Nursing home disaster plans are lacking many of the specific steps required by the government, such as coordination with local authorities, notification of relatives or even pinning name tags and medication lists to residents during an evacuation, according to an article from The Associated Press.

Nationally, more than 3 million people spent at least some time in a nursing home during 2009, according to the article, and nearly 40 percent of them, 1.2 million, were in the top 10 disaster-prone states (Texas, California, Oklahoma, New York, Florida, Louisiana, Alabama, Kentucky, Arkansas and Missouri). The typical resident is a woman in her 80s or older, dealing with physical and mental limitations leaving her dependent on others for help with daily basic activities, according to AP.

Investigators began by looking at the number of nursing homes that met federal regulations for emergency preparedness, then they went into the field to test how solid those plans were, using a 24-home sample drawn from 210 facilities substantially affected by floods, hurricanes and wildfires across seven states during 2007-2010. 

On the surface, AP reports, 92 percent of the nation's 16,000 nursing homes met federal regulations for emergency planning, and 72 percent met standards for emergency training. When inspectors showed up at the facilities to pull files and interview staff, a different picture emerged. 

According to the investigators' report:

At one home, the emergency plan was stored in several boxes; in another, it was on a legal pad, the article says.

Twenty-three (of 24) plans did not describe how to handle a resident's illness or death during an evacuation.

Fifteen had no information about specific medical needs of patients, such as feeding tubes or breathing apparatus.

Seven plans did not specify how to identify residents in an evacuation.

Fifteen made no provision for including medication lists.

Twenty-two had no backup plans to replace staff who could not report to work during a disaster. 

None of the homes met a government recommendation for a seven-day supply of drinking water if residents were to be sheltered in place during a disaster.

Transportation was a major concern for the nursing homes, as none of them had planned to ensure the transportation of adequate food and water for evacuees, and 19 had no plan for transporting wheelchairs and equipment. Twenty-two of the plans did not describe how medication would be transported. 

Seventeen had no plan for working with local emergency coordinators to decide whether to evacuate or not.

A common problem identified by administrators and staff of nursing homes was that transportation contracts would not be honored after an evacuation was called. Four homes that had to evacuate had difficulty keeping track of patients, who were, in some cases, temporarily lost.

Many of these problems are the same gaps seen in the aftermath of Hurricane Katrina seven years ago, said investigators. An investigation from the Houston Chronicle found that at least 139 nursing home residents died during the hurricane or its aftermath. Thirty-five of them were residents of St. Rita's Nursing Home just outside New Orleans. Some drowned in their beds, the article says.

The report recommends that Medicare and Medicaid add specific emergency planning and training steps to the existing federal requirement that nursing homes have disaster plans.