There are two tropical storms presently aimed at the Texas Coast. Here is the latest on Tropical Storm Erin:

Here is its projected path:

In the Gulf of Mexico, Tropical depression Five took shape last night, and has been upgraded to Tropical Storm Erin at 10 am CT moving northwest toward the southeastern Texas Coast.

Conditions appear favorable for Tropical Storm Erin to be a flooding rain threat into Friday night.

The current forecast track brings this system into the southern Texas Coast on Thursday, but the impacts will be felt along all of the Texas Coast, from Brownsville, through Corpus Christi and Houston, to Lake Charles, LA.

Tropical Storm Dean is a potential threat:

Meanwhile, our second area of concern, Tropical Storm Dean (60 mph), continues to move quickly west in the Atlantic.

Dean is forecast to become a hurricane by Thursday night or early Friday, and should be threatening the Lesser Antilles as early as Friday. From there, Dean should continue west-northwestward into the Caribbean.

It is too early to tell what, if any, impacts Dean will have on the United States.

Here is Dean’s potential path:

I spoke with someone at DADS today. By next Monday, the Governor’s Division of Emergency Management should be tracking Tropical Storm Dean (which may be a hurricane by then), so keep up with information from that site. Also, providers should be checking with Regional Offices for regulatory questions about evacuations, etc.

In a provider letter dated June 1, 2007, DADS is notifying Texas long-term care facilities that it will be conducting a hurricane preparedness exercise “involving local, state, federal, and private sector partners.” DADS is requesting that you update your number of vacancies in the Facility Inventory, Vacancy and Evacuation Status application (FIVES) on a daily basis.

FIVES can be accessed here.. The provider letter can be accessed here.

In a letter dated May 14, the Texas Department of Aging and Disability Services (DADS) notified assisted living providers, provider organizations, and surveyors about a conference called, “Clarifying the Myths in Assisted Living Facilities.” The conference will be held on July 19, 24, and 31.

Topics to be presented include aging in place, emergency preparedness, and medication management. For locations and times, you may download the letter here.

DADS reminded nursing facilities (in a May 15 letter) about the need to notify Medicaid clients of increases in their monthly applied income amounts — which resulted from a cost of living adjustment to Social Security benefits in January — pursuant to federal regulations and the state administrative code. You may download the letter here for more information.

Hopefully this hurricane season won’t be as devastating as the last, but it’s good to be prepared.

Texas providers (and all residents) should visit the disaster preparation resource page at TexasOnline to stay up-to-date on current news and tips. You’ll find links to organizations and agencies that specialize in preparing for disasters, including the Federal Emergency Management Agency and American Red Cross.

There are links to state and local government agencies and organizations, and advice on how to avoid charity scams. For more information, visit the Disaster Recovery Resources page at the Texas Cooperative Extension Disaster Education Network.

Last week I linked to the Inspector General’s report on nursing home emergency preparedness and response. Click on this link to read the post and download the report.

The Office of Inspector General (OIG) of the U.S. Department Health and Human Services has released a report titled, “Nursing Home Emergency Preparedness and Response During Recent Hurricanes.”

OIG reviewed 20 nursing homes for the study. According to the report, 94 percent of nursing homes met government guidelines for emergency plans, and 80 percent met guidelines for sufficient emergency training in 2004-2005.

However, nursing homes didn’t always follow the plans. For example, 5 of the 20 deviated from their emergency plans for various reasons. In some cases, there was a lack of coordination between state and local emergency entities.

OIG recommended that the Centers for Medicare and Medicaid Services strengthen certification standards for nursing home emergency plans by developing a “core set of required elements” and encourage better communication between government entities and nursing homes.

For more information about the report, see “Study of Nursing Home Disasters in Last Year’s Hurricanes Recommends Changes.”

You may download the 48-page report here (PDF).

The Texas Department of Aging and Disability Services (DADS) has issued a provider letter (July 17) to Home and Community Support Services Agencies (HCSSA) and Adult Day Care Facilities (ADC) on using the 211 system.

The 211 system is a telephone number that connects callers to local health and human services agencies. People looking for social service assistance for food, housing, education, legal help, child care, physical and mental health, financial support, transportation, or emergencies can dial 2-1-1 and speak with trained professionals who will refer them to the appropriate agencies.

The Texas Health and Human Services Commission, Texas Alliance of Information and Referral Systems, and various community-based organizations collaborate to provide this service.

DADS requires that HCSSAs and ADCs have written plans for disaster preparedness, including triage, evacuation, sheltering, etc. You may download the letter here.

Providers are bracing themselves for another hurricane and more tough decisions. Nursing homes are faced with whether to evacuate patients, some connected to feeding tubes and oxygen tanks, or ride out Hurricane Wilma in place. From the Washington Post:

The decision to stay or flee in the event of a hurricane can be difficult even for the able-bodied. But as the evacuations for hurricanes Katrina and Rita showed this year, the decisions made at nursing homes more likely could be a matter of life and death. Several nursing home patients died in Louisiana because they were not evacuated before Katrina hit, and in one case the owners of a home were charged with negligent homicide. On the other hand, several nursing home patients perished because they were evacuated; they died in transit.

In the aftermath of Hurricane Katrina, Senator Chuck Grassley asked the Office of Inspector General of the U.S. Department of Health and Human Services to investigate nursing home deaths last month. I blogged about it here. No doubt deaths resulting from Hurricane Wilma will spark more investigations.

Hurricane Wilma struck the Florida mainland this morning.

General Honore takes no guff from the reporters in New Orleans(HT Radioblogger):

Honore: And Mr. Mayor, let’s go back, because I can see right now, we’re setting this up as he said, he said, we said. All right? We are not going to go, by order of the mayor and the governor, and open the convention center for people to come in. There are buses there. Is that clear to you? Buses parked. There are 4,000 troops there. People come, they get on a bus, they get on a truck, they move on. Is that clear? Is that clear to the public?

Female reporter: Where do they move on…

Honore: That’s not your business.

Male reporter: But General, that didn’t work the first time…

Honore: Wait a minute. It didn’t work the first time. This ain’t the first time. Okay? If…we don’t control Rita, you understand? So there are a lot of pieces of it that’s going to be worked out. You got good public servants working through it. Let’s get a little trust here, because you’re starting to act like this is your problem. You are carrying the message, okay? What we’re going to do is have the buses staged. The initial place is at the convention center. We’re not going to announce other places at this time, until we get a plan set, and we’ll let people know where those locations are, through the government, and through public announcements. Right now, to handle the number of people that want to leave, we’ve got the capacity. You will come to the convention center. There are soldiers there from the 82nd Airborne, and from the Louisiana National Guard. People will be told to get on the bus, and we will take care of them. And where they go will be dependent on the capacity in this state. We’ve got our communications up. And we’ll tell them where to go. And when they get there, they’ll be able to get a chance, an opportunity to get registered, and so they can let their families know where they are. But don’t start panic here. Okay? We’ve got a location. It is in the front of the convention center, and that’s where we will use to migrate people from it, into the system.

Male reporter: General Honore, we were told that Berman Stadium on the west bank would be another staging area…

Honore: Not to my knowledge. Again, the current place, I just told you one time, is the convention center. Once we complete the plan with the mayor, and is approved by the governor, then we’ll start that in the next 12-24 hours. And we understand that there’s a problem in getting communications out. That’s where we need your help. But let’s not confuse the questions with the answers. Buses at the convention center will move our citizens, for whom we have sworn that we will support and defend…and we’ll move them on. Let’s not get stuck on the last storm. You’re asking last storm questions for people who are concerned about the future storm. Don’t get stuck on stupid, reporters. We are moving forward. And don’t confuse the people please. You are part of the public message. So help us get the message straight. And if you don’t understand, maybe you’ll confuse it to the people. That’s why we like follow-up questions. But right now, it’s the convention center, and move on.

Male reporter: General, a little bit more about why that’s happening this time, though, and did not have that last time…

Honore: You are stuck on stupid. I’m not going to answer that question. We are going to deal with Rita. This is public information that people are depending on the government to put out. This is the way we’ve got to do it. So please. I apologize to you, but let’s talk about the future. Rita is happening. And right now, we need to get good, clean information out to the people that they can use. And we can have a conversation on the side about the past, in a couple of months.

I think that the Long Term Care profession needs a spokesman like General Honore. Wouldn’t you love to hear the General say something similar to a regulator berating you about a problem you’ve already fixed?

“Hey Mr. Surveyor, don’t get stuck on stupid.”

Hurricane Rita is on its way and it’s time for Coastal areas to think about their evacuation plans. The word on the street is that FEMA is starting to grab buses to evacuate the Katrina evacuees out of Houston. I have heard that bus companies are requiring payment up front from nursing homes.

Things to be concerned about:

1. Chartering buses that end up being commandeered by FEMA or local authorities.

2. Are your local governmental entities working with nursing homes for Plan B in case your buses don’t show up because they’ver been commandeered or the drivers aren’t showing up for work? (this happened during Katrina)

Review your plan, get your buses lined up and check with local authorities. If the local authorities aren’t cooperating, please come here and fill out a comment to that effect.

The media is reporting the following:

Authorities Wednesday began removing the remains of more than 30 people from a flooded nursing home in a suburban parish.

The discovery at St. Rita’s Nursing Home in lower St. Bernard Parish came as 25,000 body bags arrived at the Louisiana Department of Health and Hospitals. (Full story)

On Thursday, the official death toll from Hurricane Katrina stood at 294, but that number is expected to rise dramatically.

Mortuary teams with refrigerated trucks began arriving Wednesday at the nursing home, where St. Bernard Parish Sheriff Jack Stevens said “30-plus” bodies were found. Between 40 and 50 other people were rescued from the facility, Stevens said.

The way this story is written, one would assume that the staff just chose to run off and leave people. However, after talking with a source who has people on the ground in New Orleans, I believe that may or may not be the case. Apparently, each Parish has its own Emergency Director. For quite some time, some nursing homes in some parishes have been trying to work with the Director regarding evacuations–particularly focusing on the fact that some residents are so fragile that it is dangerous to evacuate them. The homes have been requesting that hospitals allow them to place such residents on higher floors out of the way of floodwaters. The hospitals have refused. (Can’t you just hear their lawyers talking?) They have refused even though most of their patients would be evacuated and space would, allegedly, not be a factor. My source, who is not affiliated with St. Rita, is unhappy that the Parish Emergency Directors would not require the hospitals to allow the nursing homes to place residents at those hospitals. After all, the government was, in some cases, willing to commandeer buses chartered by the facilities to move residents–why couldn’t they require hospitals to give up unoccupied floors?

Apparently, what happened in some of these cases is that when the nursing homes started flooding, the staff could not move the residents (who had no where to go), as the water rose–the staff had to escape to save themselves from drowning. If this is true, it is a horrible scenario–but you can’t blame the staff.

Another problem according to my source, was that, although some facilities chartered buses, the bus drivers had fled the area and there was no one to drive them. I wonder how many residents were impacted by that?

Regardless, you may read many stories about dead residents found in nursing homes over the next few days. Just remember, the media may not be giving you all the facts behind these stories.

Update: I am updating this because I am extremely angry at the media for not adequately reporting about this. I think that they are setting up a situation where these nursing homes are going to be blamed. Perhaps some of them have fault. I doubt it. If you own one of these nursing homes, please ensure that you have documented every action your staff took to evacuate residents. If your buses were commandeered, document it. If the bus drivers didn’t show up, document it.

If you followed your emergency plan and were thwarted by the government, document it. If CMS moves against you–call your lawyer.