For immediate release
Tuesday, Aug 29, 2006
12:01 a.m. EDT


Christopher Fleming

Hurricane Katrina Underscored The Need To Revamp The New Orleans Health Care System, Say Kaiser Authors In Health Affairs

University of South Florida Author Stresses Importance
Of Including Long-Term Care Facilities In Emergency Planning

Bethesda, MD -- Hurricane Katrina devastated New Orleans’ health care system, but it also provided an opportunity to address the serious flaws that plagued health care in New Orleans before the storm struck, researchers at the Kaiser Commission on Medicaid and the Uninsured say in a paper published today on the Health Affairs Web site. The paper also provides an in-depth overview of the effects of Katrina on New Orleans, the federal and state response to the storm, and the current state of health care in the city.

“New Orleans traditionally relied on a hospital-centric structure, anchored by the Louisiana State University system’s overworked and underfunded Charity Hospital, to care for its large numbers of uninsured residents,” said lead author Robin Rudowitz, a principal policy analyst at Kaiser. “Moving forward, expanding health coverage and providing better access to neighborhood-based primary care will help improve access to care in the battered city.”
As the nation marks the first anniversary of Hurricane Katrina, Health Affairs is publishing two new papers on its Web site that focus on the lessons to be learned from Katrina and its aftermath. In the second Health Affairs paper, Kathryn Hyer and coauthors report on insights from a multistate gathering that examined ways to improve outcomes in hurricanes and other emergencies for the frailest of older adults: those living in long-term care (LTC) facilities such as nursing homes and assisted living facilities.

“LTC facilities have been the neglected stepchild in our emergency planning system,” Hyer said. “These facilities provide essential health care to the nation’s most vulnerable citizens, but those responsible for dealing with health care and medical services during emergencies have not recognized this. In turn, LTC administrators are unfamiliar with the emergency planning process.”

Rudowitz And Coauthors Advocate Moving From Hospital-Centric
To Patient-Centric Health Care Financing In New Orleans

Going into the 2005 hurricane season, “low rates of private coverage, high rates of poverty, and limited public assistance through Medicaid for adults left Louisiana . . . with more than one in five, or almost 900,000 residents, without health insurance,” say Rudowitz and her coauthors, Diane Rowland, the executive director of the Kaiser Commission, and Adele Shartzer, a policy analyst with the commission. The state “essentially had a ‘two-tier’ health system, in which the insured population (including those with Medicare and Medicaid) had access to a range of community hospitals and physicians, while the poor and uninsured were mostly cared for through the state-run safety-net system of public hospitals.”

To a much greater extent than is the case for similar institutions in other states, Louisiana’s safety-net hospitals were financed by heavy doses of Medicaid disproportionate-share hospital (DSH) funding, designed to compensate hospitals that treat large numbers of uninsured and indigent patients: In 2004, about 20 percent of Louisiana’s Medicaid spending was DSH money, while nationally DSH accounts for only about 6 percent of Medicaid spending.

“Most of these DSH dollars were channeled to the LSU system to finance care for the uninsured. Louisiana’s use of Medicaid DSH funds in this way created a dependence on institutional hospital care for the poor, rather than outpatient or ambulatory care settings, because states generate DSH dollars through inpatient use,” Rudowitz and her colleagues observe. Pre-Katrina, there were only two federally qualified health centers (FQHCs) in the New Orleans area, and the lack of adequate access to neighborhood-based primary care around New Orleans and in the rest of Louisiana was evidenced in the state’s perennially high levels of hospital emergency department use.

Rudowitz and coauthors suggest transforming this institutionally oriented financing arrangement into a more patient-oriented system: “If DSH funds are reallocated and health coverage for the uninsured is expanded via Medicaid, health care financing dollars will follow the patients to the providers who are ready and able to serve them,” the Kaiser team states. “Expanding public coverage through Medicaid for the predominantly poor and uninsured populations that relied on Charity Hospital for their health care would allow the state to draw down a federal matching rate of 70 percent to help finance coverage and provide financing to support the development of more community-based providers,” Rudowitz and coauthors say. The Kaiser paper notes that Louisiana had already made “much progress” before the hurricanes by raising Medicaid income eligibility for children to 200 percent of poverty. “Maintaining Medicaid coverage for children, raising eligibility levels for parents to match the levels for children . . ., and obtaining waiver authority to cover poor adults without dependent children would provide coverage for a majority of the working poor,” say Rudowitz and coauthors.

Nursing Home Deaths In Katrina Showed Peril Of Leaving
LTC Facilities Out Of Planning Process, Hyer And Coauthors Say

In their paper, Hyer and her colleagues emphasize the importance of making the LTC community a full partner in the emergency planning process. “The deaths of thirty-four residents believed to have drowned in St. Rita’s Nursing Home in Louisiana and an estimated thirty-six additional deaths in twelve more nursing homes during or in the days after Hurricane Katrina underscored the terrible consequences of insufficient preparation and inadequate response to hurricanes,” write Hyer, USF colleague Lisa Brown, Amy Berman of the John A. Hartford Foundation, and LuMarie Polivka-West of the Florida Health Care Association.

Homeland Security’s National Response Plan mandates that state and county response plans be organized around fifteen Emergency Support Functions (ESFs). ESF-8, “Health and Medical Services,” is responsible for “public health and medical services,” but “few ESF-8s consider LTC facilities to be medical facilities. Because LTC facilities are not recognized as being essential, restoration of public utility services to them is not a high priority.”

To remedy this situation, “state and local ESF-8s must include LTC representatives in . . . all phases of emergency management,” say Hyer and coauthors. Florida has already integrated LTC representatives into the state-level planning process and is working toward doing the same at the county level. During the 2004 hurricane season, before Florida gave the LTC community a seat at the planning table, “LTC facilities initially were given the same priorities as day spas for restoration of electricity, telephones, water, and other basic services.”

Hyer’s paper is based on the findings of a February 2006 “Hurricane Summit” that was sponsored by the Florida Health Care Association and funded by the John A. Hartford Foundation, American Health Care Association, and AARP. Attended by representatives from the federal government, the LTC communities in six states, USF, and others, the summit was designed to “identify disaster preparedness issues and best practices” concerning LTC facilities, and to offer Florida’s reforms “as a model for disaster preparedness.”

Other priorities identified by summit participants included the following:

-- establishing decision-making criteria and guidelines for LTC facility resident evacuation;
-- developing effective communication systems for LTC facilities;
-- establishing resident tracking and case management systems for LTC facilities; and
-- developing and refining disaster preparedness guides.

You can read the article by Rudowitz and coauthors at

You can read the article by Hyer and coauthors at


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at


©2006 Project HOPE–The People-to-People Health Foundation, Inc.