AMA journal publishes Dr. Smith’s study on pandemic plans

Philip Smith, M.D.

If influenza pandemic hits the United States, acute care hospitals are likely to be overwhelmed and nursing homes may be expected to assist with the patient overflow.

But a new study in the Journal of the American Medical Association suggests that many nursing homes are not prepared for such a task.

Of the more than 400 nursing homes in the study, just 23 percent had specific pandemic influenza plans. Another quarter of the nursing homes had a pandemic response incorporated into an overall disaster response plan. And more than half — 52 percent — did not have any pandemic plan.

“If nursing homes are called upon to serve as alternative care centers for patients who can’t be treated in overcrowded hospitals, the impact on the nursing homes could be vast. Nursing homes serve a vulnerable population prone to dire consequences from an emergency,” said the study’s lead author, Philip Smith, M.D., a professor and chief of the UNMC section of infectious diseases. “While most facilities felt that nursing homes were being counted on to take hospital overflow patients in a pandemic, in reality few homes would be able to do so. The biggest finding is that nursing homes have started some preparedness work but they have a lot more to do.”

“Nursing homes may not be equipped to handle an influx of influenza as well as non-influenza patients. They may also be unwilling to accept overflow patients, if it means displacing their current residents,” said senior author Lona Mody, M.D., assistant professor of internal medicine at the University of Michigan Health System. “Nursing homes run a high occupancy rate, making it logistically difficult to accept a lot of patients if there is a time crunch.

“Specific areas for improvement,” Dr. Mody said, “include communication with nearby health departments and hospitals during the planning stage and exercising formulated plans. Planning for staff shortages also is critical.”

Half of the nursing homes in the study had stockpiled some commonly used supplies such as gloves and hand hygiene products. Less than half had provided pandemic education to staff members. Just 6 percent had conducted pandemic influenza outbreak exercises.

“While most facilities felt that nursing homes were being counted on to take hospital overflow patients in a pandemic, in reality few homes would be able to do so.” Philip Smith, M.D.

In more optimistic findings, more than three-quarters — 77 percent — of all Michigan and Nebraska nursing homes had a person or staff position designated as being responsible for pandemic preparedness. Access to laboratory facilities for the detection of influenza was available at 84 percent of these nursing homes. Another 71 percent provide mental health and/or faith-based services.

The study results are not an indictment of nursing homes, Dr. Smith said.

“Nursing homes have really done a great job,” he said. “They do not have a lot of money or personnel. They have good laboratory backup for diagnosing flu, they have mental health support and resources. Many of them have started stockpiling, which is fairly sophisticated measure and perhaps most importantly, a majority of them — three-quarters — have designated a person to be in charge of pandemic flu preparations. And that’s great.”

He credited Connie Wagner of the Nebraska Health Care Association for the almost 75 percent response rate of nursing homes responding to the study survey.

A pandemic is an outbreak of a disease on a global scale. Typically, a pandemic is lengthy and would create a strain on traditional health care institutions, infectious disease experts say. To relieve some of that burden, additional sites known as acute care centers and neighborhood emergency help centers would be set up at places such as schools, armories, shopping malls and nursing homes.

Click here for more information about the federal government’s information about pandemic influenza preparedness and here for state-by-state information about pandemic preparedness.