1. Through the Eyes of the Surveyor

3.  There are gaps!  Emergency Preparedness is now a focus!

4.  2004/05 Hurricanes  2006 OIG report  94% emergency plans met Federal regulations  80% met training requirements  Reality:  Many lacked information recommended by experts  Were not followed during actual incidents  Lack of Emergency Management coordination

5.  2007 CMS publishes emergency preparedness checklists as “recommended tools “for Healthcare Facilities, State LTC Ombudsman, and State SA.

6.  transportation contracts were not always honored  evacuation travel took longer than expected  medication needs complicated travel  host facilities were unavailable or inadequately prepared

7.  facilities could not maintain adequate staff  food and water shortages occurred  prompt return of residents was difficult.

8.  CMS should consider strengthening Federal certification standards for nursing home emergency plans by including requirements for specific elements of emergency planning.

9.  210 facilities effected in 7 states with hurricanes, floods, and wildfires.  Review of 24 facilities whose residents were sheltered in place or evacuated. (2010)

10.  Floods 2009 Red River Flooding 7 facilities evacuated  Hurricanes 2008 (Gustav and Ike ) 92 facilities in Louisiana and 84 in Texas.

11.  Department of Health and Human Services OFFICE OF INSPECTOR GENERAL  ◦ GAPS CONTINUE TO EXIST IN NURSING HOME EMERGENCY PREPAREDNESS AND RESPONSE DURING DISASTERS: 2007–2010

12.  Inadequate staff training  Surveyors not trained to review nursing home emergency plans  Procedures for finding missing residents  Most administrators did not use CMS checklist (13/24 aware and 7/13 used it)

13.  Staffing backup plan  Resident care  Resident identification, information, tracking  Sheltering in Place  Evacuation  Communication and collaboration

14.  Staffing Tasks (during a disaster)  Did not ensure sufficient staffing levels for care  22/24 have backup for staff unable to report to work  Resident Care tasks  illness or death with evacuation  disaster counseling to residents  info on specific needs (oxygen, vents, feeding tubes) and characteristics (dementia)

15.  Resident Identification, information, and tracking  How to identify (wristband, tags)  What information must accompany resident  Identify next of kin/ power of attorney  Sheltering in Place  Amount of potable water  Extra medical supplies

16.  Evacuation  How to transport and protect medical records  Evacuation routes and alternates  Transport adequate food and water ◦ Communication and Collaboration  No plan to communicate with ombudsmen and authorities  Did not include collaboration with EM to develop plan or determine whether to evacuate or shelter in place

17. ◦ February 2012  Looked at 4 hurricane (Katrina, Rita, Gustav, and Ike) and 36,389 residents to compare SIP vs evacuation ◦ ◦ Conclusion  Evacuation significantly exacerbated subsequent morbidity/mortality.  Universal evacuation policies require reconsideration.

18.  Address safeguarding human resources, ensuring business continuity, and protecting physical resources.

20.  §483.75(m)(1) The facility must have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents.

21.  §483.75(m)(2) The facilities must train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.

22.  Subsistence (§ 483.73(b)(1))  Training and Testing (§ 483.73(d))  Generator Testing (§ 483.73(e))

23.  subsistence needs for staff and residents, whether they evacuate or shelter in place, including ◦ food, water, and medical supplies alternate sources of energy

24.  facilities must participate in or conduct a mock disaster drill and a tabletop exercise bi-annually.  facilities review their procedures with staff, conduct unannounced drills

25.  a minimum of 4 continuous hours at least once every 12 months

26.  Essentials needed to provide health care is available: ◦ safeguarding human resources ◦ ensuring business continuity ◦ and protecting physical resources.

27.  (1) risk assessment and planning ( All Hazards and HVA)  (2) policies and procedures (based on the emergency plan and risk assessment)

28.  (3) communication (develop and maintain an emergency preparedness plan)  (4) training and testing. (staff know and exercise the plan)

30.  Michigan Deficiencies in Emergency Planning 2009 -2010 *  Number of Nursing Homes Surveyed…431*  Total of Tags F517 and K48…86 (20%)…National Average 7.6%*  Total of Tags F518 and K50…164 (38.1%)…National Average 27.9%*

32.  Be Prepared! Practice  Know your plan!  Know your staff!  Know the CMS Survey!

35.  Emergency Management collaboration  Description of amounts and types of food supply  Extra pharmacy stock, medical supplies and equipment

36.  Planning for emergency financial needs and security  Transporting adequate food and water to relocation  Transported items with each resident

37.  Assure assistive devices are transported  Resident becomes ill or dies in route  Training for all transport vendors and volunteers  How will residents be identified and info secured

38.  Communication with LTC Ombudsman  Conducting exercises and drills  Loss of resident’s personal effects  Re-entry