Long Term Care Emergency Planning Workshop

1. Produced with funding from: Long Term Care Emergency Planning Workshop Preparing Your Agency Engaging in Community Preparedness

2. Agenda • Goals • Introductions • Project Overview • Community and Facility Resources • Emergency Management and Emergency Preparedness Concepts • Scenario Based Discussion • Moving Forward

3. Goals • Facilitate the understanding of National Incident Management System and Incident Command System concepts as they relate to long term care providers and healthcare coalition initiatives.   • Discuss the assessment of hazards and vulnerabilities and how the assessment can improve emergency management capability within an agency. • Review best practices for facility emergency operations planning and equip participants to coordinate the creation of an emergency operations plan within their facility.

4. Introductions • Name • Agency and role • Experience with emergency preparedness • Emergencies at a facility or in the community • Concerns about emergency preparedness

5. Project Overview Partners Requirements Benefits

6. Program Overview

7. Mission …to facilitate coordination and cooperation throughout the Metrolina region to ensure partners have the capability to mitigateagainst, preparefor, respond to, and recover from emergent health and medical events.

8. The Metrolina Region

9. Grant Funded Hospital Preparedness Program

10. North Carolina Hospital Preparedness Program

11. Entities within the Region • Emergency Management • Public Health • Hospitals • Emergency Medical Services • Fire • LEPCs • Law Enforcement • Patient Transport Providers • Community Health Providers

12. Use of Funding… ASPR Healthcare Capabilities… • Healthcare System Preparedness • Healthcare System Recovery • Emergency Operations Coordination • Fatality Management • Information Sharing • Medical Surge • Responder Safety • Volunteer Management

13. 1 of 8 SMAT II’s across NC (1/region) • 30 SMAT III’s across NC (7 in Metrolina) • Part of the State Medical Response System • Medical and Non-Medical Volunteers • Multiple mission types (Disaster/Spec Evts)

14. Metrolina SMAT

15. Metrolina SMAT

16. Resources! • Western Shelter Tents Systems • Medical Support Units (MSU) • Communications Package • Telemetry Units • Water Filtration • Medical Equipment • Training and Exercise Supplies • …and MUCH more…

17. MHPC Staff Sarah Seiler, MSN Healthcare Preparedness Coordinator Travis Cryan, BA Asst. Reg. Coord. Hannah Gompers Program Specialist

18. Regional Steering Committee • Hospitals • EMS • Emergency Mngmt • Long Term Care • Public Health • Ad Hoc Derrell Clark, CHS Mercy & Rehab Facilities Mark Lamphiear, Gaston County EMS Don Moye, Union Co Emergency Mngmt Jill Demuth, CHS Corporate Emily Walmsley, Union County Public Health Mike Helton, Catawba Valley Medical Center

19. The Need for Preparedness

20. Why are we here? • Engagement • With the coalition • With local hospital • With local EMS • With local Fire • Reduce planning within a silo • Improve preparedness planning • Requirements vs Recommendations

21. Regulatory Requirements- Assisted Living NC Administrative Code • Title 10A- Health & Human Services • Chapter 13- NC Medical Care Commission • Subchapter F- Licensing of Homes for the Aged & Infirmed

22. Regulatory Requirements- Assisted Living 10A NCAC 13F .0309- Plan for Evacuation • (b) rehearsals quarterly on each shift • (d) written disaster plan- approved by local Emergency Management and agency designated to coordinate special needs sheltering- updated annually 10A NCAC 13F .1004- Medication Administration • (g) within one hour before/after prescribed time, unless precluded by emergency situations • (o) A resident's medication shall not be administered to another resident except in an emergency

23. Regulatory Requirements- Assisted Living 10A NCAC 13F .1604- Rating Calculation • (c) (1) (H)- if the facility permanently installs a generator or has a contract with a generator provider to provide emergency power for essential functions of the facility, the facility shall receive 2 merit points • One merit point for maintaining the generator in working order or continuing the contract with a generator provider

24. Regulatory Requirements- Skilled Nursing Code of Federal Regulations • Title 42- Public Health • Chapter IV- CMS, DHHS • Subchapter G- Standards and Certification • Part 483- Requirements for States and Long Term Care Facilities

25. Regulatory Requirements- Skilled Nursing §483.75- Administration • (m) Disaster and emergency preparedness • (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 • (2) The facility 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

26. CMS Proposed Rule Changes…

27. REALLY?! “Current LTC facility requirements do not require facilities to conduct a risk assessment or to have a plan, policies, or procedures to ensure continuity of facility operations during emergencies.” Federal Register, Vol. 78, No. 249, Pg. 79109

28. Identifies 4 Elements… • Risk Assessment & Planning • All-Hazards Risk Assessment • Emergency Plan • Addresses resident population, services offered, continuity of operations, delegation of authority, succession plans, etc… • Collaboration with local, tribal, regional, State, and Federal partners to ensure integrated response • Policies & Procedures • Based upon risk assessment and plan • Provision of subsistence needs for staff & residents, alternate sources of energy, patient tracking, documentation, arrangements with other facilities, etc…

29. 4 Elements continued… • Communication Plan • “Develop and maintain an emergency preparedness communication plan that complies with both federal and state law. Patient care must be well coordinated within the facility, across health care providers, and with state and local public health departments and emergency systems.” • Training & Testing • Including drills and exercises • Conduct a tabletop exercise annually • Participate in a community mock disaster drill at least annually • Revise policies and procedures based upon findings

30. Resources to Support Preparedness

31. DHHS- Administration on Aging Emergency Assistance Guide “The focus of the new technical assistance materials is a ‘systems’ approach, because effective disaster preparedness and response is dependent upon a number of service delivery systems coming together for a common purpose.”

32. CMS- Emergency Planning Checklist • Recommended Tool for Effective Healthcare Facility Planning

33. NCEM- Risk Management Portal

34. NCEM- Risk Management Portal

35. Benefits of Preparedness • More than checking a box… • Provide safe environment for your residents and staff • Business Continuity • Peace of Mind!

36. Emergency Management Concepts An Overview

37. Concepts • Planning • Incident Command System (ICS) • Emergency Operations Center (EOC) • Emergency Support Functions (ESF) • Health Coalition coordination/planning • Managing events with ICS and connecting with community resources to support response/recovery

39. Hazard Assessment • How do you identify hazards? • Who is involved in hazard identification? • What do you do when you identify a hazard?

40. Hazard Assessment • Identify the hazards • Evaluate probability • Determine impact • Examine preparedness

42. Utilizing the HVA • Facility and Regional • Planning • Training • Exercising

43. NIMS and ICS

44. Topics to Cover • Review the National Incident Management System (NIMS) • Basic overview of the Incident Command System (ICS) • Examine the Incident Command and Emergency Operations Center Interface • Understand Emergency Support Functions

45. NIMS and ICS Familiarity • What is your level of training on NIMS and ICS? • How often have you utilized NIMS or ICS concepts at your facility? • How comfortable are you with NIMS and ICS concepts?

46. NIMS • What is NIMS? • How is it useful?

47. NIMS Overview • Flexible and standardized • Preparedness • Training, certification, resource allocation • Resource management • Descriptions, inventories • Mobilization, dispatch, tracking, recovery • Incident management

48. NIMS: • Is not an operational incident management or resource allocation plan. • Represents a core set of doctrines, concepts, principles, terminology, and organizational processes • Enables effective, efficient, and collaborative incident management.

49. Incident Management NIMS and the National Response Framework (NRF) operate on the premise that incidents should be managed at the lowest jurisdictional level possible.