After abortive evacuation to warehouse, Louisiana increases scrutiny of nursing home plans | Hurricane Center | nola.com

2022-06-20 15:48:08 By : Forrest Huo

A warehouse in Tangipahoa Parish temporarily housing 843 residents of seven nursing homes owned by Baton Rouge businessman Bob Dean is evacuated on Sept. 2. Dozens of residents died after conditions at the warehouse deteriorated. Authorities have classified five of those deaths as "storm-related." 

A sign lies on the ground outside the Maison DeVille of Harvey, one of seven nursing home owned by Bob Dean, photographed March 3. The state has shut down all of Dean's homes after he evacuated residents to a poorly equipped warehouse in Tangipahoa Parish before Hurricane Ida to (Photo by Chris Granger | The Times-Picayune | The New Orleans Advocate)

A warehouse in Tangipahoa Parish temporarily housing 843 residents of seven nursing homes owned by Baton Rouge businessman Bob Dean is evacuated on Sept. 2. Dozens of residents died after conditions at the warehouse deteriorated. Authorities have classified five of those deaths as "storm-related." 

Every year, three months before hurricane season, nursing homes along Louisiana’s Gulf Coast are required to submit a stack of paperwork to state and local officials, detailing how and where they’ll evacuate their medically fragile residents in the event of an emergency.

But last year’s botched evacuation of hundreds of nursing home residents to a squalid, ill-equipped warehouse in Tangipahoa Parish as Hurricane Ida bore down raised questions about how closely regulators scrutinized those plans.

Months before nursing home magnate Bob Dean ordered his seven facilities to evacuate, his staff filled out the required paperwork, listing the old pesticide warehouse as their primary evacuation site.

As Ida careened toward Louisiana, Dean followed through on that plan. And for several days, more than 840 residents languished at the partially flooded warehouse, with inadequate clothes, hygiene and food.

Louisiana Department of Health inspectors, who had been monitoring the site and had initially found it met minimum standards, finally shut it down after days of deteriorating conditions. They described patients on mattresses on the floor, crying out for help, many lying in their own feces and urine.

Dozens of patients later died. State officials — who took away Dean’s nursing home licenses days after Ida — have said at least five of those fatalities were "storm related." Dean’s facilities remain closed, though he is fighting to get his licenses back. He is also the target of numerous civil suits and a criminal investigation; a pending civil lawsuit also blames the LDH for the botched evacuation.

Following the fiasco, state lawmakers wondered aloud who, exactly, was responsible for approving nursing homes’ emergency preparedness plans, copies of which are generally kept by state and parish officials.

LDH lawyers answered that, technically, nobody was responsible for signing off on them. The statute that mandates nursing homes in Louisiana’s coastal zone draw up evacuation plans, they said, only required the health department to review — not “approve” — them.

The relevant state law was passed after Hurricane Katrina, when a handful of nursing-home residents died from the stress of lengthy evacuations and dozens of others died after the homes’ managers decided against leaving. 

To add a layer of accountability, state lawmakers this session passed a bill, backed by Gov. John Bel Edwards, that will require nursing home preparedness plans to go through a more thorough vetting process.

Under the regulatory scheme laid out in House Bill 933, sponsored by state Rep. Joseph Stagni, R-Kenner, the LDH must approve a nursing home’s plan in order for the facility to keep its operating license.

Also, all nursing homes in Louisiana — not just those located on or near the Gulf Coast — will be required to submit plans. And the approval process will include input from a range of state and local entities, including the state fire marshal and parish emergency preparedness offices.

Much of the proposed law won’t go into effect until later this year, but Louisiana isn’t waiting to beef up its oversight.

Around 23,000 Louisianans are residents of nursing homes. About 9,200 live in the parishes most at risk of getting struck by a hurricane.

Usually, when a nursing home evacuates, it will send its residents to another licensed nursing home or medical facility with empty beds. But they can also evacuate to an “unlicensed” site, like a school or church.

Ahead of this year’s hurricane season, which began on June 1, the state health department, for the first time, conducted inspections of all unlicensed evacuation sites. Dean’s warehouse was one such site.

A sign lies on the ground outside the Maison DeVille of Harvey, one of seven nursing home owned by Bob Dean, photographed March 3. The state has shut down all of Dean's homes after he evacuated residents to a poorly equipped warehouse in Tangipahoa Parish before Hurricane Ida to (Photo by Chris Granger | The Times-Picayune | The New Orleans Advocate)

The plans submitted this year by the 98 nursing homes along the coast listed 14 unlicensed facilities as primary or secondary evacuation sites.

All of those sites have undergone a preliminary inspection. If an evacuation is triggered, they’ll face another inspection. The new law requires nursing homes to notify the LDH within one hour of their decision to evacuate.

“It’s one thing to do a review in an empty building. It’s another thing to do a review once it’s set up,” LDH Secretary Courtney Phillips said in May.

In the past, inspections typically took place in the lead-up to evacuations.

In fact, days before Ida made landfall, the state twice inspected Dean’s warehouse and determined it had the “minimum necessary components to provide a safe sheltering environment for a very short period of time.”

This year, the team of inspectors includes a “concerted, larger group of surveyors and specialists,” from across state government, a health department spokesperson said.

Over the next several months, the LDH is expected to promulgate a set of rules that detail what they expect evacuation plans to include.

Stagni's bill sets out minimum requirements, but the forthcoming regulations are expected to go into more granularity, spelling out, for instance, how many bathrooms are needed at an evacuation site.

Those regulations will be based on recommendations from the Nursing Home Emergency Preparedness Review Committee, which will grow from 17 to 24 members under Stagni’s legislation. Nine of those seats will be reserved for nursing-home industry officials. Most of the other members will come from across state government.

So far, the state’s policy response to the crisis in Independence has won high marks from advocates for Louisiana’s senior citizens.

“Do I think the state has done what it needs to do in order to be prepared? I do,” said Denise Bottcher, Louisiana state director for AARP.

But Bottcher, who served as then-Gov. Kathleen Blanco’s chief spokesperson when Hurricane Katrina struck, said with the increasing severity of storms, it’s hard to predict what might go wrong.

Bottcher said it’s important to have “open and transparent conversations about what worked and what didn’t” following evacuations.

An earlier draft of HB933 required nursing homes to submit after-action reports following evacuations but would have kept those records secret. The final draft of the bill removed the obligation to submit those reports altogether.

Altogether, Bottcher said the reforms that have emerged since last year’s debacle have put Louisiana in a stronger position.

“When I talk to my counterparts in Florida and Texas, they don’t have all those stakeholders around the table,” Botcher said.

Under the new law, nursing homes in Louisiana’s 22 most hurricane-prone parishes will have to submit new emergency plans to the LDH by Sept.1. The department will have to either approve or reject those proposals by May 15, 2023.

Nursing homes in the 42 other parishes will go through the same process. They need plan approval by May 15, 2024.

In the years that follow, all Louisiana nursing homes will have to submit updates to their emergency plans by Nov. 1.

Bottcher said it’s important that as the reforms are phased in, and administrations are replaced, Louisiana officials don’t lose sight of why oversight is necessary.

As Phillips, the LDH secretary, put it back in May: “What happened last year at the Independence site cannot happen again.”

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