Long-term care facilities house the most vulnerable population and during an emergency ensuring their wellbeing and continuity of care can be challenging. Emergencies can be large-scale such as flooding and earthquakes or isolated, such as water-main breaks. Regardless of the type of emergency, potable water is essential, not only for drinking, but for maintaining facility operations, such as food preparation, dialysis, and cleaning and sterilization. Lessons from Hurricane Katrina suggest that having enough supplies and equipment to operate for 72 hours may not be sufficient. So, what does this look like in long-term care facilities?
The Centers for Medicare and Medicaid Services (CMS) published an Emergency Preparedness Checklist for healthcare facilities. The checklist does not specify how to ensure water and for what amount, but rather explains that these vary with population and vulnerabilities. However, the Centers for Disease Control and Prevention (CDC) recommend healthcare facilities to develop an Emergency Water Supply Plan and provide the Emergency Water Supply Planning Guide for Hospitals and Health Care Facilities. This plan would be incorporated into the facility’s Emergency Operation Plan. In the Guide, the CDC highlights a case study involving a nursing home:
A 165-bed nursing home in Florida experienced a water supply interruption in 2004 because of Hurricane Ivan. As with most hurricanes, there were a few days to prepare before the hurricane made landfall. This facility stocked up on bottled water and other water containers and filled up every available container before landfall.
When the hurricane made landfall, the public water supply was interrupted because of a loss of power and the facility had to use the stocked water supply. As the loss of water service persisted through day one to day two, toilet flushing became a problem because each flush required a few gallons, rather than a few cups, of water, and the facility had shared bathrooms, thus preventing the option to wait longer between flushes.
As the loss of water service continued through day two to day three, facility staff went to the homes of staff who had swimming pools (which is relatively common in Florida) and filled up buckets and containers with pool water to bring back to the facility for toilet flushing. This effort was very labor-intensive (e.g. a gallon of water weighs more than 8 pounds) but it provided an adequate volume of water necessary for toilet flushing.
In this case study, the nursing home facility secured bottled water and water containers. While facilities general depend on bottled water and water containers to maintain limited operations, one would ask if this is really enough in terms of water supply planning. What the case study does not mention is the interruption effects beyond toilet flushing (e.g. food preparation, drinking water, patient care and hygiene, etc).
While bottled water can provide for limited drinking and operation capacities, it has its limitations. Facilities need space to store stockpiles of bottled water. If there is no warning for a water event, as in water-main breaks and severe storms, facilities may not have that stockpile to maintain operations and continuity of care. Bottled water can be rather expensive due to logistics if purchased for an emergency event. If each person had two gallons per day for 3 days of interrupted water supply, in a health care facility, this would amount to a large quantity. For a 165-bed facility, this would be close to 1,000 gallons. During an emergency, factoring logistic costs, bottled water can be around $10-$15/gallon and for 1000 gallons, this would cost the facility about $10,000-$15,000. Also, facilities need to consider handling the waste of empty water containers.
Are there alternatives in securing enough potable water in times of an emergency? Yes. There are some companies in the water industry that offer solutions for facilities to have in-house water purification systems. These purification systems can take any fresh water source, and through a multi-step filtration process, can provide enough potable water to sustain facility operations, including food preparation, consumption, dialysis, showering, laundry, etc. There are different technologies in the market that purifies water at point-of-use for public use and consumption. Typically they include carbon block, ultra-violet light, and/or chlorination. The equipment can be portable and uses less space than what would be needed for a stockpile of bottled water. For most cases, emergency water purification systems can be used for the entire duration of an emergency event.
An example of how this technology was used occurred in at a hospital in Georgia in 2007. A damaged 48” water main caused pressure to drop and water to a hospital to become undrinkable. As the three-day event unfolded, the facility contacted a water vendor and its Strike Team through the Georgia Emergency Management Association (GEMA). The vendor responded with an assortment of water purification equipment and deployed them at strategic ice machines in the emergency department, food service areas and post-mortem floors. They also installed equipment at beverage dispensers. Additional equipments were positioned at sterilizing and dishwashing equipment and other items necessary to maintain a normal surgery schedule. The hospital remained at a normal operating level throughout the entire event.
As with any healthcare facility, budget is always the concern. Depending on the vendor, there are options that factor the facility’s budget and size in determining what equipment is needed. Vendors may have grant options for facilities. Also, vendors can provide a deployment plan in which the equipment would be made available at the time of an emergency. And, the costs are often less than what could amount if the facility is trucking in bottled water. For facilities vulnerable to emergencies (i.e. flooding and storms), this may be a more cost-effective solution.
While there are resources available to help plan for emergencies, smaller facilities such as long-term care and nursing homes may not be equipped to sustain operations during a water emergency event. With improved technologies in water purification, facilities have the option to secure potable water at any given time.