Emergency Preparedness Is Also a Burden for Long-Term Care

April 1, 2021
April 1, 2021

The long-term care industry is struggling to deal with a variety of issues. Some such as preventing falls and ensuring emergency preparedness have been concerns for these facilities for quite some time; others such as new regulatory oversight and handling the COVID-19 pandemic are new to the mix. The result is that industry leaders are faced with a multitude of new challenges to manage simultaneously. Needless to say, grappling with the pandemic by itself would be more than all-consuming. When we overlay all of these other elements on top of COVID-19, we find many in this industry overwhelmed by the scope and variety of the issues at hand. This article is Part 2 of our attempt to look more closely at some of the serious concerns of organizations across the continuum of care.

Emergency Preparedness, While Necessary, Is a Burden for Long-Term Care Facilities

For different providers across long-term care, CMS has established emergency preparedness requirements. Not only must organizations have emergency plans, but they need to review them regularly, provide training to staff on a regular basis, and test them periodically. As part of CMS’s recent initiative to reduce the regulatory burden in healthcare in 2019, much of the care continuum was allowed “relaxed emergency preparedness requirements for most settings—except long-term care facilities (LTCs). The new rule changes a mandate for an annual self-review of a provider’s or supplier’s emergency program to every other year, except for LTCs, which will still have to submit reviews every year” (APTA, 2019). Prior to this revision, “providers were required to document efforts to contact local, tribal, regional, state, and federal emergency preparedness officials in emergency planning. All providers continue to be required to have a process for cooperation and collaboration with these entities as part of the emergency plan in order to maintain an integrated response during disaster, but providers are no longer required to document efforts to contact these entities in emergency planning” (Eyigor, 2020).

The burden for emergency preparedness compliance continues to fall more heavily on long-term care. While the rest of the continuum can review their programs on a biannual basis, “Long-term care providers (nursing homes) continue to be required to review the emergency program on an annual basis” (Eyigor, 2020). Likewise, “Long-term care providers must continue to provide additional training on an annual basis thereafter, while all other providers are now required to provide additional training only biennially” (Eyigor, 2020). Plan testing requirements are now split, with inpatient providers required to conduct two training exercises annually, one of which “must be a full-scale community-based exercise” (Eyigor, 2020). Outpatient “providers are now required to conduct only one training exercise annually. The exercise must be a full-scale community-based exercise or individual facility-based functional exercise at least every other year” (Eyigor, 2020). CMS opted to maintain the more stringent requirements for long-term care “after receiving feedback from nursing home resident advocates. [CMS Administrator Seema] Verma said the requirements for nursing homes are necessary because of their ‘unique patient and safety needs’” (Brown, 2019).


APTA, “SNF Patient-Driven Payment Model (SNF PDPM),” 12/11/2019, American Physical Therapy Website, Retrieved at https://www.apta.org/PDPM/SNF/.
Brown, D., “Feds keep the heat on nursing homes’ emergency prep training,” McKnight’s Long-Term Care News: September 26, 2019, Retrieved at https://www.mcknights.com/news/feds-keep-the-heat-on-nursing-homes-emergency-prep-training.
Eyigor, J., “Revisions and Interpretive Guidance for Emergency Preparedness Requirements,” LeadingAge.org: January 8, 2020, Retrieved at https://leadingage.org/regulation/revisions-and-interpretive-guidance-emergency-preparedness-requirements.


This blog post continues a series based on our article, Top Issues Across the Care Continuum - Part Two, which looks more closely at some of the serious concerns of healthcare organizations across the care continuum. An earlier blog post series was based on our article Top Issues Across the Care Continuum – Part One. Subsequent challenges to be examined during this blog post series include:

  • The Abuse Icon on the Nursing Home Compare Website is Problematic for Many Long-Term Care Organizations.
  • Falls with Injury Are a Serious Concern for Long- Term Care Facilities and the People Who Reside in Them.
  • Nursing Homes Struggle with the Demands of Required Compliance Surveys and Regulatory Oversight.
  • Long-Term Care Faces Even More Requirements with QAPI Phase 2 and Phase 3 Regulations.
  • Changes Related to COVID-19 Will Impact Surveys and Visitation Policies in the Future

There is a long list of challenges for providers across the care continuum, outside of acute care. For example, with consistent wage pressures, shifting compliance regulations, and rising acuity levels among resident populations, the skilled nursing and LTC workforce is feeling more pressure than ever before. HealthStream works with organizations throughout non-acute care to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. By partnering with HealthStream, organizations are equipped to seamlessly manage the pressures of surveyor visits, while remaining focused on high-quality patient and resident care. Learn more about HealthStream solutions for non-acute care organizations.