Being Prepared in the Eye of the Storm: Disaster Response 101 Mary T. Henderson Associate Commissioner Texas Long-Term Care Regulatory Services

Learning Objectives: Ensuring your state is ready when disaster hits Successful partner engagement Triaging the Unexpected Lessons learned in the aftermath 12/5/2019

Are you ready when disaster hits? Harvey Impact Timeline

Forecast Advisory – 1000 08/23/17 (Wednesday)

Forecast Advisory – 0700 08/24/17 (Thursday)

Forecast Advisory – 2200 08/25/17 (Friday)

Rainfall by 0800 Saturday 08/26/17

Rainfall by 0700 Monday 08/28/17

Rainfall by 0700 Wednesday 08/30/17

La Vita Bella (Assisted Living Facility), Dickinson, Texas (31 miles southeast of Houston)

Is your state ready? (A hurricane doesn’t care if your agency is transforming) Advance Communication Internal Call down lists are current and tested; staff shelter in place/evacuation plans are communicated Know your state agency emergency contacts, and state emergency management contacts See: http://www.dps.texas.gov/dem/stateLocalorganization.htm Participate in training and exercises throughout the year; Review state situation report and FEMA briefing Determine who will be staffing your state operations center (SOC) and stay in contact External By June 1, alert is sent to providers to remind of hurricane season and emergency preparedness responsibilities Notify every licensed residential facility (SNF/NF, ALF, ICF, PPECC, and In-Patient hospice) and ask their plans (if hurricane is forecast to hit their area) Remind providers if they evacuate, they must advise us when and where they are going If mandatory evacuation order in place, provider refuses to evacuate, I've notified local law enforcement and they enforce the order or monitor 12/5/2019

Successful Partner Engagement Have designated liaison with state operations center (SOC) (In Texas, Director of Survey Operations) On call 24/7 to match hours the SOC is operational until they stand down Daily calls with internal/external stakeholders to relay latest weather news, where there are issues, challenges providers are experiencing, etc. Set up a webpage visible/accessible to providers and remind them that is where they can find specific information State media services available 24/7 to post latest information (EX: contact person for the 1135 waiver requests) Partner with trade organizations, quality monitoring program, and ombudsman to ensure communication on policies, issues, etc. 12/5/2019

Successful Partner Engagement (continued) Monitor locations where LTC residents have moved; sometimes daily onsite monitoring is involved If sheltered in place, daily calls to ensure sufficient staff and supplies (food, medication, generator fuel) Call each HHA and hospice agency to ensure operations and consumer continuity of care Respond to inquiries from public media, legislators, Governor’s office, CMS, etc. Coordinate calls from family members trying to locate loved ones; encourage registration with American Red Cross’ Safe and Well program Assist shelters that call with high medical needs individuals who may need NF placement; we assess the individual and coordinate with local NFs 12/5/2019

Triaging the unexpected New leadership in your agency Mandatory evacuation order vs. Non- mandatory The need for Governor’s approval to waive licensing rules/statutes; obtaining CMS waivers Facilities can never do too many recounts (resident left bus and hid in closet) 214 providers evacuated (NF, ALF, ICF, HHA) Total # of residents/individuals evacuated: 5447 Total # of facilities still closed: 22 Facilities refusing mandatory evacuation, but ultimately requiring evacuation/rescue 12/5/2019

Lessons Learned in the Aftermath Have a list of current staff and contact information of all stakeholders to ensure consistent, prompt communication Know what the expectation is for communication between area/agencies; develop a communication plan agency-wide Have standardized rule waivers in place pre-approved by the Governor’s office Complaint investigations must be thoroughly reviewed and evaluated Need for more specific emergency management plans and requirements in rule for assisted living facilities Implement more specific regulations for assisted living facilities related to content of emergency plans and require mandatory compliance with emergency evacuation orders Expect the unexpected…Always “Facts” are not always true (social media) 12/5/2019

Lessons Learned in the Aftermath (continued) https://www.strongtowns.org/journal/2017/8/30/houston-hurricane-harvey-land-use https://www.washingtonpost.com/news/capital-weather-gang/wp/2017/08/30/harvey-has-unloaded-24-5-trillion-gallons-of-water-on-texas-and-louisiana/?utm_term=.3f8ff897ef9b https://hhsconnection.hhs.texas.gov/news-announcements/hhs-news/2018/09/05/commentary-reaching-wrong-conclusions-after-hurricane-harvey Houston wasn’t flooded because of its land use planning. Harvey unloaded 33 trillion gallons of water in the U.S. La Vita Bella Left Adrift Report Commentary: reaching the wrong conclusions after Hurricane Harvey HHSC Regulatory Request for Suspension of Rules Under Disaster Declaration 12/5/2019

THANK YOU! Questions? Contact information: Mary T. Henderson Associate Commissioner Long Term Care Regulatory Services Mary.Henderson@hhsc.state.tx.us O: (512) 438-2635 C: (512) 845-6835 12/5/2019