From Hurricanes Irma and Harvey to the California wildfires, there has been no shortage of extreme weather around the country. While difficult to handle under any circumstance, the more than 67,000 paid, regulated long-term care service providers in the United States face exceptional circumstances. 

In many cases, natural and man-made disasters force these facilities to evacuate a vulnerable resident population — one that is often older, frailer and less mobile.

In light of these events, long-term care facilities must develop robust emergency preparedness plans to ensure the safety of their combined nine million residents. The development of such a plan, however, isn’t just about complying with new federal guidelines. 

Rather, it also helps protect long-term care facilities from general and professional liability exposures—which can result in costly financial settlements. Here’s what providers need to know when building such an emergency preparedness plan.

  • You might be further behind than you think

    Despite being top of mind for industry executives since Hurricane Katrina in 2005, most organizations haven’t made as much progress as they should over the past decade.
    In fact, a 2012 report from the Department of Health and Human Services found that many facilities continued to face emergency planning shortfalls, with just half of providers meeting then-CMS guidelines. Specific challenges included unreliable transportation contracts, poor collaboration with local emergency management officials and caring for residents who developed new health problems. 

    With the implementation of the Centers for Medicare and Medicaid Final Rule on Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers, long-term care facilities can no longer wait. With reimbursement payments, accreditation status, and professional and general liability exposures all on the line, long-term care facilities should immediately conduct an “all-hazards” risk assessment. This risk assessment should span the entire enterprise and be shepherded by a multidisciplinary team. Ideally conducted once per year, it should form the foundation of a provider’s emergency preparedness plan.

  • Best practices are your friend

    While it may appear as a daunting task, having pre-established protocols in-place during an emergency can be the difference between success and failure.

    Clear guidelines are particularly important when it comes to communications, both before, during and after an emergency. To start, every long-term care organization should keep an organizational chart on file. This should include procedures for activating emergency operation plans and command structure, along with details about who is in charge during an emergency and who has the authority to make decisions for the facility.

    Establishing a personnel call down list is vital for ensuring employees are notified of a situation and that information is being shared with other providers, state and local health departments, and emergency management officials.

  • Knowing the details is critical

    Emergency situations often invite stress. This can make recalling and thinking through the details particularly challenging, especially when resident lives might be at stake.

    In order to help ensure all possible risk mitigation measures have been implemented and no detail is overlooked while a crisis is unfolding, long-term care providers should compile a comprehensive list of facility details as part of their emergency preparedness plan. The list should include characteristics about a facility’s physical structure, including the number of buildings on-site, the years in which they were built, floor plans and the type of construction materials used.

  • Don’t overlook the logistics

    The central component of any emergency preparedness plan is an evacuation strategy. For long-term care providers, the physical act of moving residents who might have mobility or cognitive issues is difficult enough. Overlooking some of the critical logistics associated with moving patients can make it unmanageable.

    To help ensure a seamless evacuation, every long-term care provider should ensure that their plan includes information about transportation, sheltering and staffing. Considerations include:

  • Transportation: In planning how residents will be transported to sheltering facilities, providers should consider the number of vehicles required, who will drive the vehicles, what medical support is required along the way, and how long it will take to get to the receiving facility. But it’s not just the resident that needs to be moved. Plans should also account for how medications, equipment and medical records will be transported.
  • Sheltering: Detailed information should be included on where residents will go in the event of an evacuation, as well as staff. For each facility selected, note how many residents can be accommodated in terms of sleeping and feeding.
  • Staffing: Many long-term care residents require complex care, so providers must determine how relocated residents will be cared for at the receiving facility. Also determine how many employees will need to stay on-site to assist with the evacuation.

It is essential that long-term care providers have contracts in place with transportation, sheltering and staffing (if additional resources are required) companies well before disaster strikes. With limited resources available during an emergency, reviewing these agreements on an annual basis and including them in their emergency preparedness plans will help ensure long-term care facilities aren’t left stranded in a moment of need.

Activating the best-laid plans

While no provider aspires to go through a real-life disaster, having the appropriate emergency preparedness plans in place can make it a much more manageable experience.  As time is not a luxury available to most executives, long-term care providers never know when they just might need to activate an emergency plan. Beginning to plan today is the best investment they can make in ensuring a safe tomorrow.   

Diane Doherty is Senior Vice President of Chubb Healthcare. She can be reached at

The material presented in this advisory article is not intended to provide legal or other expert advice as to any of the subjects mentioned, but rather is presented for general information only. You should consult knowledgeable legal counsel or other knowledgeable experts as to any legal or technical questions you may have. This advisory article contains links to third-party websites and references third-party entities solely for informational purposes and as a convenience to readers and not as an endorsement by Chubb of the entities referenced or the contents on such third-party websites. Chubb is not responsible for the content of linked third-party sites and does not make any representations regarding the content or accuracy of materials on such linked websites.