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The Florida Health Care Association is committed to bringing long term care emergency management planning to the forefront of our profession by aiding nursing homes in the development of effective emergency management plans which are comprehensive and aligned with state and local governments. FHCA’s Education and Development Foundation has partnered with the John A. Hartford Foundation, the University of South Florida, the Florida Department of Health and the American Health Care Association in the development of tools to support the emergency response system nationally, at the state and local levels, and at the nursing home.
The design components have been aligned with the comprehensive emergency management requirements of the federal Department of Homeland Security, the Centers for Medicare and Medicaid Services, the Center for Disease Control and the Florida Agency for Health Care Administration. The intent is for nursing homes’ emergency management plans to describe who will do what, when, and with what resources before, during, and after an emergency.
This guide provides nursing home administrators, corporate representatives, owners, and key emergency management staff with information on a national concept for developing risk-based, all-hazard plans.
This guide provides an established format for developing a basic plan, offers direction for developing standard operating procedures for use during an emergency, and addresses specific hazards which may threaten a nursing home.
FHCA welcomes recommendations on how this guide may be improved to better serve the nursing home community and the residents they protect and serve. Comments should be directed to: FHCA, Attn: Emergency Management Guide.
About this Document
This guide is meant to assist nursing home administrators, corporate representatives, owners, and staff in their efforts to develop and maintain a practical all-hazard emergency operations plan. This guide is a collection of ideas and advice, not a sample emergency operations plan. Each nursing home’s emergency operations plan must indicate what that nursing home will do to protect itself from its hazards with the resources it has or can obtain.
This guide is intended primarily for use by nursing home staff responsible for emergency operations plan development and maintenance. It creates no requirements for any nursing home, and its recommendations may be used, adapted, or disregarded, based on a particular facility’s own policies and state law.
This guide is new. It replaces the 2005 Florida Health Care Association – American Health Care Association Disaster Planning Guide.
This guide is issued by the Florida Health Care Association in partnership with the University of South Florida and the Florida Department of Health’s Office of Emergency Operations. Funding for the guide’s development came through the John A. Hartford Foundation and the FHCA. The planning format is based on the Federal Emergency Management Agency in their Guide for All-Hazards Emergency Operations Planning to be used by jurisdictions at the state and local level. Further, the components set forth in this guide satisfy the basic emergency management requirements of 400, Part II, Florida Statutes, s. 59A-4.126, Florida Administrative Code, as well as the new national recommendations of the Centers for Medicare and Medicaid Services. Nursing homes may use this guide to supplement guidance they receive from their states.
Overview of Contents
Part I of the guide explains what a comprehensive emergency management plan is and details the recommended organization of an all-hazard basic plan. It describes plan components and employs sample statements to clarify meaning.
Part II of the guide provides highly specialized tips and procedures developed by providers through lessons learned and is organized in an appendix format. These appendices are intended to help with the creation of policies and procedures.
Part III of the guide highlights and describes incident-specific hazards. The incident-specific hazard appendices extend beyond the all-hazards tone of the basic plan explained in Part I and address special response procedures, notifications, protective actions, and other needs which may be generated by a specific hazard. The incident-specific hazard appendices supplement a facility’s basic plan and standard operating procedures.
Part IV of the guide introduces the Nursing Home Incident Command System. The Incident Command System concentrates direction and control actions on field operations for staff who are responding to the scene of an emergency. This part of the guide demonstrates why and how the Incident Command System may be adopted for use by nursing homes in the creation of their emergency plan.
Part V of the guide offers a description of and a process for creating emergency preparedness training and exercises that are based on the specific standards given by the National Incident Management System.
Part VI of the guide is a compilation the federal regulations and interpretive guidelines which are used to conduct inspections of nursing homes to determine compliance with 42CFR 483, Subpart B – Requirements for Long Term Care Facilities.
The guide has to reflect the 2004-2005 hurricane seasons and the lessons learned in order to be relevant. The effected Gulf Coast states convened a 2006 summit where nursing home providers connected with each other to “blow up” the experience and examine the actions that were effective and the ones that were not. Nursing homes across the region committed to a more connected relationship with local and state emergency managers and to share best practices and this guide reflects that intent. In 2006, the grant, Hurricane and Disaster Preparedness for Long-Term Care Facilities, was awarded to the Florida Health Care Education and Development Foundation by the John A. Hartford Foundation to develop emergency preparedness tools, such as the Comprehensive Emergency Management Software Application for Nursing Homes, the National Criteria for Evacuation Decision-Making in Nursing Homes, and this guide, the Emergency Management Guide for Nursing Homes.
Part I The Basic Plan
Defining a Comprehensive Emergency Management Plan vii
Executive Summary x
Plan Review and Maintenance x
Authorities and References xi
Risk Assessment xv
Zones and Local Points of Interest xviii
Vulnerability Assessment for Residents xix
Planning Assumptions xxiv
Concept of Operations xxv
Alert, Notification, and Activation xxv
Command and Coordination xxxi
Command Structure xxxi
Sheltering in Place lii
Host Receiving Site lx
Training and Exercises lxii
Appendix A: Emergency Staffing 67
Appendix B: Emergency Communication Needs 70
Appendix C: Resident Care Services by Vulnerability Assessment 74
Appendix D: Vendor Support Communication Chart 82
Appendix E: Routine Mail Processing 85
Appendix F: Life Safety and Environmental Evaluation 87
Appendix G: Incident Command Post Sample Planning Meeting Agenda 94
Appendix H: All Hazards Staff Response to Emergency 95
Appendix I: A Staged Implementation of a Resident Identification System 96
Appendix J: Insured’s Guide to Hurricane and other Catastrophic Claims 98
Appendix K: Resident Survival Kits 105
Appendix L: Staff Survival Kits 106
Appendix M: Pet Policies 108
Appendix N: Employee Staffing Letter and Form 110
Appendix O: Re-entry to Area Letters or Vehicle Display Passes 112
Appendix P: Generators and Utilities 114
Appendix Q: Sample Letter to Families, Guardians, or Responsible Parties 120
Appendix R: Website References 121
Appendix S: Glossary of Common Terms and Acronyms 123
Appendix T: Business Continuity
Appendix U: Supplies, Quantities 138
Appendix V: Timeline for Disaster Preparedness Activities 139
Appendix W: Housekeeping Tips 140
Appendix X: Dietary Department Tips 141
Appendix Y: Nursing Department Tips 143
Appendix Z: Guidance for the Safe Transportation of Oxygen 146
Appendix AA: Emergency Resident Handling 148
Appendix BB: National Criteria for Evacuation Decision-Making in Nursing Homes 152
Key Considerations 159
Incident Command System 160
Internal Factors 162
External Factors 169
Hurricane and Disaster Preparedness Project Summary 176
Incident-Specific Hazards 178
Biological Event 179
Bomb Threat 185
Extended Power Outages 192
Extreme Temperatures 194
Hazardous Materials 205
Severe Weather (Tornados) 212
Tropical Cyclones (Hurricanes) 215
Winter Storms 219
The Nursing Home Incident Command System 224
A Nursing Home’s Introduction to the Incident Command System 225
Job Action Sheets 232
Training and Exercises 290
Federal Regulations 319
Table of Sample Statements
The Basic Plan
This part of the guide defines the four components of a comprehensive emergency management plan. It also outlines an organizational structure recommended by the Federal Emergency Management Agency. Also described are the plan components supported by sample statements.
In addition to a basic plan, nursing homes will include other items such as procedures, checklists, maps, mutual aid agreements, vendor contracts, and hazard-specific appendices to support their plan.
Defining a Comprehensive Emergency Management Plan
Nursing homes can carry out their emergency management responsibilities by focusing on four interrelated activities: mitigation, preparedness, response, and recovery. Each of the activities is a phase of a comprehensive emergency management process. The overall goal is to protect residents and staff from environmental and man-made threats and to minimize their impact on operations. These four activities are described below.
Mitigation activities involve long-lasting, enduring reduction of exposure to, or probability of, loss from emergency events. Examples include: zoning and building code requirements for rebuilding in high-hazard areas; analyses of floodplain and other hazard-related data to determine where it is safe to build in normal times; or to coordinate mutual aid agreements with other nursing homes. Mitigation also can involve educating staff and family members on measures they can take to reduce loss and injury, like creating a family emergency plan. Cost-effective mitigation measures are the key to reducing disaster losses in the long term. Where there is a willingness to mitigate, opportunities can be found. Ongoing efforts might include assessing and addressing the facility’s structural vulnerabilities or planning response activities with dialysis centers and local hospitals.
While mitigation does make nursing homes safer, it does not eliminate risk and vulnerability for all hazards. Facilities must be ready to respond to threats that have not been mitigated away. Since emergencies often occur with little or no notice and evolve rapidly, a facility must take certain actions beforehand. This is preparedness.
Preparedness involves establishing authorities and responsibilities for emergency actions and garnering the resources to support them. A facility must assign personnel to emergency management duties and designate equipment and other resources for carrying out assigned duties.
This investment in emergency management requires upkeep and this is part of preparedness. Conducting meaningful drills and exercises is critical to educating personnel, testing the plan, and putting equipment through its paces.
When an emergency occurs, time-sensitive actions must occur in order to reduce the negative impact to residents and staff. Such actions will also begin stabilizing the situation so that the facility can regroup. Such response actions include notifying emergency management personnel of the event, notifying residents and family members, evacuating or sheltering, keeping everyone informed, providing nursing services, feeding and hydrating residents as routinely as possible, and communicating with external partners and stakeholders.
Recovery is the effort to restore infrastructure and resident life to normal. Short term recovery refers to bringing necessary lifeline systems (e.g., power, water and sewage, transportation) up to an acceptable standard while providing for basic resident needs, security, and demonstrating that people do care and things are getting better. Once some stability is achieved, the nursing home can begin long term recovery efforts such as restoring infrastructure and routine operations.
The contents and organization described in this section follow the basic components which are recommended by the Federal Emergency Management Agency in their Guide for All-Hazards Emergency Operations Planning to be used by jurisdictions at the state and local level.
Elements of a nursing home’s basic plan should include:
Additionally, nursing homes will include other items such as procedures, checklists, maps, mutual aid agreements, vendor contracts, and hazard-specific appendices to support their plan.
A nursing home’s basic emergency management plan should be prefaced by an Executive Summary in order to enhance accountability and ease of integration of the plan. The Executive Summary is a promulgation document, usually a statement written by the nursing home’s chief executive officer giving the Administrator authority and responsibility to initiate emergency operations, perhaps citing the legal basis for his or her authority to make that declaration.
The Executive Summary should also mention the facility’s responsibility to prepare and maintain emergency policies and procedures, conduct training and exercises based on those procedures, and to maintain the plan. The Executive Summary also allows the chief executive to affirm his or her support for emergency management.
The Executive Summary also should reference how the facility’s plan is organized based upon the framework of the National Response Plan which, in turn, relies upon the National Incident Management System (if developed using this guide or the FHCA Comprehensive Emergency Management Program Software Application for Nursing Homes).
Plan Review and Maintenance
The basic emergency management plan will include the overall approach to the planning process, including assignment of planning responsibilities. Statements should focus on the planning process, participants in the process, and how the plan will be tested and maintained.
It is recommended that the nursing home administrator and command team review the facility’s emergency preparedness plan at the same set time every year. The plan may also be reviewed and revised as often as needed, especially as a result of findings from an exercise drill.
The annual review could include, but not be limited to:
Facility team leaders should schedule a time when the plan will be reviewed and should outline in advance how the review will take place, and who is responsible for conducting the review. Additionally, the person responsible for updating the plan and for integrating changes into the training and exercises will be identified.
Once the plan has been approved and signed by the Administrator, it will be considered the active plan to be used for submitting to state authorities as needed, and for all training and exercises.
Nursing homes should establish procedures for maintaining their emergency plan including the assignment of preparing and maintaining emergency procedures to department heads. Each department may also be responsible for communicating any staff changes in the plan.
To maintain the viability of the plan, updated supplementary material will be attached:
If any changes to the emergency preparedness plan occur during the year rather than at the annual review, such changes will be documented and incorporated into training and exercises.
Authorities and References
In order to support the decisions and activities of the command team and staff, a nursing home’s emergency management plan should clearly reflect applicable state laws and regulatory rules. These laws and rules will serve as the legal basis from which the plan is built. It is important to specify the extent and limits of the emergency authorities granted to the Administrator, the circumstances under which these authorities become effective, and when they would be terminated. The references will identify other relevant and accurate sources and materials beyond the laws and rules used in the development of the plan.
The final emergency management plan should include an attached hierarchy of authority to be initiated during an emergency. This may take the form of an organizational chart, clearly identifying persons in charge and how they interrelate and delegate responsibilities.