For long-term care facilities, fallout from recent disasters around the country, from hurricanes in Texas, Florida, and Puerto Rico to fires in Oregon and California, highlight the importance of having clear, well-defined procedures in place to prepare for and respond to disasters, whether arising from natural causes or from human actions.
Diminished resources and system failures can have serious consequences for the residents under a facility’s care if the facility has not taken adequate steps to prepare. Preparation requires a clear, achievable plan, supported by policies and procedures, that identifies potential emergencies and describes how the facility will prepare for and respond to the emergency.
In developing emergency plans, facilities may find it challenging to anticipate what might occur during an emergency and to plan for unexpected contingencies that may arise. For this reason, clear lines of authority and effective communication are the central features of effective emergency planning. The facility may be able to ensure it has, for example, sufficient supplies on hand if conditions make it difficult to access the usual sources of supplies.
But a facility may not anticipate a system failure that affects its ability to carry out aspects of its disaster plan. In that scenario, knowing the answers to certain questions becomes critical. Who is responsible for making decisions as a situation unfolds during an emergency? How will decisions be communicated to staff, residents, and residents’ families as they are made? If an emergency is confined to the facility, how will staff communicate with one another? If an emergency affects an entire region, how will the facility communicate with emergency responders?
As the facility proceeds through the steps of assessing its risk, developing policies and procedures, and training its staff on emergency response, these questions should be at the forefront. New federal regulations on emergency preparedness for health care facilities emphasize detailed, facility-specific planning for emergency situations. They also require the development of a communication plan with clear lines of communication and coordination with regional authorities and other health care providers to ensure effective management of emergencies.
The first step a facility should take in creating an emergency response plan is to perform a risk assessment. A risk assessment should identify emergency situations that may arise based on the facility’s location, its resident population, and other relevant factors. Federal emergency preparedness regulations require that the risk assessment take an “all-hazards” approach, meaning that the assessment should identify all of the potential hazards that a facility may face and develop plans to respond to the specific hazards that the risk assessment identifies. The risk assessment should assess the likelihood that an emergency situation would affect the facility, identify how the situation would affect the facility, determine the resources necessary to respond to the emergency, and consider the types of decisions that may need to be made while the situation is unfolding. It should address issues including, but not limited to, staffing, essential supplies (food, water, and pharmaceuticals), sources of energy to maintain critical systems, and accounting for the whereabouts of residents and staff.
Based on their assessments of the risks, different facilities may prioritize different types of hazards in the planning process. For example, a long-term care facility in Missouri probably does not need an emergency plan for a hurricane — but it should have one for tornadoes and other severe storms. Emergency plans should also identify specific risks that may arise based on the facility’s population.
For example, all facilities should be prepared to respond if a resident goes missing, but a facility that specializes in patients with dementia should develop a plan that includes aspects specific to the heightened risks faced by dementia patients who elope. The facility should refer to its own facility assessment to ensure that its risk assessment addresses the different patient populations that it describes itself as serving and takes into account any vulnerabilities that may arise due to patients’ unique needs.
After the facility has identified the risks, it should develop emergency-specific policies and procedures that address the full range of needs and issues identified in the risk assessment. They should include, for example, how the facility will address subsistence needs for both residents and staff — food, water, medication, temperature control, and similar — evacuation plans (including how evacuated patients will be tracked and eventually returned to the facility), procedures for maintaining critical systems, and the management of resource shortages.
Policies and procedures should clearly identify who is responsible for which aspects of the facility’s emergency response, particularly, as noted above, with regard to decision-making and communication. Coordination with other providers in the area, as well as emergency responders, will also be important to ensuring that plans are both realistic and effective.
For example, a facility might plan to rely heavily on ambulance services operated by a locality for evacuation during an emergency — but if the locality’s plan for the same emergency prioritizes using the ambulances in a different way, the facility’s plan will not be effective should an emergency arise.
Finally, a facility should thoroughly train its staff on emergency preparedness and run drills, both announced and unannounced. Federal regulations require an annual, full-scale drill (preferably involving community-based emergency responders) and at least one “tabletop” exercise. Both of these required drills should result in a written analysis of the facility’s response, and the emergency plan should be updated if issues are identified.
Meredith N. Larson is an attorney at Baker Donelson representing healthcare providers. She is based in Baltimore.