California nursing homes in high-risk wildfire zones are ill-prepared for emergencies: study

Nursing homes in California located in higher-risk wildfire exposure zones tend to be less prepared for emergencies than facilities without such risk, a new study has found.

Despite being located in fire-prone regions, these nursing homes demonstrate poorer compliance with Medicare’s emergency readiness standards, according to the study, published on Wednesday in the Journal of the American Geriatrics Society.

“Emergency preparedness in nursing homes should be commensurate with local environmental risks to ensure residents’ safety,” a statement from the journal said.

To draw these conclusions, researchers from Yale University investigated California nursing homes that had received certification from the Centers for Medicare & Medicaid Services and were located within 5 kilometers (3.1 miles) of a wildfire risk area.

Among the 1,182 facilities identified, the authors then determined that 495 sites were considered “exposed” and 687 were “unexposed.” They defined exposed as those homes with “moderate” to “very high” wildfire risk, using designations from the California Office of the State Fire Marshal.

Looking into emergency preparedness deficiencies at these homes, the researchers found that the exposed facilities had a greater percentage of at least one such issue — 83.9 percent versus 76.9 percent.

The total number of emergency preparedness deficiencies also tended to be higher for exposed facilities than for unexposed sites, according to the study.

California nursing homes were most likely to be deficient in their use of emergency and standby power systems, the researchers observed.

Power outages are directly linked with adverse outcomes among nursing home residents — many of whom are dependent on electric health care equipment and struggle to tolerate temperature fluctuations, according to the study.

“Our study suggests that there may be opportunities to better align nursing home emergency preparedness with local wildfire risk,” first author Natalia Festa, of Yale University School of Medicine, said in a statement.

Festa stressed the importance of conducting additional research on the subject, which could help pinpoint the underlying reasons for these discrepancies.

The poorer emergency preparedness at high-risk nursing homes suggests, however, that staff members may be either unaware of or not adequately incentivized to respond to wildfire risk, the authors explained.

Although guidance from the Centers for Medicare & Medicaid Services encourages nursing homes to collaborate with municipal risk assessment and disaster planning initiatives, no clear standards exist to verify such partnerships, according to the study.

To solve these issues, the authors advocated for a “responsive regulatory” incentive structure, in which regulatory interventions are aligned with both the risks incurred by the homes and their emergency preparedness status.

Such a response could be governed by emerging health care coalitions — regional partnerships that integrate emergency planning, health care and public health organizations, the researchers explained. 

“The medical complexity and functional needs of nursing home residents render them susceptible to disproportionate harm from exposure to environmental hazards,” the authors concluded.

“Ensuring that nursing home emergency preparedness is commensurate with local environmental risks is important for safe-guarding residents,” they added.