Arleen Johnson, PhD

1. Arleen Johnson, PhD Arleen Johnson, PhD, is the Director of the Ohio Valley Appalachia Regional Geriatric Education Center (a consortium of the Universities of KY, Louisville, Cincinnati and East Tennessee State University), which is administratively based at the University of KY College of Public Health in Lexington. Since 1970, she has been a researcher, educator and direct service worker in the field of aging. She helped to develop the national agenda for emergency preparedness for aging and actively participates on the National GEC Collaborative. Her work in emergency preparedness is focused on rural aging services and long term care providers. She is co-developer of the KY All Hazards Long Term Care Planning and Resource Manual that was designated as a 2010 National Best Practice by the US Department of Health and Human Services (DHHR) Office of the Assistant Secretary for Preparedness and Response (ASPR).

2. Disaster Preparedness: Creating an All Hazards Long Term Care Plan Arleen Johnson, PhD Director OVAR/Geriatric Education Center University of Kentucky College of Public Health SESSION HANDOUT

3. Session Objectives Upon completion of this session, learners should be able to: 1. Identify rural issues for emergency preparedness for aging 2. Describe why long term care residents are at high risk during emergencies. 3. Discuss the primary features of an all hazards long term care plan.

4. Obj. 1: Disaster Preparedness - Rural Issues • Geographic Isolation • Socioeconomic status • Farm land/animals • Public Transportation • Personal Vehicles • Telephones • Educational status • Technological Infrastructure • Availability of services • Access to services • Chronic diseases • Independence/Self-reliance

5. Obj. 2:LTC Residents at High Risk • 70% age 75 or older • 68% cognitive impairment (13% severe/very severe) • Average 11 daily medications • 80% at least one chronic condition • 83% help with one Activity of Daily Living; 60% help with 5+ • 50% extensive help with 4 out of 5 bed mobility, transferring, dressing, eating, or toileting • 50% incontinence bladder and bowel; 38% severe • 3% have feeding tubes • 40-150 times greater risk of pneumonia • Higher risk of infectious illness • Reduced immune function • Reduced response to antibiotics • Assistance with mobility • Dialysis ( age 75+ fastest growing group) • Oxygen & other medical supplies • Wheelchairs, walkers, canes, assistive devices • Bariatric (equal to or greater than 500 pounds)

6. Obj. 3: Features of an All Hazards LTC Plan • Hazard Vulnerability Analysis • Community Planning • Memorandums of Understanding (MOU) • Communication • Direct Care Procedures for All Hazards • Shelter-in-Place • Evacuation • Continuity of Operations • Recovery • Training and Exercises

7. Hazard Vulnerability Analysis • Hazard Vulnerability Analysis: Use to assess the proximity and level of potential hazard Examples of Usual & Natural Threats Flood, Tornado, Severe Weather, Earthquake, Power/Energy Related Hazard, Fire, Chemical Spill, Landslide, Mine/ Sinkhole, Transportation Accident, Water Shortfall, Bomb Examples of Unique Threats Roadways, Woods, Bodies of Water, Railroads, Airports, Dams, Military Bases, Pipelines, Gas Stations, Chemical Plants, Nuclear Plants See handout and go to http://www.mc.uky.edu/aging/gec.html

8. Hazard Vulnerability Analysis • Probability: High, Medium, Low or None • Known risk • Historical data • Manufacturer/vendor statistics • Risk: Life Safety, Health Safety, High/Medium/Low Disruption • Threat to life and/or health • Disruption of services; Damage/failure possibilities • Loss of community trust; • Financial impact • Legal issues • Preparedness: Poor , Fair or Good • Status of current plans and training • Insurance • Availability of backup systems and community resources

9. Community Planning • Identify community partners • Host facility meeting • Share contact information • Discuss roles in an emergency • Review transportation plans • Identify locations of communication sources • Share emergency plans • Conduct exercises

10. HealthcarePlanning Coalitions Prior to an emergency LTC facilities can qualify for HPC funding for equipment & supplies and network with other LTC providers. Must meet these 3 criteria: • Complete Incident Command System ICS 100 & 200, NIMS 700, and NIMS 800 • Actively participate in regional Hospital Planning Coalition/Long Term Care Committee meetings • Register with and/or provide LTC facility data on EMSystems, WEB-EOC, or other data base required by Department of Public Health or other responsible state agency

11. KY Hospital Preparedness Program (HPP) Regions

12. Memorandums of Understanding (MOU) • Long Term Care Facilities • Hospitals • Alternate Care Sites • Vendors • Aging Services Providers • Faith-Based Communities • Schools • Transportation Services • Funeral Homes/County Coroner

13. Case Study: Communicating in a Disaster It is 3:00 am and your region has just experienced a 7.7 magnitude earthquake. Your facility has sustained damage, may be experiencing flooding and your street is blocked with debris as sirens blare in neighboring areas. There is no community power source. There is no access to landline telephones, cell phones or the internet. All transportation is blocked by downed trees, power lines, flooding and/or damaged streets. Residents and staff may be injured or dead. • Identify as many communication issues as you can for responding to this catastrophic no-notice disaster.

14. Case Study: Communicating in a Disaster • Risk assessment • Emergency plans in place • Staff preparedness • ICS/NIMS training/Activation • Communications • Staff, residents, families, others • Contact numbers/Call trees • Phones • Runner messenger service • Internet • Radio/Television • Newspapers/Fliers • Memorandums of Agreement • Facility and area damage assessment • Extent of structural and area damage • Supplies/Equipment/Vendors • Accessibility • Life safety assessment • Staff, residents, volunteers, others • Number Injured; severity of injuries • Number deceased; plan for holding • Reporting status to county/state • Where is nearest satellite phone • How to get there; Who will take • Shelter in place plan • Evacuate plan • Within facility, another LTC, shelter

15. Direct Care Procedures for All Hazards • Templates for All Hazards • Bomb, Earthquake, Severe Weather, Fire, Flood, Dam, Hazardous Materials, Landslide, Medical Emergencies, Missing Resident, Nuclear, Severe heat, Shelter in place, Snow, Terrorist, Tornado, Tsunami, Utility Outage, Workplace Violence, etc. • Emergency Procedures • Emergency Job Tasks • Checklists • Facility Action Cards

16. Shelter-in-Place • Decision Criteria • Incident Command System • Notifications/ Call lists • Staffing/Communication Plan • Supplies/Equipment/Utilities • Safety/Security • Fewer resources • Limited accessibility • Surge from community, hospitals, LTC

17. Surge to LTC • Assessment of potential numbers of residents/patients • Assessment of potential number of beds available • Memorandums of Agreement • Facility Assessment • Capacity – number that can be served • Capability- staffing and type of special care • Licensure/Certification Issues • National emergency DHHS 1135 Waiver procedures

18. Evacuation • Decision Criteria/Incident Command System • Notifications/Activate call lists • Surge from LTC to community or other LTC • Security/Shut-down • Staffing/ Emergency packets and “Go Bags” • Transportation/Return to facility plan • Costs to sending facility • Fewer resources • Limited accessibility/ More time needed • Surge TO community, hospitals, LTC

19. Continuity of Operations • Reduced staff plan • Staffing-up plan • Staff supervision • Essential functions • Assuring safety • Protecting equipment, records & assets • Minimizing disruption • Timekeeping • Continued Payroll • Invoice Payment • Cash on Hand • Accessing Records • Photo/paper trail Documentation for FEMA and Insurance

20. Recovery • Damage assessment • Authority to Re-Enter • Post-Evacuation Return of Residents • Reimbursement Costs/Documentation • Psychological First Aid • Recovery Analysis • Costs to sending facility • Fewer services and resources

21. Training and Exercises • National Incident Command System Training and Certification: • ICS 100 Introduction All staff • ICS 200 Applying ICS All Supervisors • ICS 700 National ICS Intro Selected Supervisors • ICS 800 National Response Public Information, Framework Safety or Risk Management For more on FEMA Hospital ICS -http://www.health.state.mn.us/oep/training/bhpp/hicstrain.pdf

22. Resources for Preparedness & Response KDPH TRAIN KY Training Modules https://ky.train.org/DesktopShell.aspx Helping Elders Prepare for Bioterrorism and Emergencies (Course ID 1006475) Disaster Preparedness: Developing Agency Emergency Plan (Course ID 1007090) CERT Community Emergency Response Team (Course ID 1005655) The Aging Network (Course ID 1006470) Medical Reserve Corps-An Introduction to Incident Command (Course ID 1014646) Pandemic Influenza (future TRAIN Course ID 1009188) Interim Link: http://cwte.louisville.edu/ovar/avianflu/index.html KY All Hazards Long Term Care Planning and Resources Manual and Emergency Training Materials http://www.mc.uky.edu/aging/gec.html FEMA NIMS Resource Center http://www.fema.gov/emergency/nims/ NIMS Training Courses – Fact Sheets http://www.fema.gov/emergency/nims/NIMSTrainingCourses.shtm#item1

23. Resources for Preparedness & Response OVAR/GEC E-News Emergency Preparedness for Aging • Geriatric Education Resources • http://cwte.louisville.edu/ovar/emergency/fall2007.htm • Preparedness for Long Term Care • http://cwte.louisville.edu/ovar/emergency/winter2008.htm • Health Literacy for Emergency Preparedness/ Aging • http://cwte.louisville.edu/ovar/emergency/spring2008.htm • Pandemic Flu and Aging • http://cwte.louisville.edu/ovar/emergency/summer2008.htm • Long Term Care: • http://cwte.louisville.edu/ovar/emergency/winter2008.htm • http://cwte.louisville.edu/ovar/emergency/winter2009.htm • http://cwte.louisville.edu/ovar/emergency/summer2009.htm • http://cwte.louisville.edu/ovar/emergency/winter2011.htm

24. Session Summary • Rural issues for emergency preparedness for aging • Reasons long term care residents are at high risk during emergencies. • Primary features of an all hazards long term care plan • Training • Resources

25. For More Information….. Arleen Johnson, PhD OVAR/GEC at UK 658 South Limestone Lexington, KY 40506-0442 (859) 257-8314 arleen@uky.edu OVAR/GEC Website: http://www.mc.uky.edu/aging/gec.html Partial funding through USDHHS, HRSA contract number 1 UB4HP19051-01-00 and KCHFS/KDPH 2010- 2011 grant #201008191611 UK Emergency Preparedness for Aging Training Grant