Collaborating to Bolster Emergency Preparedness and Response in New York City Nursing Homes New York City Healthcare Coalition Leadership Council February 18, 2016 Continuing Care Leadership Coalition Greater New York Health Care Facilities Association Southern New York Association

-Southern New York Association, Inc., (SNYA) founded in 1981, represents over 70 skilled nursing facilities, with approximately 16,000 residential health care facility beds (voluntary, proprietary, and government owned) that operate in the southern New York regional area. -A major focus of our organization is to provide information and consultation to our membership to enhance quality of care for residents, while assuring that members are prepared for policy and legislative changes that impact nursing homes. Who is Southern New York Association?

-SNYA provides continuing education for nursing home administrators and is a certified sponsor for the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB). -SNYA’s associated and partner companies include the New York Health Care Alliance (NYHCA) IPA, The Audacia Foundation, Inc. (a 501 (c)(3) educational and workforce development organization) and Southern New York Associates, LLC (multi-employer bargaining group) Who is Southern New York Association?

The Core Characteristics of Nursing Home Residents in New York State As of July 2010, there were 111,407 individuals residing in 632 Nursing Homes throughout New York State Credit: Leading Age New York : 2012

Short-Stay Patients and Long-Stay Residents, NYC vs. the Rest of NYS -Medicaid is the key payer in NHs (typically covering long stay) -Yet capacity for short-stay increasing, year-over year -Medicare increasingly prominent as a payer Credit: Medicaid Institute at United Hospital Fund

Nursing Home Discharge Destinations -Hospitals and nursing homes work in close partnership -Relationships are changing due to drivers including DSRIP, network development, etc. Credit: Medicaid Institute / United Hospital Fund

Age Composition of Residents in New York City Nursing Homes, vs. Statewide Numbers Credit: Medicaid Institute / United Hospital Fund -New York City nursing homes house a larger percentage of those under 65 than elsewhere statewide -Downstate expertise in special populations and harder-to serve

‒Greater New York Health Care Facilities Association (GNYHCFA) is a non for profit membership organization that provides support services to approximately 80 nursing homes and rehabilitation centers in New York City, Long Island, Westchester, Rockland County and upstate New York serving approximately 18,000 residents. ‒GNYHCFA provides members with on-site training programs for facility staff members, including a mock survey process in order to improve facility management, safety and quality improvement. Who is Greater New York Health Care Facilities Association?

‒GNYHCFA organizes and provides educational seminars for members covering topics relevant to the post-acute care setting and across care transitions, including clinical, regulatory and emergency preparedness. ‒The Association serves on multiple committees and initiatives which include NYSDOH, NYCDOHMH and NYS QIO, functioning as a liaison to disseminate information through memoranda and direct support to implement regulatory changes and evidenced-based clinical practices promoting quality care. Who is Greater New York Health Care Facilities Association?

Nursing Homes Offer a Variety of Key Services Nursing homes provide services across many patient types, with a growing focus on medically complex patients: Therapies (Physical Therapy, Occupational Therapy, Speech) Pharmacy Services Respite Care 24 Hour Care Dietary services Professionally directed programs of activities to meet the interests and needs for well being of each resident Personal hygiene items and service

Associations Together: Key Intermediary for Government and Providers Funded by annual commitment from Office of the Assistant Secretary for Preparedness and Response (U.S. Dept. of Health and Human Services), with support from the Centers for Disease Control and Prevention, and administered by DOHMH Focus on core preparedness competencies, training, and exercises among NYC nursing facilities Boost participation, troubleshoot, advise

Key Association Role: Curricular Implementation Three-Year curriculum to engage nursing homes in emergency preparedness and response LTC Emergency Management Program - Associations assisted in the engagement of 100 NHs to participate in the program, now in its 3rd year LTC Exercise Program - conducted first ever functional exercise with 14 NHs and 6 NYC hospitals (The Associations assisted with recruitment and worked in the SIM CELL at NYC EM) LTC Continuity Planning Program

Key Association Role: Curricular Implementation Growth of facility core competencies to weather emergencies and coordinate care in the healthcare continuum Networking with other facilities, blossoming into full-fledged drilling and exercise Serve on advisory board which meets quarterly, to develop the curriculum and refine it Attend trainings and provide on-the-ground support to facilities in real time Educational Webinars to instruct facilities on topics relevant to preparedness, such as upcoming session on proposed Federal Conditions of Participation for health care facilities

Key Association Role: Emergency Radio Communication Spotlight: 700 MHz radios: New York City Emergency Radio Communication Program (ECRP) expanded to include nursing homes in New York City, free of charge ERCP is operated by NYCEM, in partnership with DOHMH and NYSDOH Approx. 160 radios distributed across NYC NH facilities, in aftermath of storms such as Sandy and Irene Recognition that radios provide critical redundant communication and direct line to NYCEM  situational awareness Used in functional exercise

-Long term care affiliate of the Greater New York Hospital Association -CCLC’s members include the preponderance of the not-for-profit and public long term care providers in the New York metropolitan area - Member services include: Home health care, skilled nursing care, adult day health care, respite, hospice care, rehabilitation and sub-acute care, senior housing, assisted living, and special population competencies Who is Continuing Care leadership Coalition (CCLC)?

-Members are mission driven, offering hard-to-find specialty services -They possess flexible competencies in short- and long-stay care, 24-hour services -They hold cross-continuum representation (same organizations often deliver home and community based services, or work closely with other members that do) -Thousands of member days of care provided annually through facilities with hundreds of beds, as well as services throughout the community -Significant deployment experience: Sandy, Irene, and Jonas just recently Who is Continuing Care leadership Coalition (CCLC)?

Key Association Role: Annual Facility Conference Hosted conference in June 2015 highlighted by Pulitzer Prize winning author, Sheri Fink, with a focus on lessons learned from the tragedies of Hurricane Katrina – and continuing energies necessary for future response Hundreds of attendees in person and by Webinar for a full-day curriculum focused on inter-connectedness among City, State and Federal actors Key speakers from NYCEM, DOHMH, NYSDOH, and Federal HHS Speakers focused on prophylaxis tools in emergencies, mental health, and protections for direct care staff, among other key areas Conference partnership with 1199SEIU HealthCare Workers East Next conference slated for June 2016 Sheri Fink, M.D., Ph.D. Credit: Jen Dessinger

Key Association Role: e-FINDS Work closely with State DOH on the administration of electronic arm bands used to track whereabouts of individuals during evacuations from health care facilities Outgrowth of responses to Irene and Sandy Tracking bands used during decanting and developed to be compatible with flexible technology for use on smart phones and other devices Coordination with NYSDOH on training of facilities on eFINDS as a tool Utilized in drilling – and commitment by associations during current grant year to profuse knowledge about tool to additional facilities

Key Association Role: Deployment in Weather Emergencies Staffing of EOC at NYCEM during Winter Storm Jonas Issuance of situational knowledge to facilities Resolving of challenges with key City agencies: e.g., ensuring snow plowing on roads for accessing of health care facilities Key credit to City leadership for excluding health care workers from road ban

Key Association Role: Partnership with New York City agencies Other key association activities in coordination with Government New York City Member of ESF-8 Assisted in obtaining the demographic information to populate the of the Healthcare Facilities Directory Close coordination with NYCEM, NYCDOHMH, and other relevant City agencies (e.g., police, fire, sanitation as needed) Credit: New York City Emergency Management

Key Association Role: Partnership with State and Federal Governments New York State Close coordination with DOH Staffing of HEC and deployment during Sandy, Irene Federal Government GETS Cards and other education of membership

Questions? Continuing Care Leadership Coalition 555 West 57 th Street, 15 th Floor New York, NY (212) Greater New York Health Care Facilities Association 519 Eighth Avenue, 16 th Floor New York, NY (212) Southern New York Association 39 Broadway, Suite 1710 New York, NY (212)