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Is your loved one's nursing home prepared for an emergency?

Hurricane Irma slammed into South Florida on Sept. 14. The next day, eight residents of the Rehabilitation Center of Hollywood Hills died. The facility did not seek evacuation even though the air conditioning was knocked out by the storm, and some elderly and disabled people are medically sensitive to heat.

The investigation into what happened at the Florida facility is ongoing. Unfortunately, you don't have to be in the path of a hurricane to need emergency preparedness. Skilled nursing facilities across the country are required to have emergency plans in case they need to evacuate, and the emergency could just as easily be an ordinary power outage, heat wave or fire.

Just how well are nursing facilities prepared for such contingencies? Not as well as you might hope, according to a review of federal inspection records reported by Kaiser Health News.

The federal government requires care facilities to submit disaster plans -- a requirement put in place after deaths at hospitals and nursing homes during Hurricane Katrina.

Advocates for the elderly and people with disabilities worry that the disaster plan requirement is only half of what is needed. The other half is effective enforcement.

"If you have not implemented and exercised plans, they are paper tigers," said the former director of the federal healthcare emergency preparedness program.

There is an inspection program and serious deficiencies have been identified in some cases. For example, one El Paso nursing home failed to plan for how to get people in wheelchairs downstairs during an evacuation. At one Colorado nursing home, the courtyard gate was locked and workers didn't know the combination.

Over the past four years, however, although inspectors issued 2,300 emergency planning rules violations, only 20 were designated as serious enough to put residents in danger.

A third of American nursing homes were cited for failure to routinely inspect and test their emergency generators. These violations were not considered major deficiencies -- even at the 1,373 facilities that were cited more than once.

"That's the essential problem with the regulatory system: It misses many issues, and even when it identifies them, it doesn't treat them seriously enough," said a spokesperson for the Center for Medicare Advocacy. "It's always the same story: We have some pretty good standards and we don't enforce them."

On the other hand, a spokesperson for the American Health Care Association, a nursing home industry group says that in practice, most evacuations go smoothly.

"After each one of these emergencies we've learned and gotten better," he said.

That may be true, but failure to have an appropriate emergency plan in place could be considered malpractice by the facility. In the South Florida case, a criminal investigation is underway.