Leadership Education

Learning from experiences in: NY State – 1 st Plan (began in 1983) 2001 Tropical Storm Alison (Houston) / Hurricanes Katrina / Rita Massachusetts Disasters (1 st New England State) May 2006 Flooding (Mother’s Day Storm) November 2006 Chemical Explosion (Danvers) 2008 Ice Storm in Central & Western MA

 Aug/Sept Tropical Storm Irene/Lee Flooding  Oct/Nov “Halloween Storm” - Snowstorm/ Power Failure  July 2012 – MA Nursing Home Generator Failure  Oct/Nov Superstorm Sandy  Jan 2013 Influenza Event – Boston & Hartford, CT Activations for Hospital Resident Decompression  Feb 2013 – Blizzard (NEMO)  Jan 2014 – Snowstorm

Plan Operation is 1 st within your town/city. Additional Support will come from your Region then other regions in a widespread disaster. ~500 LTC / 30 Hospitals / 4 LTACs or Rehab Hospitals 151 LTC 213 LTC / 11 Hospitals Regions 1, 3, 4 & 5

Identify needs and provide supplies/ equipment/pharmaceuticals as necessary Assist with transportation of supplies / staff / equipment / evacuated residents Provide staffing support (whether a facility is evacuating or isolated) Place and support the care of evacuated residents (continuity of care / surge locations)

Memorandum of Understanding (MOU) Sign it - Transfer Agreements with everyone If no MOU=No transfer agreement (per RIDOH, DHS & CMS) Who are we qualified to care for? (# and type) Surge Capacity – Accept 110% of licensed beds (not mandated; but a process to support others) Required Plan Forms for Use: Resident Emergency Evacuation Form Resident / MR / Staff / Equipment Tracking Sheet Influx of Residents Log Controlled Substance Receiving Log Mandatory Attendance at Annual Meeting Exercise Annually with the LTC-MAP

The MOU is a “voluntary agreement” among members By signing the (MOU) all facilities agree to their intent to abide by the terms in the event of a disaster. The terms are to be incorporated into the facility’s Emergency Management Plans and Emergency Operations Plans PUSH IS FOR A SUMMER OF 2014 MOU SIGNATURE AND RETURNED TO Alysia Mihalakos, Interim Chief of CEPR, Rhode Island Department of Health (RIDOH):

NO – Why? If you are impacted by the disaster, it could be more dangerous to move them to your location Infrastructure issue Staffing issue (and they can’t send staff) Example: Superstorm Sandy – NYC was looking to move 2,000 residents into CT. ONLY facilities that were on commercial power were considered.

Resident Accepting Facility (RAF) receives the resident: Do not admit (being reviewed with DHS) Under the care of the RAF Return the resident to the facility or origin after completion of the disaster Ethical standpoint – no marketing efforts to the residents and their families

Disaster Struck Facility Can the facility reopen within 30 days? IF YES – The resident is never discharged and they are “sheltered” at the RAF IF NO – The resident is discharged and permanent placement will be addressed Process of not admitting (“sheltering”) – enables surge to 110% of licensed beds to take place (waiver)  RIDOH & CMS will support this process

Disaster Struck Facility Paid by CMS (Medicare), DHS (Medicaid) or private pay RAF is paid by DSF at DSF rate If 100% of services provided by RAF, 100% of payment If staff, equipment and meds come from DSF, amicable division (incremental labor costs & consumables) If exceeding licensed beds, amicable division Mediation or Arbitration (called out in MOU)

What we need to have internally: Have an Incident Command System (Nursing Home Incident Command System – NHICS) Full Building Evacuation Plan Get residents to the sidewalk Influx of Residents (Census Reduction / Surge Capacity Plan) Resources & Assets for 96 hours Self-sustainability

Shelter-in-Place / Evacuating Disaster Struck Facility (when speaking with RIDOH and Local Emergency Manager or 911) Size-up the Situation Resource & Assets needs to stay operational Failure of infrastructure to remain in the facility Who – Your contact name and phone number Where – Facility Name, Address and Town/City What – What is the issue? When – Window of time the resources will be required in / How long until the evacuation must commence Why – Reason

Shelter-in-Place / Evacuating

NOTIFY: Call 911 / begin Internal Activation process ACTIVATE: RIDOH Duty Officer (CEPR) at to activate the LTC-MAP and Critical Partners through the alert notification system ACTIVATE: Emergency Reporting System (Could be done by RIDOH) PREPARE: Evacuation? Staffing? Equip? Supplies? PREPARE: Transportation Evacuation Tool - Complete (if evacuating) PREPARE: Generator Information - Update (if pre- storm/event)

Provides Department of Health, Fire, EMS and Emergency Management with strong knowledge of the resources needed to evacuate our facility (Ambulances, wheelchair vehicles and buses) Consider completing with monthly fire drills (each resident care area) On website for an automated tool

 Total Vehicles Owned by Members 160 Vehicles 1,266 Total seats 179 Residents in Wheelchairs Capacity: 1,445 Transportable Residents Supplies / Equipment: 11 Dump / Box Trucks & Pick-ups / Golf Cart / Gators

Pre-established Evacuation Sites Primary sites should be pre-selected using the LTC Patient Care Categories (next slide – from website) Address highest acuity residents first Who matches up best with our residents Address their surge numbers next Always assume they have no open beds How many of your residents can they accept at 110% surge Process to communicate with them Know where they are, their point person and contact information

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Resident Emergency Evacuation Form 1 per resident - info and acuity / mobility / risks Active Chart (or Current Service Plan for AL) Include MAR (Med List), Meds/Controlled Substances Wristband (name / DOB) Resident, MR, Staff & Equip Tracking Sheet List of residents; by facility they evacuated to Transportation vehicle info and time departed What (and whom) went with them Photo, if possible DNR Bracelets / Personal Belongings

Actions of Resident Accepting Facilities/Lenders Prepare to receive residents Open beds vs. Surge Area Complete Emergency Reporting Complete the Influx of Resident Log - residents arrive Confirm with DSF or LTC Group Responders that the residents are received – “CLOSE THE LOOP” Start a new chart for resident Notify RIDOH and your local AHJ about activating a Surge Plan (Influx / Surge Guidelines) If Lender: Prepare to provide Resources/Assets

What happens at 2:00 AM? Anyone who might answer the phone: Basic knowledge that RI LTC-MAP exists (there is a plan) Get the name of the person calling, facility, contact number and issue or request OR – Listen to the automated message and take down directions for what it tells you to do Inform the Nursing Supervisor ASAP Nursing Supervisor – Scope will determine actions Immediate analysis of open beds – M / F / Either Activate internal emergency notification tree Complete Emergency Reporting- Evacuation? Prepare to receiving incoming residents Resource & Asset Request: Prepare to provide staff, equipment, supplies or transportation

Influx of Residents / Surge Plan Algorithm

Know your generator information in advance of an emergency

Internal Situation-Status Report & Emergency Reporting: What You Should Know (and WHY) Operational Issues at your facility (other plan members) Open Beds Available Transportation for Resident Transportation Movement of Supplies and Equipment Resources & Assets (needed) Resources & Assets (you could provide) Equipment Supplies Staffing HANDOUT

RIDOH Department Operations Center (LTC Group Responders)

Function of the LTC Group Responders “Air Traffic Control” Staffed by RIDOH & volunteers from the LTC-MAP Assist with resident placement Support resident tracking - “Close the loop” Assist with obtaining staff, supplies and equipment Assist with transportation of residents, staff, supplies and equipment Support interaction with local and state agencies ENSURE ALL MEMBERS ARE ACCOUNTED FOR

David Hood Scott Aronson Department of Health Center for Emergency Preparedness & Response Alysia Mihalakos Joseph Reppucci Russell Phillips & Associates Jim Garrow Scott Aronson Lori Cheever Darren Osleger