Disaster Preparedness-Lessons Learned from Katrina and Gustaz

1. Biograph of Charles A. Cefalu MD, MS-applicant for reappointment to the Board of Directors of ADGAP • Dr. Cefalu has been an academic clinician educator during his 32 year career including academic appointments at LSU, Tulane, Bowman Gray/Wake Forest and Georgetown University Schools of Medicine. He is currently Professor and Chief of the Section of Geriatric Medicine at LSU School of Medicine and Program Director for the Geriatric Medicine Fellowship. He is also the author of numerous regional, national, and international publications relative to Geriatric Medicine and has spoken at various local, regional, and national geriatric conferences. Hartford/ADGAP Geriatric Scholar and is board certified in family medicine and geriatrics He was also elected in 2010 to serve a three year term on the Board of Directors of the American Geriatrics Society. He also currently serves as Chair of the Clinical Practice Committee of the American Medical Directors Association.

2. Disaster Preparedness-Lessons Learned from Katrina and Gustaz Charles A. Cefalu MD, MS Professor and Chief, Section of Geriatric Medicine Medical Director, LSU Affiliated Nursing homes LSUHSC, NO, La.

3. Statistics • 300 nursing homes in La. • 120 in the NO Metro area affected by Mandatory Evacuation • 40 nursing home patients died in NO Metro area nursing home • Result-State law now mandates dual Responsibility of specific nursing home and oversight by DHH relative to Evacuation Procedures

5. La. Healthcare Review Organization • Serves as Medicare’s LTC review organization in Louisiana for nursing home quality care • Had weekly teleconferences with physicians across the state for several months after Katrina to provide assistance and communications/advise to displaced physicians, clinics, and hospitals • LTC Committee (Workforce) group also met monthly to provide assistance and advice to nursing homes

6. Workforce Group Recommendations • Hurricane Preparedness-Advance Planning • Hurricane plans should be reviewed every year • Contract with 2 evacuation sites-one east and one west • Review your bus service contract • Stock extra medications during hurricane season; keep these supplies separate • Choose a pharmacy that keeps backup electronic medical records • Keep Hurricane supplies separate from regular supplies

7. Workforce Recommendations • Evacuating • Leave as early as possible • Make up emergency kits for each bus • Designate a person to be the first on arrival to direct activities at the evacuation site • Notify families regarding the evacuation • Staff buses by acuity of residents • Place roommates on bus together • Triage residents by ambulatory or functional status • Use of diapers versus catheters-make sure all residents toilet prior to getting on bus

8. Workforce Recommendations • Identification of residents • Use of armbands • Make pictures of all residents • Supplies/Equipment • Each bus with separate supplies • Order extra medications • Have ice and water in each bus • Send large equipment ahead of bus • Make sure oxygen tanks are secure on bus

9. Workforce Recommendations • Weathering the Hurricane • Use of some type of radio system; adequate communications-many hospitals or facilities could not communicate with each other • Designate a local hospital in route to serve as a common communications point

10. Workforce Recommendations • Security-after the Hurricane, break-ins • Power-making sure a large enough generator is secured for after the Hurricane especially as it relates to powering the ice maker

11. Workforce Recommendations • Vital identification and records • Armbands for residents and pictures • Supplies-chain saws, tarps, and plenty of IV fluids • Pharmacy supplies need some type of backup computer records stored in a different geographical area • Transportation-for employees coming to work after Hurricane-an emergency transportation system • Serving as an Evacuation Shelter

12. The Big Uneasy: Katrina’s Unsung Heroes The Big Uneasy: Katrina’s Unsung Heroes (2009) is a tribute to the staff of Louisiana’s nursing homes who brought thousands of residents safely through the storm and its aftermath. The DVD was produced by Cathie Brady & Barbara Frank, B&F consulting, Inc. and Susan Wehry, MD with funding provided by a grant from the Louisiana Department of Health and Hospitals. The DVD may be purchased for a nominal fee and a pdf of the Facilitator’s Guide is available at no charge. • For DVD information and/or orders: • Linda Sadden, State Long-Term Care Ombudsman, Louisiana • LASadden@goea.la.gov • For Facilitator’s Guide: • http://www.bandfconsultinginc.com/Site/The_Big_Uneasy%3A_Katrinas_Unsung_Heroes.html

13. Workforce Recommendations • Serving as an Evacuation Shelter • Resident population may double overnight • Triage residents upon arrival • Place residents in rooms and areas of the nursing home according to their needs-tube feeding versus bed bound which allows rooms to be stocked quickly • Arriving facility should bring identification of residents and medicine sheets • Partner with Schools of Nursing to use as a resource to man shelters or help out at nursing homes

14. Workforce Recommendations • Need for local law enforcement early and security in the nursing home parking lot • Residents need to know how to file for FEMA assistance • Facilities should have business interruption insurance to cover overhead costs such as payroll, mortgage. • Consider a computer services contract for back up services in a separate geographic location

15. Disaster Management Disasters come in all shapes and sizes. Some are natural and some are accidents or purposeful actions. Although hurricanes are most frequently associated with disaster management plan development in long term care facilities, we are engaged in all aspects to include fire, life safety, pandemic, terrorist, bomb threats, and other potentials.

16. Providers are encouraged to be self sufficient and to preplan! • How will you handle: Emerging clinical crises? Infection control? Deaths? Possible staff shortages? Lack of power? Lack of communications? • Are supplies in appropriate amounts? • Will staff be able to travel? • How to externally communicate? • SNFs potentially become Special Needs Shelter ?

17. Disaster-Specific Position Descriptions • Administrator • Director of Nursing • Risk Manager • Maintenance • Housekeeping • Dietary • Social Services • Activities • Medical Director • Other?

18. Role of the Medical Director • Disaster Preparedness Planning • Evacuation Decision Considerations • Shelter in place Considerations • During the Event • Post Event • Look Back and CQI

19. Keys to Clinical Management • Regardless if a disaster results in planned or unplanned response, including evacuation from entire facility or a part, the clinical care and critical services must go on…….

20. Identify Conditions that may Worsen With Stress • Confusion • Pain • Anxiety • Diabetes • Constipation • Hospice or declared terminal services ? How will you manage infection control as a whole and for residents with infections?

21. Diabetic Considerations • Blood Sugar MachineMedication Records • Oral Antihypoglycemic • Insulin Syringes • Insulin (Reg., NPH, etc.) • Glucerna • Instant Glucose • Urine Test Strips • Hydration/snacks • Other? • Batteries • Lancets • Test strips • Alcohol wipes • Testing Agents • Sharps container • Hand Gel • Gloves • Physician OrderSheet

22. More Lessons Learned: • Develop state to state relationships • Identify what members have facilities in other states: This facilitates state to state sharing of supplies, services, and human resources • Affiliate with your state board of nursing • Advocate for licensure and reciprocity agreements for staffing; • Keep abreast of board openings and opportunities for LTC representation • Act as a central repository for provider ideas and offers: housing, employment for displaced workers