Louisiana Imposes New Evacuation Rules for Nursing Homes

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The Louisiana Department of Health removed nearly 850 nursing home residents from this warehouse in late August 2021 after nursing home owner Bob Dean transferred people there during Hurricane Ida. (Photo by Wesley Muller/Louisiana Illuminator)

BATON ROUGE (Louisiana Illuminator) — Louisiana issued long-awaited new evacuation rules for nursing homes last month, over a year after the disastrous evacuation of seven homes by owner Bob Dean brought to light the state’s weak authority over nursing home emergency plans.

The regulations establish requirements for the homes’ “unlicensed” evacuation shelters, including churches, school gymnasiums, auditoriums and other non-medical facilities.

The sites will now have to have at least 60 square feet per person for sleeping areas, adequate ventilation, and a working heat and air-conditioning system that can maintain a comfortable temperature.

The regulations also establish guidelines for the number of showers (one per 15 people), hand-washing stations (one per 15 people) and toilets (one per 20 people) at the sites, though the state will allow nursing homes to apply for waivers to those restrictions.

Health and disaster preparation officials will be required to inspect “unlicensed” shelters for nursing homes at least once a year. If inspectors are denied access, the health department will be entitled to revoke the license of the associated nursing home.

The new rules are temporary. Health officials adopted them through an emergency approval process that is only supposed to last six months. Permanent regulations that are similar – if not exactly the same – are expected within the next year.

Nursing homes also won’t implement the evacuation standards right away. Facilities located in Louisiana’s 22 most hurricane-prone parishes won’t see their plans approved until May 15. Those in the rest of the state will wait until the middle of 2024.

The new standards are a direct response to Dean’s decision to move 850 nursing home residents from his facilities in southeast Louisiana to a former pesticide warehouse for Hurricane Ida in 2021. Health inspectors described the warehouse as overcrowded, partially flooded and with no air conditioning when they responded to the site days after the storm. They also reported it was too hot and smelled of human waste.

Inspectors found nursing home residents in soiled clothing and sheets. There weren’t enough showers, meals or staff members to serve the hundreds of people staying there, according to their reports.

Dean also harassed health department staff and kicked inspectors off the property during the evacuation. His animosity prompted the agency to undertake a rescue effort to remove people from the warehouse. They were transferred to other nursing homes and shelters, and then officials revoked Dean’s seven nursing home licenses.

Last month, a Jefferson Parish judge endorsed a $12.5 million settlement from Dean’s estate to the nursing home residents who were stuck in the warehouse, according to The Times-Picayune. Attorney General Jeff Landry has also brought criminal charges against Dean over the evacuation.

The new regulations address some of the concerns legislators raised last fall in the wake of the Dean debacle, but not all of them.

Lawmakers expressed outrage last year that Dean had put  nursing home residents on air mattresses on the floor for days. They also balked at the idea that elderly people were being asked to use portable toilets.

“The idea that we allow standards where port-a-lets inside a building is an acceptable standard? There’s no kitchen in there. We had men and women lying on the floor,” Senate Pro Tempore Beth Mizell, R-Franklinton, told health officials last September.

“This is something we should hold our heads in shame about as a body because we should have addressed the lack of standards a long time ago,” she said.

The new standards, however, still allow homes to use portable toilets, and they are silent on what type of bed, cot or air mattress qualifies as an adequate sleeping area.

Recent inspections of evacuation sites also reveal Dean was hardly the only nursing home owner with a problematic hurricane shelter.

Health officials cited 16 other nursing homes for having inadequate evacuation facilities after site visits last summer. Many shelters didn’t have enough space, showers or sinks for the number of people they would have to house.

Through the new rules, the health department is also allowing for longer stays at unlicensed evacuation sites. In the previous regulations, nursing homes could only send residents to these shelters for up to 15 days. In the new regulations, that timeline has been extended to 20 days.

Nursing home owners provided feedback to the health department on the new rules before they were enacted. The Louisiana Nursing Home Association could not be reached for comment for this story.

The nursing home industry is among the largest political donors in Louisiana politics.

Nursing home owners contributed $400,000 to Gov. John Bel Edwards’ first gubernatorial campaign in 2017, according to The Advocate. Dean, by himself, gave the governor’s reelection campaign $42,000 in 2019.

Two lawmakers also hold financial interests in nursing homes. Sens. Fred Mills, R-Parks, and Bob Hensgens, R-Abbeville, are partial owners in separate facilities and sit on the Senate Health and Welfare Committee, which oversees legislation dealing with nursing homes. Sen. Jay Luneau, D-Alexandria, is a cousin of nursing home owner and former state Sen. Joe McPherson.

The health department, which is overseen by Edwards, initially planned to issue the new nursing home rules at the end of September. It has not explained why their release was delayed until November 18, nearly two months later.

“It simply took us a bit longer than we originally hoped,” said Kevin Litten, a health department spokesman, in an email this week.

There’s one significant change between a draft of the rules released in September and the versions enacted last month.

Health officials are now given the option of holding a conference call with a nursing home owner right before they make a decision to approve or reject the home’s emergency plan.

Under the previous version, health officials were expected to make a decision about the nursing home plan based on written input from emergency preparedness officials and the nursing home – but without a phone call. The revised rule gives nursing homes another chance to make the case for accepting their plan before health officials make a final decision.

A rejected plan could jeopardize the nursing home owner’s license to operate.

By Julie O’Donoghue

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