On January 7, 2025, the Palisades and Eaton fires broke out in Los Angeles County. Over the next 24 days they burned more than 37,000 acres combined and destroyed more than 16,000 structures, according to CAL FIRE. Skilled Nursing News reported that at least 130,000 people were evacuated as the fires spread, including nursing home residents. Many residents of care facilities cannot walk, drive or leave without help.

Nursing homes and assisted living communities in California are required to have emergency plans, and those plans have to answer the same hard question: how will residents actually be moved? This guide covers what federal and California rules require on evacuation transportation, what the 2025 fires revealed, and practical steps for facilities and for families caring for someone at home.

What Happened to Care Facilities in the January 2025 Fires

The scale was significant. Skilled Nursing News reported on January 14, 2025 that more than 35 facilities had been evacuated, citing the California Department of Public Health and the California Department of Social Services. The Associated Press, citing the Department of Public Health, reported that around 850 patients and residents of nursing homes, assisted living facilities and group homes had been evacuated. Two skilled nursing facilities and an assisted living facility burned down, according to reports cited by Skilled Nursing News.

The AP's account of one assisted living community's evacuation shows how varied the transportation needs were: three residents were loaded into an ambulance, while others were put on buses to the Pasadena Convention Center.

The logistics were hard. A spokesperson for the California Association of Health Facilities told Skilled Nursing News that because the evacuations were so sudden, providers were limited to getting residents out of the building. Activating mutual aid agreements for transfers was not achievable, and many residents were taken directly to hospitals with no staging areas while they waited to be placed. Skilled Nursing News also reported that L.A. County's Emergency Medical Services Agency coordinates evacuations of most nursing homes and assisted living facilities, with support from local health officials and the state.

In November 2025, the Los Angeles Times reported that the California Department of Social Services had cited two assisted living facilities over their Eaton fire evacuations, and that both facilities had appealed the findings.

The lesson: A plan that assumes residents can be moved one at a time by the usual vendors on a normal schedule may not hold up when an entire area is evacuating at once. Transportation needs to be planned in detail, resident by resident, before fire season.

What Federal Rules Require

CMS's Emergency Preparedness rule applies to all 18 provider and supplier types that participate in Medicare and Medicaid. For long-term care facilities, the requirements are in 42 CFR 483.73. The facility's policies and procedures must address:

The communication plan must include contact information for entities providing services under arrangement, residents' physicians, other long-term care facilities and emergency preparedness officials, plus a method for sharing appropriate parts of the plan with residents and their families or representatives. Long-term care facilities must review the plan and provide training at least annually, and conduct exercises at least twice per year, including unannounced staff drills.

Hospitals have nearly identical evacuation language under 42 CFR 482.15, with plan reviews at least every two years. Dialysis facilities must teach patients where to go if the area must be evacuated and how to disconnect themselves from the dialysis machine in an emergency, and home health agencies must include an individual emergency plan for each patient.

What California Rules Require

Skilled nursing facilities

California's regulations for skilled nursing facilities (Title 22, section 72551) require a written external disaster and mass casualty plan that includes arrangements for transporting patients, procedures for emergency transfers to other health facilities "including arrangements for safe and efficient transportation and transfer information," a record of patient relocation, and an evacuation plan. They also require "a tag containing all pertinent personal and medical information" to accompany each patient who is moved, transferred, discharged or evacuated. Disaster drills are required at six-month intervals, and a related regulation (section 72553) requires fire and internal disaster drills at least quarterly for each shift.

Assisted living (residential care facilities for the elderly)

For residential care facilities for the elderly, California Health and Safety Code section 1569.695, strengthened by AB 3098 in 2018, requires an emergency and disaster plan that includes:

Facilities must train each staff member on the plan when hired and annually, conduct a drill at least quarterly for each shift, and review the plan annually.

Building the Transportation Piece of Your Plan

The rules say transportation must be in the plan. They do not tell you how many wheelchair vans, stretcher vans or ambulances you will need. That is the part worth working out now. From a medical transportation provider's point of view, these are the steps that matter most:

  1. Sort every resident by transport level. Who can ride a bus or car with assistance? Who needs a wheelchair-accessible vehicle? Who is bedbound and needs a stretcher? Who needs oxygen, monitoring or an ambulance? Our guide to stretcher versus wheelchair transport explains the differences. Update the list as residents change.
  2. Plan for the residents who take the most time. Bariatric residents, residents on oxygen and residents with memory care needs often require extra staff, equipment and time. See our guides to bariatric transport and oxygen and medical equipment during transport.
  3. List more than one transportation provider. In a regional emergency, every facility in the area may be calling the same companies. Know who you will call second and third.
  4. Pre-arrange receiving sites and confirm they can accept residents at each level of care, including at least one outside the immediate area.
  5. Prepare the paperwork to travel with each resident: the identification and medical information tag, medication list and contact information for the responsible party and physician.
  6. Track every move. Record which vehicle took which resident, and the name and location of where they went.
  7. Drill the transport part, not just the fire alarm. Using staff, volunteers or simulated residents (California's assisted living rules say drills must not require resident participation), practice how long it would take to bring bedbound residents to a staging point.

For Families Caring for Someone at Home

People who use wheelchairs, are bedbound, depend on oxygen or go to dialysis need their own plan. Official guidance offers a starting point:

If a family member will need a wheelchair van, stretcher van or ambulance to leave home, call a transport provider before fire season to ask how far in advance trips need to be booked and what information they will need. In an immediate threat to life, call 911.

How West Coast Ambulance Can Help

West Coast Ambulance provides wheelchair and stretcher transportation across Los Angeles, Orange and Kern Counties, and BLS ambulance and critical care transport in Los Angeles and Orange Counties. Facilities can set up an account through our For Facilities page, and our guide to setting up a medical transport account explains how. Our dispatch team answers 24/7/365 at 800-880-0556.

Frequently Asked Questions

Do nursing homes have to plan for evacuation transportation?

Yes. Under the CMS Emergency Preparedness rule (42 CFR 483.73), a long-term care facility's policies and procedures must address safe evacuation, including the care and treatment needs of evacuees, staff responsibilities, transportation, evacuation locations and communication with outside sources of assistance. California's skilled nursing facility regulations also require arrangements for transporting patients and procedures for emergency transfers to other health facilities.

What does California require of assisted living facilities in an evacuation?

California Health and Safety Code section 1569.695 requires residential care facilities for the elderly to have an emergency and disaster plan that covers transportation needs and evacuation procedures, a contact list that includes transportation providers, at least two shelter locations with one outside the immediate area, an evacuation chair at each stairwell, and keys available on each shift. Facilities must drill at least quarterly for each shift and review the plan annually.

How many care facilities evacuated during the January 2025 Los Angeles fires?

Skilled Nursing News reported on January 14, 2025 that more than 35 facilities had been evacuated, citing the California Department of Public Health and the California Department of Social Services. The Associated Press, citing the Department of Public Health, reported that around 850 patients and residents of nursing homes, assisted living facilities and group homes had been evacuated.

When should someone with a medical condition evacuate?

Follow instructions from local authorities and call 911 for an immediate threat to life. The Orange County Sheriff's Department advises that people with medical conditions, or who need more time to leave, should treat an Evacuation Warning as their signal to leave rather than waiting for an Evacuation Order.

How can dialysis patients prepare for a wildfire evacuation?

The CDC recommends keeping contact numbers for your regular dialysis center and another center nearby, at least a 3-day supply of each medicine, and following the 3-Day Emergency Diet if you cannot get to dialysis. The Kidney Community Emergency Response (KCER) hotline is 1-866-901-3773. Dialysis facilities are also required to teach patients where to go if the area must be evacuated.

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