Kathleen Collins Pagels and Stan Szpytek

Since 2011, Arizona’s Disaster Ready program has proactively addressed emergency preparedness in skilled nursing facilities (SNF) throughout the state. Managed by the team at the Arizona Health Care Association and funded through a grant overseen by the Arizona Department Health Services (ADHS), this program provides emergency management resources to all SNFs in the state. The Disaster Ready initiative is unique to Arizona and is one of the very few highly evolved SNF emergency preparedness models in place across the country. 

The Disaster Ready leadership team recognized that the needs of one sector stood out while working with skilled nursing providers since 2011 through the grant — the behavioral care population. Many SNFs are now caring for individuals with significant gero-psych issues, serious and chronic mental illness and behaviors associated with advanced dementia. These residents are younger and ambulatory. Some of them have significant co-morbidities and multifaceted care needs. These unique resident characteristics seem to call for an innovative approach to emergency preparedness. Yet, there were no resources available that focused specifically on preparedness strategies for behavioral long term care. This compelling need demanded a closer look and Arizona initiated a first of its kind program to further assess the situation.

And so began this pilot. In 2019 the Disaster Ready team conducted a targeted gap assessment with three behavioral care SNFs in Arizona to identify strengths, vulnerabilities and opportunities for improvement. This analysis included a detailed examination of their emergency management plans, along with a comprehensive interview process to further identify the specialized resources and training needed for these properties to remain operational during emergencies and disasters.

This pilot study was submitted to ADHS and provided an in-depth overview of the challenges that these specialized behavioral facilities experience during incidents that require some type of emergency response. All of the potential threats and perils that could impact the pilot facilities both internally and externally were clearly itemized in each provider’s Hazard Vulnerability Assessment (HVA) developed in accordance with the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule 

Twenty recommendations were developed as a result of this pilot study. They addressed both the needs identified and a path forward. One of the main findings of the report revealed that these facilities should generally only be evacuated as a last resort based on the acuity and complexity of residents’ physical and behavioral conditions. It became clear that a formalized decision-making process was needed to determine if a facility should evacuate or shelter-in-place during an emergency or disaster. Other recommendations placed emphasis on the high priority of elopement risk, staffing needs and transportation considerations.

ADHS funded a second phase of this project that focused on the development of an SNF Behavioral Care Took Kit. This tool kit offers providers the resources needed to help prepare, respond and recover from emergencies and disasters. Key components of the tool kit include the following:

  • Elopement risk best practices for behavioral SNFs
  • Evacuation/Shelter-in-Place Decision Making Guide
  • Revised Incident Command forms for behavioral SNFs
  • Behavioral specific disaster scenarios for tabletop exercises (TTX)
  • Mental health resources
  • Utility guides
  • Emergency kit inventory information

The SNF Behavioral Care Pilot Study and subsequent development of the SNF Behavioral Care Tool Kit by Arizona’s Disaster Ready program clearly reveals that one size does not fit all when it comes to emergency preparedness in facilities that provide services to behavioral residents. There is undoubtedly much more to learn. This information is being shared in the hope that it will generate increased public policy dialogue, funding and advocacy for one of the most vulnerable resident populations we serve in any emergency or disaster scenario.

Stan Szpytek is the president of consulting firm Fire and Life Safety Inc., in Mesa, AZ, and is the life safety/disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities (CAHF). Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.

Kathleen Collins Pagels is the president of KC Pagels & Associates, a national long-term care consulting firm. She was formerly the executive director of the Arizona Health Care Association and currently serves a consultant to the organization. Kathleen was the founder of the Disaster Ready program and has been an advocate for long term care for more than four decades.