Louisiana lawmakers look to assign responsibility for nursing home evacuation plans

Louisiana edged closer Tuesday to assigning responsibility for nursing home emergency plans to a specific state agency and closing a regulatory loophole that may have contributed to the horrific evacuation of over 800 nursing home residents to an old pesticide warehouse last year.

The House Health and Welfare Committee moved forward House Bill 291 to require the Louisiana Department of Health to approve emergency plans annually for all nursing homes in the state. Under current law, the health department has to “review” the nursing home plans, but doesn’t have the authority to accept or reject them. 

“To me, the Legislature has the responsibility to declare oversight,” said Rep. Rick Edmonds, R-Baton Rouge, who sponsored the legislation. “The buck has got to stop somewhere.”

Rep. Joe Stagni, R-Kenner, said he also intends to amend another nursing home reform proposal, House Bill 933, to give the health department this same authority. His bill, which was crafted by Gov. John Bel Edwards’ administration, is supposed to come up for consideration in committee next week.

The Senate Health and Welfare Committee moved a more limited proposal Tuesday in Senate Bill 167. The legislation, sponsored by Sen. Kirk Talbot, R-River Ridge, empowers the state fire marshal to approve or reject evacuation sites for nursing homes in Louisiana’s 22 most hurricane-prone parishes. The fire marshal and health department would come up with a list of minimum standards for evacuation sites through the state’s rulemaking process. 

Under Talbot’s proposal, the fire marshal would have 15 days from the submission of the emergency plan to inspect the evacuation site. If that timeline isn’t met, the shelter site would receive approval contingent on it passing a routine federal inspection. 

The bills are all attempting to address a regulatory shortfall that came to light after nursing home owner Bob Dean evacuated seven of his southeastern Louisiana facilities to a Tangipahoa Parish warehouse for Hurricane Ida. 

Lawmakers were stunned to learn last fall that no sector of government claimed to have responsibility for vetting the nursing evacuation and “shelter in place” strategies during natural disasters.

They were aghast the health department had not pushed back on Dean’s plan to use a warehouse to host more than 800 nursing home residents, despite knowing about it months before Ida hit in August. Dean listed the warehouse as an evacuation site in emergency plan documents he submitted to the health department and local parish emergency operations staff in March 2021. 

The warehouse didn’t have enough bathrooms to accommodate the hundreds of people sent there. There was no kitchen equipment or cots available. During the evacuation, state inspectors found nursing home residents lying on air mattresses on the ground in unsanitary, overcrowded conditions. Many of them were in soiled clothing and didn’t have enough to eat.

Conditions deteriorated to a point where the state was forced to rescue hundreds of the nursing home residents from the warehouse days after Ida had passed. Fifteen people died, with at least five of those deaths attributed to the evacuation. Health officials also immediately revoked Dean’s seven nursing home licenses, an action he is fighting in court.

“What happened last year is something we never, never want to see happen again,” Sen. Beth Mizell, R-Franklinton, said Tuesday.

Yet no government entity has been eager to step forward to hold nursing homes accountable for their natural disaster management. Fire Marshal Butch Browning is the only state leader who has agreed publicly to take on any of that responsibility so far, lawmakers said. 

Talbot and Stagni said local parish emergency operations offices have insisted they don’t have enough resources to vet the nursing home plans. Despite the legislation moving forward, it is still not clear that state health department officials want their agency to be responsible for plan approval. The department fears the legal liability of that responsibility. It’s already been sued by some of the Dean warehouse evacuees. 

To what extent the Louisiana Nursing Home Association, made up of nursing home owners, supports the proposals will also be relevant. It’s nearly impossible to get the Legislature to approve a bill the association opposes.

Nursing home owners are some of the largest donors to political campaigns in Louisiana. 

They contributed at least $400,000 to the governor’s first gubernatorial campaign in 2015, according to a 2017 investigation by The Advocate. Dean alone gave the governor’s reelection campaign $42,000 in 2019. 

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

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The Louisiana Nursing Home Association on Tuesday publicly backed Talbot’s proposal to involve the fire marshal in emergency plan vetting, but was silent on Edmonds’ bill. 

The Senate committee on Tuesday also moved forward another piece of legislation, Senate Bill 33, that the nursing homes association supports.

It requires nursing homes to install generators that can power 50% of an existing facility’s air conditioning or heating system for 48 hours with fuel or electricity on site. The homes would also need contracts in place with a fuel or electricity provider to service the generator for at least 168 hours, under the legislation sponsored by Mills.

Mills’ bill would allow nursing homes until the mid-2023 to meet this mandate, but the health department would also have the option of waiving the generator requirement for a nursing home if local ordinances and the size of the home’s site didn’t allow it to be installed.

Mark Berger, executive director of the Nursing Home Association, told the Senate committee about 250 nursing homes already have generators that would meet the specifications of the bill. Approximately 25 nursing homes would need to purchase new equipment to comply with the legislation if it was approved.

Berger said he was too busy to answer questions Tuesday from the Louisiana Illuminator as he left the committee meeting with Hensgens. Two other association lobbyists, Lemmie Walker and Wes Hataway, also declined to comment after the committee hearing and said they weren’t authorized to speak with reporters.

No one from the Louisiana Nursing Home Association has responded to other interview requests over the past several weeks.

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