by requiring nursing homes to submit an “after-event report” each time they evacuate or experience problems while “sheltering in place” for a natural disaster.
The reports would provide details on how a nursing home’s emergency plan held up in the face of a hurricane or other weather event. The Louisiana Nursing Home Emergency Preparedness Review Committee would use them to adjust evacuation and shelter-in-place regulations moving forward.
Yet the bill calls for the after-event reports to be kept out of the public record. Nursing home residents, their families, media outlets and others would not be able to access them, even if there was reason to think a facility’s emergency response had gone awry.
Scott Sternberg, an attorney with the Louisiana Press Association, questions why the reports would be kept confidential. Nursing homes are privately owned and operated but rely almost exclusively on public funding through the Medicaid and Medicare programs.
“The entirety of the report being withheld is extremely concerning,” Sternberg said. “[Being transparent] would inspire confidence in the nursing home industry and in the Legislature’s ability to manage the industry.”
The legislation would also impose more stringent requirements and deadlines for nursing homes to submit their emergency response plans to the state. It formalizes the process for local parish emergency operations staff and state health officials to provide feedback on those plans to nursing homes and allows for more inspections of evacuation sites.
Who approves the plans?
One notable element missing from the bill is that it does not clarify which government officials are ultimately responsible for approving the nursing home emergency plans – a question that has come up repeatedly since nursing home owner Bob Dean took residents from his facilities to the Tangipahoa warehouse.
Dean told the Louisiana Department of Health he intended to evacuate his facilities to the warehouse months before Hurricane Ida hit in August. He listed the warehouse as an evacuation site in emergency plan documents he submitted to the health department and local parish emergency operations staff in March 2021.
Yet the warehouse didn’t have enough bathrooms to accommodate the hundreds of people sent there. There was no kitchen equipment or cots available. During the evacuation, state inspectors found nursing home residents lying on air mattresses on the ground in smelly, overcrowded conditions. Many of them were in soiled clothing and didn’t have enough to eat.
Lawmakers were aghast the health department hadn’t pushed back on plans to use the warehouse as a nursing home evacuation site in the first place.
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“It just doesn’t seem like an appropriate place for people who are medically fragile to be housed,” Rep. Thomas Pressly, R-Shreveport, told health officials in September.
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The health department responded to criticism by saying the agency is required to “review” nursing home evacuation plans, but it is not responsible for “approving” them – an answer that left lawmakers frustrated.
“[Nursing homes] have to have evacuation plans but no one has to approve them,” Rep. Tony Bacala, R-Gonzales, said at a September hearing. “What is the purpose of a mandated plan that can say anything, apparently, if no one has to approve it?”
Though Stagni’s bill doesn’t make any government official answerable for the evacuation plans, it includes language that shields the state and its employees from lawsuits over botched nursing home evacuations and emergency responses.
Nursing homes could get more input on laws
Two other lawmakers have filed legislation to place someone with responsibility over the nursing home emergency plans, even if the bill backed by the Edwards’ administration does not. Rep. Rick Edmonds, R-Baton Rouge, requires the state health department to approve the plans in House Bill 291. Sen. Kirk Talbot, R-River Ridge, mandates that local parish emergency operations officials approve them in Senate Bill 167.
Stagni’s bill, which the Edwards’ administration backs, likely has an advantage that Edmonds’ and Talbot’s proposals do not though. Leaders in the nursing home industry helped put together the Stagni proposal, and it’s not clear if they support what Edmonds or Talbot has suggested.
The Stagni legislation is based on unanimous recommendations from the Nursing Home Emergency Preparedness Review Committee, which includes nursing home owners. The panel is made up of a state transportation official, a disability rights advocate, five state health officials, five local emergency operations officials and five members of the nursing home industry, including the executive director of the Louisiana Nursing Home Association.
Getting eldercare bills through the Legislature is nearly impossible without the support of the Louisiana Nursing Home Association. Nursing home owners are among the biggest campaign donors to state elected officials in Louisiana. They contributed $400,000 to Edwards’ first gubernatorial campaign in 2015, according to a 2017 investigation by The Advocate.
Nursing home owners are also lawmakers. Sens. Fred Mills, R-Parks, and Bob Hensgens, R-Abbeville – as partial owners of nursing homes – sit on the Senate Health and Welfare Committee, which has to approve any nursing home-related bills that go through the Legislature.
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Under Stagni’s bill, the nursing home industry would increase its influence over nursing home evacuation policy. The legislation expands the Nursing Home Emergency Preparedness Review Committee from 17 to 24 members and increases the number of nursing home industry representatives from five to nine. Stagni’s proposal calls for that committee to help draft new laws and regulations on nursing home evacuations and shelter-in-place policies moving forward.
If Stagni’s legislation is approved, the new nursing home evacuation plans won’t be fully vetted and finalized until May 2023 at the earliest, meaning they won’t be in place for next hurricane season, which starts June 1 and goes through November.
The Louisiana Department of Health still needs to create the minimum requirements for evacuation sites, evacuation transportation and other aspects of the home’s emergency preparedness through the state’s rule-making process.
The penalties that nursing homes will face for not complying with any of the new state rules haven’t been determined yet.
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