1. DISASTER PREPAREDNESS Is It Necessary?

2. Federal Regulations Standard Survey The standard survey incorporates two assessments of emergency preparedness to include: O Emergency Planning O Emergency Training

3. Emergency Planning Surveyors are instructed to review emergency plans of a facility to determine: O Emergency plan includes procedures to deal with all potential emergencies such as fires, severe weather, and missing residents O If the surveyor finds the emergency plan to be deficient, they can cite deficiency tag F- 517

4. Emergency Training O Surveyors are instructed to interview the Charge Nurse and two nursing home staff members (e.g. nurse aide, housekeeper, maintenance worker) about the facility the facility emergency plan O If staff members are unable to annunciate roles and responsibilities of the emergency plan, surveyor can cite deficiency tag F-518

5. Federal Regulations Life Safety Code Survey The Life Safety Code Survey requires facilities to comply with a set of fire protection provisions designed to provide safety from fire, smoke and panic to include: O Written plan for the protection and evacuation of all residents in an emergency O Facility Fire Drills

6. Emergency Planning and Training O If a surveyor determines that emergency fire plans are deficient, they can cite the facility with a deficiency of Tag K-48 O If surveyor determines that fire drill records or staff responses to roles and responsibilities are insufficient, surveyor can cite deficiency of Tag K-50

7. CMS Emergency Preparedness Checklist In 2007, CMS published an emergency preparedness checklist as a “recommended tool” for health care facilities O Checklist includes 70 tasks, which are grouped into 23 task categories O Implementing these tasks assists a facility in developing a comprehensive emergency plan designed to respond to any disaster O http://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/Downloads/SandC_EPCheckli st_Provider.pdf

8. Office Of Inspector General Report O Office of Inspector General released report in April 20102 (OEI-06-09-00270) O Gaps Continue to Exist In Nursing Home Emergency Preparedness And Response During Disasters: 2007-2010 O The report identifies implementation gaps in Emergency Preparedness Checklists for facilities, State Agencies and State LTC Ombudsman Program O https://oig.hhs.gov/oei/reports/oei-06-09- 00270.asphttps://oig.hhs.gov/oei/reports/oei-06-09- 00270.asp

9. Develop Emergency Plan Gather all relevant information to include: O State and local emergency planning requirements O Facility personnel names and contact information O Facility organization chart O Building construction and Life Safety Systems information O Information regarding characteristics and needs of the individuals for whom care is provided

10. All Hazards Continuity of Operations (COOP) Plan O Develop a continuity of operations business plan using an all-hazards approach that could potentially affect the facility directly or indirectly O Indirect hazards could affect the community but not the facility resulting in an interruption of utilities, supplies or personnel.

11. Collaboration O Collaborate with local emergency management agencies to make certain they are included in the development of a comprehensive and effective emergency plan

12. Analyze Each Hazard O Analyze the specific vulnerability of the facility and determine actions for each identified hazard to include: O Actions to be taken for each identified hazard O Key staff responsible for implementing the plan O Staffing requirements and defined staff responsibilities

13. Analyze Each Hazard Continued O Identification and maintenance of sufficient supplies and equipment to sustain operations and delivery of care and services for 3-10 days based on the facility’s assessment of their hazard vulnerabilities O Communication procedures to include warnings/alerts and for communication with staff, family members, residents receiving care before, during and after the emergency O Designate critical staff and how you will meet staff needs such as transportation and shelter to include critical staff member’s family

14. Collaborate with Suppliers/Providers O Collaborate with suppliers and/or providers who have been identified as essential for continuity of care and services to residents to include pharmacy, physician services, oxygen provider, durable medical supply provider, hospice providers, restoration company, licensed contractor, fire suppression and equipment company, etc.

15. Decision Criteria for Executing Plan O Establish protocols and factors to follow when deciding to evacuate or shelter in place O Determine who at the facility level has authority to make the decision to execute the plan to evacuate or shelter in place O Identify the chain of command

16. Communication Infrastructure Contingency O Establish a contingency plan for the facility communication infrastructure in the event of telephones to include: O Walkie-talkies O Ham radios O Text messaging systems

17. Develop Shelter-In-Place Plan Due to the high risk in transporting frail, vulnerable residents, evacuation should only take place if sheltering in place poses a greater risk. A Shelter- In-Place Plan should include: O Procedures to assess whether the facility is able to withstand strong winds, flooding, etc. O Measures to secure the building against damage O Procedures for collaborating with local emergency management agency, police, fire and EMS agencies regarding the decision to shelter-in-place

18. Shelter-In-Place Plan Continued Sufficient resources are in supply for at least seven days to include: O Emergency power (back-up generator, fuel) O Adequate supply of potable water O Description of amounts and types of food in supply O Maintaining extra pharmacy stocks of common medications O Maintaining extra medical supplies and equipment (oxygen, linens, vital equipment)

19. Shelter-In-Place Plan Continued O Identify and assign staff who are responsible for each task O Description of hosting procedures to include details to ensure 24-hour operations for a minimum of 7 days O Contract with vendors for supplies and transportation O Develop a plan for addressing emergency financial needs and providing security

20. Develop Evacuation Plan O Development of evacuation plan to include: O Identify person(s) responsible for implementing the facility evacuation plan (even if no order is given) O Plan for multiple pre-determined evacuation locations (contract or agreement) with a “like” facility with at least one location being 50 files away O Identify evacuation routes and alternative routes O Develop procedures for protecting and transporting resident medical records

21. Develop Evacuation Plan Continued O Describe logistics to transport medications, including ensuring their protection O Identify how residents, family members and staff will be notified of evacuation and communication methods that will be used during and after the evacuation O Identify staff responsibilities and how staff will be cared for during and after the evacuation O Develop back up plan for staffing

22. Develop Evacuation Plan Continued O Develop procedures to make certain that resident equipment (wheelchairs, other assistive devices), are transported so their equipment will be protected and personal needs met during transport O Develop procedures to transport other critical supplies and equipment O Develop procedures to make certain staff accompany evacuating residents O Develop procedures to respond if resident becomes ill or dies in route

23. Transportation And Other Vendors O Establish transportation arrangements that are adequate for the type of resident being served O Obtain assurances from transportation vendors and other suppliers/contractors identified in the emergency plan that they have ability to fulfill their commitments in the case of disaster affecting the entire area

24. Facility Reentry Plan O Describe who will authorize reentry to the facility an evacuation O Describe the procedures for inspecting the facility O Describe how it will be determined when it is safe to return to the facility after an evacuation O Address the process to plan return travel back to facility

25. Residents And Family Members O Determine how residents and their families/guardians will be informed of the evacuation to include information on where they are going, for how long and how they can contact one another

26. Resident Identification O Determine how residents will be identified to include: O Name O Social Security number O Photograph O Date of birth O Diagnosis O Current medications O Diet O Name and contact information for responsible party

27. Resident Identification Continued O Determine how resident information will be secured during transport O Determine how medical records and medications will be transported so they can be matched with the resident to whom they belong

28. Staff Training O Make certain that facility staff on each shift is trained to be knowledgeable and follow the emergency plan O Conduct periodic reviews and appropriate drills and other demonstrations with sufficient frequency to ensure new staff members are fully trained

29. Informed Residents and Patients Make certain that residents and responsible parties are aware of and knowledgeable about the emergency plan including: O Responsible Party is informed on how and when they will be notified and when they will be notified about evacuation plans O Responsible Party is informed on how they can be helpful in an emergency situation O Responsible Party is informed on how/where they can plan to meet up with their loved one

30. Location of Evacuated Residents O Determine the location of evacuated residents O Document and report this information to the clearing house established by the state or partnering agency

31. Review Emergency Plan O Complete an internal review of the facility plan on an annual basis to make certain the plan reflects the most accurate and up-to-date information O Updates may be necessary to reflect: o Regulatory changes o New hazards are identified or existing hazards change o After tests, drills when problems are identified o After actual disasters/emergency responses o Infrastructure changes o Funding or budget-level changes

32. Insurance O Business Continuity/Interruption Insurance O Do you have any? Do you know what it is? O Do you know what it covers? O Review annually with Agent O Notify Agent of Event IMMEDIATELY! Define and Track (Negotiate with Insurance): O Lost Revenue O Room and Board Expenses of Alt Location O Evacuation Expenses O PVt Pay vs Govt Funded O Shared Labor Costs O Going Concern Labor Costs O Damages/Re-entry prep

33. Other Resources All Hazards Emergency Management Template, Long Term Care/Skilled Nursing, New Mexico Health Care Association