Linking LTC to Public Health for Disaster Planning

In a recent study, authors Michael Wasserman and R Tamara Konetzka^[1] advocated for the integration of public health services for long-term care (LTC) facility residents in order to prevent the next disaster—whether that includes the next communicable disease or the next natural disaster. The authors identified recent hurricanes and COVID-19 as examples of inappropriate responses to these emergencies, as well as proactive facility leadership.

It has generally been the case that LTC is dependent upon state departments of health to provide guidance and regulations regarding infection control and disaster planning rather than local departments of health. Perhaps COVID-19 has elevated the profile of the LTC facility in the eyes of public health; however, the exact mechanisms of how the facilities can utilize the expertise of public health services remains unclear. 

Several years ago, I taught a masters level course in public health and aging which examined housing, transportation, sidewalks, preventive care, firearms, drugs, tobacco, and a host of issues commonly seen in geriatric patients. A prestigious school of public health initially was interested in the course as not one of their courses or lectures focused on issues associated with aging. When I offered to give them the course syllabus and materials, it had been decided that there was not enough interest in aging to expand the coursework directly to this population. Not for a course. Not even for a lecture. 

There are many opportunities to link community aging as well as institutional aging to public health concepts, however there must be a willingness by both entities. A collaborative approach is necessary to address the needs of older adults. 

LTC has not been integrated into the Federal Emergency Management Agency (FEMA). The guidance offered by FEMA, “Public Health and Medical Services^[2] does not provide specific directives for institutions, therefore additional efforts need to be made to include aging service and LTC providers. These initiatives as well as support need to be integrated before the next disaster.”

Reference:
1. Wasserman, M, Konetzka, TR.  Beyond compliance: a more integrated public health approach to outbreaks in nursing homes and other disasters. Health Aff. 2022;41(6):831-837. doi:10.1377/hlthaff.2021.01839
2. Federal Emergency Management Agency. Emergency support function #8-public health and medical services annex. Washington, DC: FEMA; 2016 June. https://www.ready.gov/business/implementation/emergency