Betty Shiels, PhD-C

1. Betty Shiels, PhD-C Betty Shiels, PhD-C, is the Institutional Director of the Ohio Valley Appalachia Regional Geriatric Education Center at the University of Louisville, Kent School of Social Work. Since 1991, she has been involved in research, training, geriatric care management and consulting in the field of aging. She serves on the board of the National Association of GECs. Her work is focused on emergency preparedness for long term care providers in Kentucky. She is co-author of the KY All Hazards Long Term Care Planning and Resource Manual that was designated as a 2010 US Department of Health and Human Services (DHHR) Office of the Assistant Secretary for Preparedness and Response (ASPR) national best practice.

2. Kentucky LTC Lessons LearnedDuring Catastrophic Earthquake Disaster Exercise Betty Shiels, PhD-C, LCSW Institutional Director OVAR/Geriatric Education Center University of Louisville Kent School of Social Work

3. Session Objectives Upon completion of this session, learners should be able to: 1. Identify the scope of National Level Disaster Exercise 2011 (NLE 2011) 2. Describe issues of special interest for Long Term Care in a no-notice catastrophic disaster, such as an earthquake 3. Discuss lessons learned from the experience of KY LTC in the May 2011 National Level Exercise (NLE)

4. National Level Exercise 2011 • Congress mandates a national level disaster exercise (NLE) occur annually • NLE is --directed by the White House --involves all appropriate federal level departments and agencies --involves regional, state, county and private sector participation

5. National Level Exercise 2011 • May 16-20, 2011 • Scenario based on the New Madrid Earthquake of 1811-1812 • 8 states impacted TN, KY, IN, IL, MO, AR, AL, MS • Population larger than CA • Scenario 7.7M Image courtesy of U.S. Geological Survey

6. New Madrid Earthquake Scenario • Effect 8 states and 4 FEMA regions • 715,000 buildings damaged • 42,000 search and rescue personnel working in 1500 teams • 425,000 breaks and leaks to both local and interstate pipelines • 3,500 Damaged bridges • 2.6 million households w/o power • 86,000 injuries • 3,500 fatalities

7. KY LTC Earthquake Initial Facility Response Most severe damage--Evacuate to a self-sustained shelter for up to 4 days with no power, water supply, communications capability, etc. awaiting evacuation by federal resources. Moderate damage--Facility is significantly damaged and must evacuate to other LTC facilities outside of the area for up to 4 weeks. Slight damage-- Facility has some damage and access/egress are blocked by trees and downed power lines. Sheltering conditions include generator power, no communications capability, depleting fuel supply with no resources available for up to 2 weeks.

8. Case Study II: LTC Evacuation During a No-Notice Catastrophic Disaster Scenario– A 7.7M earthquake has hit your region. Your facility is located on a sinkhole and has sustained damage from flooding due to liquefaction. The long term care facility cannot sustain operations due to moderate damage and risk of aftershocks. Your facility must evacuate to multiple LTC facilities outside of the region for up to 4 weeks. The county Emergency Manager is managing transportation out of the facility. What issues would you want to consider for month-long placement across multiple long term care facilities outside of your region?

9. NLE Earthquake Exercise Outcomes for Long Term Care • Kentucky LTC is now: • included in the KY State Emergency Operations emergency planning and response protocols • included in the KY Dept. of Public Health Emergency Operations Center during a disaster response • included in the KY Div. of Emergency Management Infrastructure list for priority response

10. Outcomes for Long Term Care Key Collaborations • State LTC Associations • KY Dept. for Public Health (KDPH) • Hospital Preparedness Program • KY Division of Emergency Management • County Emergency Managers • State and Federal Departments of Veterans Affairs • KY Hospital Association. • KY Office of Inspector General • KY LTC Ombudsman Program • KY ESF #8 (FEMA Emergency Support Function for hospitals and healthcare)

11. Outcomes for Long Term CareLTC Surge Response • LTC in Kentucky had been unable to respond to surge needs during disasters due to regulatory barriers (citations and fines) if a receiving facility exceeded licensed beds • NLE activities created dialogue and partnerships with the KY licensing authority regarding surge barriers • Change occurring as Kentucky long term care facility accepted surge evacuees from Missouri during the most severe Midwest flooding

12. KY LTC Lessons Learned State and Federal Resources • Know your state’s Emergency Operations Plan (EOP) • Know the local, state and federal systems involved in disaster response and their roles, particularly • County Emergency Managers • State Div. of Emergency Management • State ESF#8 Coordinator (Hospitals and Healthcare) • U.S. Public Health Service

13. KY LTC Lessons LearnedDHHS 1135 Waiver and Surge • 1135 Waiver allows for waiving of select regulatory guidelines allowing hospitals and healthcare organizations to respond to community needs during a disaster • 1135 Waiver allows for expanded beds beyond CMS licensed numbers, accelerated reimbursement, etc. • 1135 Waiver is requested of DHHS in a disaster and must include a Presidential Emergency Declaration and a Public Health Emergency Declaration. • 1135 Waiver can be retrospective • http://www.hhs.gov/katrina/ssawaiver.html

14. KY LTC Lessons Learned State and Federal Resources • Be familiar with the DHHS 1135 Waiver • Establish agreement with LTC, state hospital association and state department of public health regarding triggers to request DHHS 1135 waiver • Evacuation and surge planning cannot start soon enough— Exercise, exercise, exercise! • Hospitals may be as uninformed as LTC about surge expectations, nursing staff, supplies, etc.

15. KY LTC Lessons LearnedState and Federal Resources • Work with the state’s Alternate Care Site and Special Medical Needs shelter planning group • Know the local, state and federal systems involved in disaster response and their roles, particularly • County and state Div. of Emergency Management • State ESF#8 Coordinator • U.S. Public Health Service

16. KY LTC Lessons Learned LTC Facility Evacuee Issues • LTC evacuee records need to include last physical exam information, medications, dietary issues swallowing condition, allergies, special services received, i.e. feeding tubes, dialysis, etc. • Resident evacuee identification needs name, etc. and current photo for matching 2 IDs to receive medical care. • Develop a coterie of volunteers and family members to assist at shelters for one-on-one attention for cognitively impaired. • Bring cards, games, bubbles, children’s games and toys to entertain cognitively impaired.

17. NLE Earthquake Exercise KY LTC Lessons Learned • Plan on 5-days supply 0f food for 3 days of sheltering-in-place • Expect resident and staff family members, incl. pets, to show up if the facility shelters in place and facility may need added food, water and shelter supplies. • Assess the facility’s emergency supply of food, water and fuel every 3-4 months.

18. NLE Earthquake Exercise Benefits from Participating • The learning is in the exercise planning • Critical partnerships are made • Key gaps and solutions are identified at the policy level and facility level • Planning and improvements continue well past the exercise • Creates confidence in the capability of the response system

19. More Information Betty Shiels, PHD-C OVAR/GEC at UL 426 W. Bloom St. Louisville, KY 40208 (502) 852-8003 betty.shiels@louisville.edu OVAR/GEC Website: http://www.mc.uky.edu/aging/gec.html Funding through KCHFS/KDPH 2010-2011 grant #PON2-728-1000004025-2 UK and UL Emergency Preparedness for Aging Training Grant