Robin Bleier
Robin Bleier

June is a glorious month. School is out for the summer, and the watermelons are sweet on the vine. Add the smell of freshly cut grass and you know summer is here. However, along the Atlantic and Gulf coasts this month means the arrival of hurricane season.

In my home state of Florida, we are constantly aware of the potential for hurricanes and tropical storms. Many of us still remember the utter devastation of Hurricane Andrew in 1992 and the non-stop pounding of eight named storms in 2004 and 2005. Thankfully, it’s been a decade since a hurricane made landfall in Florida, but the flipside of that good fortune is the risk of preparation complacency.

<>I have served the last 12 years as chair of the Florida Health Care Association’s Emergency Preparedness Council, and I’ve been involved in emergency preparedness for nearly three decades. I have seen my share of disasters and the devastation they can cause to the long term care community. That experience has reinforced the wise advice of a former head of the Texas Health Care Association: “Experience is what you have after you need it.”

One experience in particular stands out as a vivid reminder of the importance of preparation. In September 1998, I was the chief operating officer of a small healthcare company with properties in the Florida Keys. As Hurricane George approached, we realized that our emergency preparedness plans had never been truly activated. But with the help of a devoted group of 35 team members, we managed to move more than 300 residents from their “homes” to temporary shelter. We were blessed to have everything go smoothly, but the lessons we learned pushed me into becoming more knowledgeable about disasters and planning. As a licensed heathcare risk manager, I understood just how lucky we were – and how many situations cropped up that we simply hadn’t anticipated.

Emergency preparedness and planning have become second nature to many of our Florida centers. Long before hurricane season arrives June 1, we try to remind providers that it only takes one storm in their area to make it an “active season.” Having an up-to-date emergency management plan is critically important, but so is discussion-based training with staff so everyone knows their roles and responsibilities. It’s essential, for example, to have a back-up plan for power failures, to stock additional supplies, and to have a staffing schedule that could cover up to 10 days of impact, should that need arise. Plans are also needed for sheltering in place, and for evacuating residents to another center if necessary.

A key focus for Florida skilled nursing centers has been building relationships with our local Emergency Management and County Health Department partners. If real estate is all about location, then emergency preparedness is all about relationships. We’ve found that having personal relationships with key local partners and a clear understanding of what we can and should expect from one another during an emergency are critical to success.

When to evacuate

One of biggest challenges is whether to evacuate. It is vitally important to have a clear understanding of what triggers that decision, and what is set in motion by that decision. You must consider your transportation capabilities, so knowing the terms of your transportation contracts is key. So is knowing just how long it will take to transport residents from bedside to bedside.

As Kenny Rogers sang, “You’ve got to know when to hold ’em, know when to fold ’em.” It isn’t always clear when the time has come to “fold,” to evacuate your residents. The decision to stay put is often really a decision to stay “for now.” Circumstances may change, and you may suddenly be faced with reasons to evacuate that were unforeseen at the time of the original decision – such as a tree crashing through an essential part of the building.

Deciding whether to evacuate is always complicated and filled with conflicting considerations, ranging from the characteristics of the center and where it’s located to the complexities of the residents served and the proximity of external concerns such as power plants. Evacuation is a skill that is developed through drills and activities with an intentional focus on being prepared. While practice won’t guarantee that you are perfect, it will certainly help you develop flexibility to better handle the unexpected when nature or man-made forces throw you a curve ball.

Additional resources

To help providers who are looking for resources on emergency preparedness, the Florida Health Care Association recently launched a comprehensive website in partnership with Emory University. The Long Term Care Emergency Preparedness Portal – – was developed to support and answer many of the questions and considerations faced by skilled nursing and post-acute care centers, as well as assisted living facilities. The site provides information to help develop all-hazards plans and conduct training exercises proven to support better outcomes during emergency events. An easy-to-use search engine can help find information on specific emergency preparation topics and preparedness resources.  

No matter how long it’s been since we last faced a major disaster, it’s important for all of us in the long term care community to remain aware and prepared. We all need to participate in in-service and education, tabletop exercises, disaster assessments, and actual disaster drills. Take an all-hazards approach to disaster management and make sure the plan you develop doesn’t just live in a dusty book on a shelf – ensure that it’s a functioning part of your clinical risk operations.

Robin A. Bleier, RN, LHRM, CLC, has been chairwoman of the FHCA Disaster Council since 2003 and is a published author, an advisory member to the FHCA Quality Foundation, Chair of the FHC-PAC, and former member of the American Health Care Association Disaster Council. She has various memberships and participations and is a diverse provider. Robin can be reached at robin (at) or at 727.786.3032.