Louisiana nursing home owners seek changes to proposed state regulations from Hurricane Ida

Nursing home owners are pushing back on proposed changes to state regulations governing their emergency operations. 

Louisiana is expected to update its nursing home rules later this month, a little over a year after a botched evacuation of hundreds of nursing home residents during Hurricane Ida ended with people dead and hospitalized. 

Mark Berger, executive director of the Louisiana Nursing Home Association, questioned whether a proposed rule prohibiting visitors from verbally abusing residents would be enforceable because nursing homes “can’t control the language of our visitors.” He also asked the health agency to add another avenue for appealing evacuation violations that might lead to a nursing home license revocation. 

Berger spoke during a meeting of the Louisiana Department of Health’s nursing home emergency preparedness plan review committee last week. 

The state’s current appeal process for nursing home license revocation involves an administrative judge and can take several years to resolve. Berger said the state’s should consider a secondary process within the health department that is less formal.

Nursing homes owners tend to have a lot of influence over the state health department as prolific campaign donors to governors and legislators who oversee the agency.   

Stephen Russo, an attorney for the state health department, told Berger that nursing homes would, in most cases, have many warnings and face other sanctions before their licenses would be pulled. The health department would likely halt government insurance payments to the homes and deny admission of new patients first, Russo said. 

“I don’t think we would pull the license without a [formal] appeal hearing. We really only do that in extreme cases,” he said.  

Scott Crabtree, who runs Lambeth House Retirement Community in New Orleans, also objected to a requirement that nursing homes set up a hotline for family and loved ones to call and find out the location of nursing home residents in the aftermath of a disaster. 

The state requirement for this hotline isn’t actually part of the newly proposed regulations. A review of the current administrative rules showed it is already on the books, but that wasn’t clear from the draft version of the new rules circulated at the meeting. 

“Our website is where we want everyone to go [for that information],” Crabtree said. “If you are requiring us to have a telephone number, I think that is going to be a challenge. … Who is going to man this phone number? Where is he going to be?”

Mike Miller, an emergency operations staff member with the Louisiana Department of Transportation and Development, told Crabtree it isn’t always practical to post information on websites during a disaster because so few people have internet access.

In response, Crabtree said that people who didn’t have internet access should go to the library to check his nursing home’s website for information.

He did not address the fact that libraries are often closed or don’t have internet access in the days following a natural disaster. 

Evacuation shelter standards under scrutiny

The health department is focusing its new requirements on nursing home shelters used for evacuations. The new rules won’t go into effect until next May, right before the 2023 hurricane season begins.

Many facilities send their residents to different nursing homes in other parts of the state for evacuations. Some use buildings like school gyms and church halls, facilities referred to as unlicensed shelters by the health department.

Under the proposed rules, the state would start requiring each nursing home to submit a floor plan and layout of the sleeping area in their unlicensed facilities. Nursing homes would also have to disclose information about the flood risk at these unlicensed sites and prove they can retain a “comfortable temperature” in the building. 

The proposed rules also include explicit guidelines for sanitation. 

Unlicensed buildings should have one hand-washing station for every 15 people, one shower or bathtub per 15 people and one toilet per 20 people. These ratios would technically be required, though nursing home owners could seek a waiver from the health department if their shelters don’t meet the standards. 

The new draft regulations are a direct response to the horrific scene of a nursing home evacuation to an old warehouse in Tangipahoa Parish for Hurricane Ida. 

Nursing home owner Bob Dean moved nearly 850 residents from seven of his facilities into a former pesticide facility he owned ahead of that storm last year. 

The residents ended up in squalid conditions, sleeping on air mattresses on the ground without regular bathing or adequate bathrooms for several days. The warehouse partially flooded, and health inspectors reported the facility was hot and smelled of human waste.

In the week after Ida, the health department carried out a large-scale rescue from Independence, moving hundreds of Dean’s nursing home residents to other nursing facilities. It also revoked Dean’s nursing home licenses, a move he is fighting in court and through the state’s current appeals process. 

Health officials said 15 of Dean’s nursing home residents died within a month after the storm and dozens more ended up in the hospital.

Problems with unlicensed shelters extend beyond Dean and his warehouse, however. 

Inspections conducted in May and June revealed 16 other nursing homes in hurricane-prone areas planned to evacuate to unlicensed buildings that didn’t meet the health department’s minimum standards.

The shelters didn’t have enough space, showers or sinks for the number of people they would have to house. Some were also prone to flooding or not structurally sound enough to withstand a severe storm, according to documents released in response to the Illuminator’s public records request last month. 

That issue has been somewhat resolved, according to health officials. At the meeting last week, they said most nursing homes who were supposed to go to problematic sites have submitted revised plans that have them evacuating to new locations. 

But there are still six nursing homes slated to go shelters the health department has already asked the homes not to use. 

They include: St. Margaret’s Daughters Home, St. Jude’s Nursing Home, Chateau de Notre Dame and Our Lady of Wisdom Health Care Center, all in New Orleans; Wynhoven Health Care Center in Marrero; and Vermillion Health Care Center in Kaplan. 

Russo said the state cannot stop the nursing homes from using insufficient shelters through the rest of the current hurricane season, which ends Nov. 30. They have to wait until the proposed, new nursing home evacuation regulations take effect next May, he said.

The proposed evacuation regulations may also get tweaked before they are implemented.