Evaluating California nursing homes' emergency preparedness for wildfire exposure

• Published in: Journal of the American Geriatrics Society (JAGS) 2023-03, Vol.71 (3), p.895-902
• Main Authors: Festa, Natalia, Heaphy, Nora M., Throgmorton, Kaitlin Fender, Canavan, Maureen, Gill, Thomas M.
• Format: Article
• Language: English
• Subjects: Aged; California - epidemiology; Civil Defense; Elder care; Emergency preparedness; environmental gerontology; Humans; Medicare; Nursing Homes; Statistical analysis; United States; Wildfires
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.18142

Background The relationship between the risk of exposure to environmental hazards and the emergency preparedness of nursing homes is not well‐understood. This study evaluates the association between wildfire exposure risk and nursing home emergency preparedness. Methods From a sample of Centers for Medicare & Medicaid Services (CMS) certified nursing homes in California, we determined the prevalence of “exposed” facilities that were located within 5 km of a wildfire risk area, as informed by a field‐tested model. Among the 1182 nursing homes, we identified emergency preparedness deficiencies from January 2017 to December 2019. We estimated associations between exposure and emergency preparedness deficiencies using unadjusted and adjusted generalized estimating equations with logistic and negative binomial distributions. Results A greater percentage of the 495 exposed facilities had at least one emergency preparedness deficiency than the 687 unexposed facilities (83.9% vs 76.9%). The mean (3.6 vs 3.2) and median (3 vs 2) numbers of emergency preparedness deficiencies were also greater for exposed facilities. In both the unadjusted and adjusted analyses, exposure to wildfire risk was significantly associated with the likelihood of at least one emergency preparedness deficiency (adjusted odds ratio 1.52, p‐value 0.007). There was a positive but not statistically significant association between exposure and the number of emergency preparedness deficiencies assigned to a nursing home (adjusted rate ratio 1.12, p‐value 0.062). These results were consistent in analyses that used more stringent distance‐ and severity‐thresholds to define exposure status. Conclusion California nursing homes at heightened risk of exposure to wildfires have poorer emergency preparedness than unexposed facilities. These findings suggest that nursing home management and staff may be unaware of important environmental risks to which their facilities are exposed. Improved integration of nursing homes into community disaster planning may better align facility preparedness with surrounding wildfire risk. See related Article by Hua et al. and Editorial by Lindsay J. Peterson in this issue.