COMPREHENSIVE EMERGENCY MANAGEMENT PLAN (CEMP) … · CATHOLIC HOSPICE, INC. Updated April 2015. COMPREHENSIVE EMERGENCY MANAGEMENT PLAN (CEMP) FORMAT FOR HOSPICES . Developed by

CATHOLIC HOSPICE, INC.

Updated April 2015

COMPREHENSIVE EMERGENCY MANAGEMENT PLAN

(CEMP) FORMAT FOR HOSPICES

Developed by Catholic Hospice, Inc. #5004095

In Compliance With: s.400.610(1)(b), Florida Statutes 58A-2.005(1)(c)1.d., Florida Administrative Code 58A-2.026, Florida Administrative Code

DOEA Form H-001, March 2007 Rule 58A-2.026, F.A.C. Page 1 of 41

Table of Contents

Page # I. INTRODUCTION 3 II. CONCEPT OF OPERATIONS 5-26

A. Direction and Control 5-8 B. Education of Patients Prior to an Emergency 8-10 C. Notification 10-15 D. During an Emergency 16-24 E. Evacuation

• Special Needs Registrant • Facility

25

F. Re-Entry • Home and Special Needs Shelter • Hospice Facility

26

III. INFORMATION, TRAINING AND EXERCISE 29-31 IV. APPENDICES 32-38

A. Roster of Employees and Companies with Key Disaster Related Roles 33

B. Agreements and Understandings 34 C. Facility Evacuation Route Maps 35 D. Information for Hospice Patients 36 E. Letter of Approval of the Annual Fire Inspection Plan 37 F. Support Material 38

(Create Additional Appendices as Appropriate.)

DOEA Form H-001, March 2007 Rule 58A-2.026, F.A.C.

Page 2 of 41

I. INTRODUCTION An active/ongoing disaster evacuation plan is necessary for any organization providing care to patients in their home. In South Florida hurricane preparedness is a high priority; however, other potential disasters – severe flooding, riots, nuclear, or bomb threats – may also present a need for readiness and swift response. The following Plan, although directed most specifically to preparation for a hurricane which is the most frequent hazardous emergency experienced in South Florida, will be modified as needed in the event another type of disaster should occur. The Executive Director or designee will be responsible for determining the existence/type of disaster and activating the plan, consistent with the directives of local and State Offices of Emergency Management. Catholic Hospice’s Comprehensive Emergency Management Plan fosters collaborative teamwork by management and staff to equally share the accountability and responsibility to protect patients, staff and the Catholic Hospice offices to the extent possible. Accountability for hurricane preparation is shared by all management staff to participate in the execution of this plan to enhance patient and staff safety and protect the offices and property of Catholic Hospice. The Emergency Management Plan is designed to manage the consequences of natural disasters and/or other emergency situations within Catholic Hospice’s geographic service area that will disrupt its ability to provide care and treatment for a period of time. The Emergency Management Plan follows criteria set forth by the Agency for Health Care Administration, in satisfaction of basic emergency management plan requirements of section 400.610(1), Florida Statutes, 58A-2.005, and 58A-2.026, Florida Administrative Code. Catholic Hospice leadership, Directors and Managers, actively participate in the planning and execution of the organization’s readiness for community emergencies. This Emergency Management Plan was developed by Catholic Hospice’s Executive Director in conjunction with the organization’s senior management team and is annually submitted to the governing board and the appropriate State and local agencies as required.


1. Basic Information about Catholic Hospice Hospice Name: Catholic Hospice, Inc. Physical Address: 14875 NW 77th Avenue, Suite 100 Miami Lakes, Florida 33014 Mailing Address: 14875 NW 77th Avenue, Suite 100 Miami Lakes, Florida 33014 Emergency Phone Number: 305-822-2380 Fax Number: 305-824-0665 Cell Phone Number: 786-368-3749 County or counties licensed to serve: Miami-Dade; Broward; Monroe 2. Person in Charge during an Emergency Primary Name/Title: Bonnie Alkema, Executive Director Work Phone Number: 305-351-7101 Cell Phone Number: 786-368-3749 Alternate Name/Title: Melinda Diaz, Sr. Director of Operations Work Phone Number: 305-351-7130 Home Phone Number: 954-805-3438 Cell Phone Number: 305-790-3095 Alternate Name/Title: Rita Kathalynas, Director of Professional Services Work Phone Number: 305-351-7004 Home Phone Number: 954-540-3854 Cell Phone Number: 786-382-1155 3. Corporation Owner(s) and Chief Operating Officer Corporation/Owner Name: Joe Catania, President & CEO Address: 4790 N. State Road 7, Lauderdale Lakes, FL 33319 Work Phone Number: 954-484-1515 (Insert additional owners as appropriate.) See attached Chief Operating Officer Name: Jim Ball Address: 4790 N. State Road 7, Lauderdale Lakes, FL 33319 Work Phone Number: 954-484-1515 4. Person(s) Who Developed Plan Name/Title: Melinda Diaz, Sr. Director of Operations Address: 14875 NW 77th Avenue, Suite 100 Miami Lakes, Florida 33014 Work Phone Number: 305-822-2380 Home Phone Number: 954-805-3438 Cell Phone Number: 305-790-3095


II. CONCEPT OF OPERATIONS

A. Direction and Control

Contact information for all Senior Management staff is available from the Executive Director’s office and is disseminated prior to the emergency. Consistent with Catholic Hospice’s Chain of Command policy, if the Executive Director has not otherwise named a designee, authority rests with the priority list of individuals noted below:

1. The chain of command to ensure continuous leadership and authority in key positions is as follows:

Executive Director, Bonnie Alkema 305-351-7100 Office (main number) 305-822-2380 Office (direct) 305-351-7100 Executive Director, Cell phone 786-368-3749 (24 hour availability)

1st Designee, Melinda Diaz, Sr. Director of Operations Cell Phone 305-790-3095

Home Phone 954-805-3438 Office (main #) 305-822-2380

Office (direct) 305-351-7130

2nd Designee, Rita Kathalynas, Director of Professional Services Cellular phone 786-382-1155 Home phone 954-540-3854

Office (main #) 305-822-2380 Office (direct) 305-351-7004

3rd Designee, Dr. Marcos Rejtman, Medical Director

Cellular phone: 786-261-8850 Home phone: 954-5545738

Office (main #) 305-822-2380 Office (direct) 305-351-7120

Whether the Executive Director or a Director/designee is in the leadership role, all members of the senior management team lead together as a team in their respective areas of expertise and responsibility.

2. The procedures to ensure timely activation of the hospice’s comprehensive emergency management plan and staffing of the hospice during an emergency are as follows:


All Catholic Hospice staff is expected to be knowledgeable about this Comprehensive Emergency Management Plan prior to the beginning of hurricane season (June 1) and to provide personal emergency contact information as requested. Employees receive education related to this Comprehensive Emergency Management Plan at orientation and annual on-going education specific to their duties as part of Plan implementation. Joint Management, annually, reviews the Plan at the beginning of hurricane season. Education is provided by Catholic Hospice Education Department and community resources as needed.

All staff is expected to maintain awareness of tropical storm activity via television, radio, and internet during hurricane season (June 1 to November 30). Staff is encouraged to make personal/family hurricane emergency plans in advance so that appropriate work time and attention may be devoted to preparing patients and CHI offices within the time frames provided by this plan. Staff members are reminded to include time before the emergency to prepare their families evacuation plans, to prepare their homes, to have available supplies, cash and gasoline to safely weather the emergency. When possible and with the Executive Director or a Director/designee’s approval, staff may be given time (late start or early departure) to assist in final personal preparations for an impending emergency, but only if patient care is not compromised. At least annually and always subsequent to any implementation of this Comprehensive Emergency Management Plan, the Plan is to be reviewed and revised as needed to continuously improve performance. Annually the Plan is submitted to the governing board for its approval and submitted to appropriate State and local regulatory organizations as required. All Managers will maintain a list of staff identifying who will be working before, during and after emergency.

A. Activation and Deactivation by the Executive Director or Designee

When a tropical storm is identified to be a potential threat to South Florida: 1. Joint Management meeting is called by the Executive Director or designee

within 24 hours, with all management staff present either in person or via conference call.

2. An individual is assigned by the Executive Director or designee for round the clock monitoring of weather conditions.

3. Communication contact with Office of Emergency Management, including Catholic Hospice contact information, is verified.

4. Team Managers verify that medical supplies are stocked at sufficient levels to provide a week’s supply to all patients AND to still have par levels adequate for a week following the emergency. If not, medical supplies are ordered immediately for delivery before the pending emergency.


5. HR assembles an address list of the home/personal telephone numbers/cell numbers and e-mail addresses of all joint management and provides it to all members of Joint Management.

6. At the discretion of the Executive Director or designee, any part of this emergency management plan may be initiated early.

Otherwise, in the event of a storm, the plan is activated when a Tropical Storm Warning and/or Hurricane Watch is announced by the National Hurricane Center and/or when an equivalent level of readiness is activated by the local Office of Emergency Management. In the event of any other type of disaster where advance notice is available, the plan will go into effect based on the information available to the Executive Director /Designee. If time permits and based on the nature of the disaster, Catholic Hospice will tailor the steps outlined in the Hurricane Watch section (24-36 hours’ warning) of this plan to meet the needs of the staff, patients and families served by Catholic Hospice. If time does not permit (less than 24 hours’ warning), and based on the nature of the disaster, Catholic Hospice will tailor the steps outlined in the Hurricane Warning section of this plan to meet the needs of the staff, patients and families served by Catholic Hospice. B. Authority to Activate The Executive Director or Designee has the authority to activate this Plan and will act as the overall coordinator of the Plan before, during and after the disaster/emergency. The Executive Director or Designee has the authority to notify the staff that the emergency has ended and return operations to normal procedures. Authority to activate this plan on holidays, weekends or evenings resides with the Executive Director or Designee. When the OEM or local emergency authority declares a Tropical Storm Warning and/or Hurricane Watch or notifies the community of an impending emergency outside of normal business hours, the Executive Director or Designee may delay the full activation by several hours while efforts are being made to contact needed staff to report to their duties as defined by this Plan. If a hurricane watch is anticipated to occur during the evening, weekend or holiday, to the extent possible, preparations are begun earlier during normal business hours. Telephone calls outside normal business hours are received by the triage nurse. Any calls related to community emergencies or calls from the Office of Emergency Management (OEM) are forwarded immediately and directly to the Executive Director or designee and then communicated to Director’s and all necessary staff according to this Comprehensive Emergency Management Plan.

B. Education of Patients Prior to an Emergency 1. The procedures for educating patients and patients’ caregivers about the hospice’s comprehensive emergency management plan are as follows: As part of the admission process, information of disaster preparedness is provided to patents and families. Receipt of this information is verified on the initial consents. DOEA Form H-001, March 2007 Rule 58A-2.026, F.A.C.

Page 7 of 41

During the first week of admission, the Team meets with the patient and family to complete the Disaster Preparedness Information. The data is entered into Suncoast (electronic medical record) for ready reference. Beginning in May and throughout the hurricane season the Team also provides education for patient and family regarding preparing for hurricanes, possible planning for evacuation, available shelters including the Special Needs Shelter and the provision of hospice services just before and just after a hurricane or similar community emergency. The Team reviews the patient and family copy of Catholic Hospice’s informational brochure, WINDD What Is Needed During Disasters, available in English and Spanish. This brochure is reviewed annually and updated as needed prior to the first of May.

Families are assisted by Social Worker, Nurse Care Manager and/or other hospice staff member to plan an evacuation site (family, friends, hotel, etc.) if the patient’s residence is located in a mandatory evacuation zone; all mobile homes in the County are mandated evacuation zones. Only patients meeting criteria for admission to an inpatient facility will be able to shelter in a hospital during the emergency, if beds are available. Family members may be unable to remain with the patient, depending on the restrictions required by the hospital or nursing home. Catholic Hospice has three Inpatient Units which will accept patients during an emergency as beds are available.

The Team identifies those patients in evacuation zones without a family provided evacuation site and who may need transportation to the Special Needs Evacuation Center for hospice patients and notifies Team Managers. The Team Managers provide a list of these patients to the Catholic Hospice Liaison who registers these names with the Office of Emergency Management as soon as possible. This list is reviewed/revised on an ongoing basis throughout hurricane season.

2. The procedures for discussing with those patients who need continued services, who are not registered with the special needs registry, the patients’ plans during, and immediately following, an emergency are as follows: During the initial psychosocial visit following admission to the program, the Social Worker meets with the patient and family to review Disaster Preparedness information and aid in the development of an individualized disaster plan. The plan is documented in the patient’s record in Suncoast for ready reference in the event of an emergency. 3. The procedures for providing written materials about the special needs registry, in their area, with those patients who will require evacuation to a special needs shelter during an emergency are as follows: Emergency preparedness information is provided to every patient admitted to Catholic Hospice in the admission packet information which includes information on Special needs Shelters. In addition, beginning in May and throughout the hurricane season, the Team provides education for every patient and family regarding preparation for hurricanes, possible planning for evacuation and the provision of hospice services just before and just after a hurricane or similar community emergency.


Patients who are identified as requiring special assistance in the event of an emergency will be registered with Social Worker assistance to the Emergency Evacuation Assistance Program (EEAP) through the Office of Emergency Management. Assessment of caregiver status will be performed by Social Worker in order to identify caregiver deficits and to ensure patient care needs are met during an emergency. Provision of caregiver services will be coordinated by CHI for those patients who require alternative caregiver services in order to ensure continuity of care during an emergency. 4. The hospice’s procedures for collecting patient registration information during admission for the special needs registry (Note: Patients must be registered with the special needs registry prior to an emergency, not when an emergency is approaching or occurring.) are as follows: At time of admission emergency preparedness education is completed and documented. The Social Workers will provide information regarding the Special Needs Registry and Shelters available in the community. Patients who are identified as requiring special assistance in the event of an emergency will be registered with the Emergency Evacuation Assistance Program (EEAP) through the Office of Emergency Management and documentation of the registration will be maintained in the team Managers CEMP and updated weekly at team meeting during hurricane season from June1 through November 30. 5. Patients will be educated in the role of administering their own medication, and maintaining their own supplies and equipment list (in accordance with Section 2 of Appendix D). In addition the following information is to be provided: *Tips for preparation to safely weather a tropical storm or hurricane *Choices related to voluntary or mandatory evacuation *Choices regarding sites for sheltering during the storm including the Special Needs shelters provided in the community; patient and family are made aware of the limited space and comfort of the Special Needs shelters and their special requirements as well as the need for registration with the Special Needs Registry prior to the beginning of hurricane season *Minimal services available in Special Needs shelters

a) Consent forms, DNRO, contact information for Catholic Hospice and physician, copy of patient’s Plan of Care and medication list

b) Caregiver should accompany patient and remain at shelter c) Patient should bring personal items, bedding, snacks, flashlights, medication, medical equipment

*Provision of hospice services before and after a storm *Criteria for nursing home (for example: patients requiring frequent nursing care that will be impossible to provide during storm; patients who require electricity for medical care; patients expected to expire within 24-48 hours) or hospital inpatient placement (for patients who meet hospital admission criteria) during a storm (patient is responsible for Medicaid, private insurance or private pay; otherwise Director of Finance approval needed) *Necessity to notify Catholic Hospice concerning any change in location. *Patient Rights and Responsibilities


6. Patients registered with the special needs registry will also be educated (in accordance with Sections 1 and 3 of Appendix D). This will include; the same type and quantity of services will be provided at the special need shelter, that conditions in the shelter may be stressful and may even be inadequate for their needs; an that special needs shelters are an option of last resort. The specific procedures for accomplishing this are as follows: For those patients likely to select sheltering in the Special Needs Evacuation Center, a list of current medications will be provided at the time of the emergency. At that time the primary nurse notifies the Team Manager what equipment and disposable medical supplies will be needed to be transferred to the shelter along with the patient. The patient and family are reminded to bring the patient’s consent forms, medication list and DNR form to the shelter along with other items to assist in patient comfort (bedding, air mattress, lawn chair, snacks, etc). A copy of INFORMATION FOR HOSPICE PATIENTS – Registered with Special Needs Registry, attached, serves as a guide in preparing patients and caregivers for Special Needs Shelters and is provided to patients and families. (see above per patient education)

C. Notification

1. The procedures on how the hospice staff in charge of emergency plan implementation will receive warnings of emergency situations, including off hours, weekends and holidays are as follows: a. Joint Management meeting is called by the Executive Director or designee with

all management staff present either in person or via conference call. b. An individual is assigned by the Executive Director or designee for round the

clock monitoring of weather conditions. c. Communication contact with Office of Emergency Management, including

Catholic Hospice contact information, is verified. d. Team Managers verify that medical supplies are stocked at sufficient levels to

provide a week’s supply to all patients AND to still have par levels adequate for a week following the emergency. If not, medical supplies are ordered immediately for delivery before the pending emergency.

e. HR assembles an address list of the home/personal telephone numbers/cell numbers and e-mail addresses of all joint management and provides it to all members of Joint Management.

f. At the discretion of the Executive Director or designee, any part of this emergency management plan may be initiated early.

In the event of a storm, the plan is activated when a Tropical Storm Warning and/or Hurricane Watch is announced by the National Hurricane Center and/or when an equivalent level of readiness is activated by the local Office of Emergency Management. In the event of any other type of disaster where advance notice is available, the plan will go into effect based on the information available to the Executive Director /Designee. If time permits and based on the nature of the disaster, Catholic Hospice will tailor the steps outlined in the Hurricane Watch section (24-36 hours’ warning) of this plan to meet the needs of the staff, patients and families served by Catholic Hospice.


If time does not permit (less than 24 hours’ warning), and based on the nature of the disaster, Catholic Hospice will tailor the steps outlined in the Hurricane Warning section of this plan to meet the needs of the staff, patients and families served by Catholic Hospice. The Executive Director or Designee has the authority to activate this Plan and will act as the overall coordinator of the Plan before, during and after the disaster/emergency. The Executive Director or Designee has the authority to notify the staff that the emergency has ended and return operations to normal procedures. Authority to activate this plan on holidays, weekends or evenings resides with the Executive Director or Designee. When the OEM or local emergency authority declares a Tropical Storm Warning and/or Hurricane Watch or notifies the community of an impending emergency outside of normal business hours, the Executive Director or Designee may delay the full activation by several hours while efforts are being made to contact needed staff to report to their duties as defined by this Plan. If a hurricane watch is anticipated to occur during the evening, weekend or holiday, to the extent possible, preparations are begun earlier during normal business hours. Telephone calls outside normal business hours are received by the triage nurse. Any calls related to community emergencies or calls from the Office of Emergency Management (OEM) are forwarded immediately and directly to the Executive Director or designee and then communicated to Director’s and all necessary staff according to this Comprehensive Emergency Management Plan.

2. The procedures for alerting key staff are as follows: Staff will be notified of activation of the plan and all updated information as it becomes available via our telephone call down tree system:

a. The Executive Director or Designee notifies all Directors and others reporting directly to the Executive Director.

b. Each Director and/or others notify their respective Department Managers and physicians.

c. Department Managers notify their respective field and office staff. All messages will also be sent via e-mail as long as this media are available; a list of cell phones numbers for staff with cell phones for business use is available per intranet (www.chsharenet.org).


http://www.chsharenet.org/

Staff update during and after the emergency: a. Three telephone numbers and the intranet website will be used to provide

updates to Catholic Hospice staff regarding the status of the organization including information about office opening and returning to normal status once the emergency has safely passed. Staff may call any of the numbers, located in three different areas of the county to receive the same information. The recorded message may change several times in a day as conditions change.

b. The telephone lines or web site is dependent on electricity. In the event of failure of electricity at one or more of these sites, Catholic Hospice has a prearranged voice mailbox where the staff updates will be posted at (305) 351-7140.

c. Catholic Hospice’s Main number (305-822-2380 or 954-676-5448) is transferred to the Answering Service for the duration of the emergency and should be used only by patients and families and staff members on duty for patient care. NO INFORMATION WILL BE AVAILABLE FROM THE ANSWERING SERVICE REGARDING OPENING OF THE OFFICES AND/OR DETERMINATION TO RETURN TO NORMAL OPERATING STATUS

In the event that phone lines are inoperable CHI will access available media utilizing the emergency broadcast system to inform staff of the office status and work instructions. The Director of Community Relations or designee will be available to serve as liaison for communication with the media. 3. The procedures for alerting patients and the precautionary measures that will be taken, including but not limited to voluntary cessation of the hospice’s operations, are as follows: . All patients are to be alerted in person by field staff to ensure that each individual has adequate pharmacy, disposable and durable supplies to last a minimum of one week. Patients/families are to be informed that if a patient moves before/during/after the storm to a site other than that identified on the patient’s disaster preparedness form, to notify Catholic Hospice as soon as possible at its main telephone number, 305-822-2380 or 954-676-5448 (The answering service which supports this telephone line when Catholic Hospice offices are closed is maintained on emergency generators and has capacity for more than a week of electrical power). At the time the National Weather Service announces a Tropical Storm Warning and/or Hurricane Watch, or sooner if deemed necessary by the Executive Director or Designee, specific duties are assigned to Catholic Hospice management and staff. In order to accomplish all tasks necessary to prepare patients to safely weather a community emergency such as a hurricane, it may be necessary to adjust assignments and/or schedules of any employee at any time during the preparation. While the emergency conditions in the county or local area are deemed by the Office of Emergency Management to be hazardous, such as during the passage of a tropical storm or hurricane, Catholic Hospice is unable to provide its usual array of services. Staffing during the actual emergency period will include a triage nurse and physician on-duty, scheduled for 12 hour shifts on the EMERGENCY STATUS schedule. The usual


AOC schedule will prevail in the event that the triage nurse or physician needs to contact the AOC. After the emergency status in the community has been lifted by the Office of Emergency Management and it is safe to begin traveling within the community, the staff that has been scheduled for response following the storm will begin working. As quickly as possible following the emergency a determination will be made by the Executive Director or designee to return to normal status; normal staffing schedules and services will resume to all patients as quickly as possible within the limits of any remaining localized or community-wide emergency conditions.

4. The alternative means of notification and procedures of notification should the primary system fail (pursuant to s.400.605, F.S.) are as follows: All messages will also be sent via e-mail as long as these media are available; a list of cell phones numbers for staff with cell phones for business use is available per intranet (www.chsharenet.org). Three telephone numbers and the intranet website will be used to provide updates to Catholic Hospice staff regarding the status of the organization including information about office opening and returning to normal status once the emergency has safely passed. Staff may call any of the numbers, located in three different areas of the county to receive the same information. The recorded message may change several times in a day as conditions change.

The telephone lines or web site is dependent on electricity. In the event of failure of electricity at one or more of these sites, Catholic Hospice has a prearranged voice mailbox where the staff updates will be posted.

Catholic Hospice’s Main number (305-822-2380 or 954-676-5448) is transferred to the Answering Service for the duration of the emergency and should be used only by patients and families and staff members on duty for patient care. NO INFORMATION WILL BE AVAILABLE FROM THE ANSWERING SERVICE REGARDING OPENING OF THE OFFICES AND/OR DETERMINATION TO RETURN TO NORMAL OPERATING STATUS. In the event that phone lines are inoperable CHI will access available media utilizing the emergency broadcast system to inform staff of the office status and work instructions. Catholic Hospice’s answering service also has a backup number, if needed (561-988-5272). In the event that access and services to the Main or Satellite offices are disrupted a temporary office will be designated by the Executive Director or Designee. Contingency site(s) will be selected based on type of disaster/emergency and space availability. If necessary, a north and south site will be arranged. These arrangements, time permitting, will be prepared prior to the disaster, with possible sites being one or more of our contracted hospitals and/or nursing homes where temporary access to supplies and communication could be arranged.


http://www.chsharenet.org/

5. The hospice will maintain a current prioritized list of patients who need continued services during an emergency. The list shall indicate how services shall be continued in the event of an emergency or disaster for each patient and if the patient is to be transported to a special needs shelter, and shall indicate if the patient is receiving services, as well as the patient’s medication and equipment needs. The list shall be furnished to county health departments and to local emergency management agencies, upon request. The specific procedures for accomplishing this are as follows: Patient Care staff will be provided with a current list of evacuation zones and public shelter locations, including the Special Needs Evacuation Center (SNEC). Information Systems will provide Team Managers with a list of patients sorted by zip code in order to identify those patients in evacuation zones. This list will be updated at the time a hurricane watch is called or this Plan is activated, whichever occurs first. Families are assisted by Social Worker, Primary Nurse and/or other hospice staff member to plan an evacuation site (family, friends, hotel, etc.) if the patient’s residence is located in a mandatory evacuation zone; all mobile homes in the County are mandated evacuation zones. Only patients meeting criteria for admission to an inpatient facility will be able to shelter in a hospital during the emergency, if beds are available. Family members may be unable to remain with the patient, depending on the restrictions required by the hospital or nursing home. Catholic Hospice has Inpatient Care Centers which will accept patients during an emergency as beds are available. The process for emergency admission to the unit is as follows:

A. The transfer planning process is initiated early and involves the interdisciplinary team, the physician and the patient/family.

B. The nurse obtains a physician’s order for transfer.

C. The attending/primary physician is notified of the transfer.

D. The nurse calls in a report to the receiving unit. The report includes:

1. A summary of the care and services provided and progress toward goals, including positive and adverse responses to treatment.

2. Continuing symptom management needs.

E. The team nurse provides medications related to the hospice (terminal) diagnosis and sends the medications to the unit with the patient.

F. Upon admission to the unit a wristband is placed on patient, medications are reviewed, and all personal property is logged in. Documentation is provided on paper.

The Team identifies those patients in evacuation zones without a family provided evacuation site and who may need transportation to the Special Needs Evacuation Center for hospice patients and notifies Team Managers.


The Team Managers provide a list of these patients to the Catholic Hospice Liaison with the OEM who registers these names with the Office of Emergency Management as soon as possible. This list is reviewed/revised on an ongoing basis throughout hurricane season. Catholic Hospice contracts with facilities for potential evacuation beds for patients meeting criteria for nursing facility or hospital placement and for emergency transportation. Finance is responsible for annually updating the contracts prior to the first of June.

Evacuation, if needed, of patients already admitted to a nursing facility or hospital may be managed by the facility to which the patient has been admitted or may become the responsibility of Catholic Hospice. Social Workers for each team need to remain vigilant if intervention and assistance is needed. Catholic Hospice maintains a contract with ambulance service. The Office of Emergency Management has oversight over ambulance transportation in the county during a declared emergency. Patient transportation by ambulance, if needed, will be coordinated with contracted agency and the OEM requirements.

At the beginning of hurricane season (June) Social Services shall contact any nursing facilities, ALF’s and hospitals in evacuation zones to determine their plans in the event a hurricane threatens Broward/Miami Dade County. 6. Explain the means by which the hospice will ensure the staff will continue to provide the same type and quantity of services to their patients who evacuate to a special needs shelter. Catholic Hospice will provide staff to attend any patient who needs to reside in a Special Needs Shelter who is unable to care for self. Triage nurses staffed(regardless of day of week on which the emergency might occur) to triage in 12 hour shifts for 96 hours during and after the storm; provide staffing whose location is dispersed across the two counties to the extent possible. Physicians (regardless of day of week on which the emergency might occur) to be on-call in 12 hour shifts for 96 hours during and after the storm; provide staffing whose location is dispersed across the counties to the extent possible.

Administrator on Call (AOC) in effect at the time of the emergency; verify with the assigned individuals that they will be available to take call. Forward a copy of the On-call lists according to the normal distribution including the answering service. Verify that the answering service has contact information for the Executive Director or Designee. Professional staff to be available to serve as runners if offices are delayed in reopening once travel in the community is deemed safe and patient visits can be scheduled. To the extent possible staff from across the two county area should be included on the schedule. Scheduled Runners are expected to maintain a full tank of gasoline in their automobiles as part of their preparation before the emergency to facilitate their availability to patients when on duty;


Continuous Care staff working before, during and after the emergency, including with patients in special needs shelters are expected to maintain a full tank of gasoline in their automobiles as part of their preparation before the emergency to facilitate their availability to patients when on duty. Inpatient units housed in host facilities will switch to generator power per host facility protocol in the event of an interruption of commercially supplied power. See Appendix B.

D. During an Emergency 1. During an emergency, when there is not a mandatory evacuation, some patients may decide to stay in their homes. The procedures the hospice will take to assure that all patients needing continuing care will receive it, either from the hospice or through arrangements made by the patient or the patient’s caregiver are as follows: At the time the National Weather Service announces a Tropical Storm Warning and/or Hurricane Watch, or sooner if deemed necessary by the Executive Director or Designee, specific duties are assigned to Catholic Hospice management and staff. In order to accomplish all tasks necessary to prepare patients to safely weather a community emergency such as a hurricane, it may be necessary to adjust assignments and/or schedules of any employee at any time during the preparation. All staff are expected to maintain a full tank of gasoline in their automobiles as part of their preparation before, during, and after the emergency to facilitate their availability to patients when on duty. All staff and authorized volunteers are expected to wear their identification badges. The cooperation of all is expected.

A. Team Managers will be responsible for coordination of the following for their respective teams:

Nurse Care managers

Triage patients to define level of care needed 1. Verify medication and equipment needs including availability of hand

cranks for electrical beds and, as needed, the same use and storage of H tanks. A week’s supply of medications and medical supplies should be available in the patient’s residence.

2. For patients in hospital or nursing homes, assess medication and supply

needs; any determination for evacuation is the responsibility of the hospital and nursing home; if the facility is to be evacuated, Catholic Hospice may be responsible for placement of the patient.

3. If a patient is close to death, notify the Team Manager so that a chaplain,

bereavement counselor or social worker may be assigned to visit the patient and family before the storm approaches.


4. If the patient is to be evacuated to a Special Needs Shelter, the primary

care nurse and social worker assist in preparing the patient and caregiver for evacuation including assembling the required documentation that must accompany the patient to the Shelter and educating the care giver with respect to medication administration during the patient’s stay at the Special Needs Shelter.

Patient Care Secretaries

5. Run disaster report on Suncoast. Provide copy to Team Manager and others as needed; Team Manager to verify that information is consistent with report from primary nurse; correct in Suncoast as needed.

6. Order up to a 7 day supply of medication for all patients (considering the

amount of medication already available in the home). The Nurse Care Manager is responsible to follow-up with the patient or family to determine that the medications and supplies have been received.

7. Oxygen

At the time a tropical storm warning or a hurricane watch is announced, Team Manager will solicit a list of patients that are on oxygen (continuous or prn) from the DME vendor. Those patients with oxygen that has been ordered prn will be reassessed to determine whether they are now using the oxygen continuously or on a more regular basis. A list of patients will be compiled to include all the patients who are on continuous oxygen and those who have been noted to have increased their oxygen use. Time permitting, oxygen will be delivered to all patients on oxygen, otherwise priority will be given to those on continuous oxygen. In the event that a patient requiring continuous oxygen lives in an apartment that is on the fourth floor or above, 2 oxygen tanks will be delivered.

The DME Company will hold all other regular deliveries in order to give priority to oxygen needs and will prioritize deliveries to those geographical areas most vulnerable if time is limited. For safety the DME company employees will cease deliveries when it becomes unsafe to travel in the community.

8. Air Mattress At the time of delivery and again before a storm, families will be educated on the fact that the air mattress is only inflated when electricity is available. Families will be instructed that in the event of a power outage, they should place the patient on a regular mattress. If this is not possible, they should place comforters underneath the patient as a form of cushioning. Instruction to family/caregiver may be given by telephone prior to a storm.


9. Suction Machines At the time of delivery and again before a storm, families will be educated on the fact that the suction machine will not work in case of a power outage. Patients will be assessed by primary nurse and the need for skilled nursing care will be determined. In the event that the patient meets criteria for skilled nursing, hospitalization should be considered.

10. All patients are to be seen by field staff to ensure that each individual has

adequate pharmacy, disposable and durable supplies to last a minimum of one week. Patients/families are to be informed that if a patient moves before/during/after the storm to a site other than that identified on the patient’s disaster preparedness form, to notify Catholic Hospice as soon as possible at its main telephone number, 305-822-2380 or 954-676-5448 (The answering service which supports this telephone line when Catholic Hospice offices are closed is maintained on emergency generators and has capacity for more than a week of electrical power).

11. Information Systems will provide Team Managers with the list of current

patients sorted by zip code in order to identify those patients in evacuation zones; to the extent possible the Evacuation Zone assigned by Broward/Miami-Dade County’s OEM will be included. Patients in mandatory evacuation zones are encouraged to evacuate. If they, or their family/caregivers, elect not to evacuate, that is documented in the patient’s record in Suncoast. The patient/family is encouraged to contact Catholic Hospice at 305-822-2380 or 954-676-5448 if circumstances change and the patient moves before, during or after the emergency.

12. Team Managers will prioritize patients according to needs/risks for staff to

contact once the emergency has safely subsided, coding each patient as follows: #1 Patients to be seen within 24 hours of emergency status being lifted #2 Patients to be seen within 48 hours of emergency status being lifted #3 Patients to be seen within 72 hours of emergency status being lifted

13. Team Managers will assemble the patient specific information to be

maintained off-site by them during the emergency: • Current face sheets • PPOCs • List of patients on oxygen • Medication list for each patient • List of patients moving and new location • List of staff members, contact information (telephone/cell

phone/beeper/personal e-mail) before, during and after emergency (available from Human Resources)


14. Each Patient Care Secretary will confirm all staff phone numbers (home, cell) within their teams/departments and anticipated location during emergency and forward to Director of Human Resources. LPNs and HHAs

15. Visit patients as scheduled or adjust schedule as directed by Team Manager.

After hours Manager/ Staffing Coordinator 16. Schedule triage nurses (regardless of day of week on which the emergency

might occur) to triage in 12 hour shifts for 96 hours during and after the storm; provide staffing whose location is dispersed across the two counties to the extent possible. Schedule physicians (regardless of day of week on which the emergency might occur) to be on-call in 12 hour shifts for 96 hours during and after the storm; provide staffing whose location is dispersed across the counties to the extent possible. Schedule the Administrator on Call (AOC) according to the already determined schedule in effect at the time of the emergency; verify with the assigned individuals that they will be available to take call. Forward a copy of the On-call lists according to the normal distribution including the answering service. Verify that the answering service has contact information for the Executive Director or Designee.

17. Prepare list of professional staff to be available to serve as runners if offices are

delayed in reopening once travel in the community is deemed safe and patient visits can be scheduled. To the extent possible staff from across the two county area should be included on the schedule. Field staff may be added to the group scheduled to provide coverage for up to 72 hours, if needed. Scheduled Runners are expected to maintain a full tank of gasoline in their automobiles as part of their preparation before the emergency to facilitate their availability to patients when on duty;

18. Continuous Care Staffing Coordinators are responsible to verify all staff working before, during and after the emergency and provide list to management

19. Inpatient Team Managers are responsible to verify all staff working before, during and after emergency and to provide a list to management.

B. The Manager of Human Resources is responsible to assemble and distribute the telephone contact list to all management, sorting lists as needed to accommodate each manager’s needs for ease of use. C. Finance will provide adequate petty cash to be used for office needs and/or small employee loans after the emergency for those without access to cash in the event of a sustained power failure in the area.


D. The Team Social Worker will assist in arrangements for patients seeking shelter in the Special Needs Evacuation shelter or in need of admission to a hospital or nursing home, with the social worker’s primary responsibility to verify bed availability. Contact will be established with those patients residing within defined evacuation zones. Evacuation plans will be reviewed with patient/families, and if necessary, will be updated in order to ensure accuracy. The Team Social Worker will educate families and patients regarding the organization’s responsibilities before and immediately after the hurricane and/or identified threat. When patients who reside within evacuation zones or meet criteria for hospitalization refuse to evacuate or heed recommendations, the Team Social Worker will educate patients and families on the limits of the service during the storm and the availability of on-call guidance via phone. A list of patients refusing to evacuate will be compiled and distributed.

E. Bereavement Coordinators and Team Chaplains and all otherwise unassigned field staff will visit patients as scheduled until travel is deemed unsafe because of winds, rain or flooding and/or the office is closed. Special attention should be given to the most critical patients and their families.

F. The Volunteer Services Manager will contact all volunteers to check availability for service and anticipated location, phone numbers during the emergency and assign to teams if need arises. The Volunteer Services Manager will distribute the list of potential volunteers and phone numbers to the Director of Professional Services and the Executive Director. G. Physicians will report to their respective team office for signing prescriptions or orders as necessary. H. Each Director will provide for their staff a list of contact numbers in the event the office is inoperable or inaccessible following the emergency. I. The Medical Director or Executive Director or Designee will contact Hospice physicians to remain "on call" for patient care needs and triage.

J. Admissions will continue until it is not longer safe to be on the roads. Referrals taken during the period of the emergency or pending admissions already in process that cannot safely be completed, will be informed that they will be attended to as soon as it is safe to travel. The information for these referrals will be passed on to the Triage nurse that will be covering during the emergency time frame by the admissions coordinator. The Triage nurse will then give the information either to the admission nurse assigned on the first day when all is safe or to the next triage nurse.


K. The Electronic Medical Record patient database is backed-up daily at a secure data center in Broward County and Information Systems staff is responsible to relocate a copy of the back-up data to a predetermined location in Miami-Dade County. M. It is assumed that all individuals will work their scheduled hours unless told not to by the Executive Director or Designee, although duties outside of the normal responsibilities may be assigned in conjunction with the implementation of this Plan. N. If the impending emergency has the possibility of disrupting payroll data entry and/or transmission to PAYCHEX or the direct pay transmission to the bank, the payroll process is accelerated, using data from the prior period payroll, in order to have the compensation deposited to employees’ direct accounts before the storm. Following the emergency, the Payroll Manager is responsible to review the payroll and determine all corrections needing to be made in the subsequent payroll to accommodate the emergency payroll. For pool staff eligible for paychecks that might not have had compensation due during the prior period, individual checks may have to be written for the employee to pick up prior to the emergency. O. Field staff with computers will ensure that the computers remain safe during a wet emergency, i.e. a hurricane or flood, by wrapping their laptop in plastic and keeping their computer in a safe area in their home or wherever they are residing at the time. P. All staff will fully charge all electronic equipment including but not limited to computers and cell phones and maintain them with a full charge to the extent possible. Q. All staff, especially field staff, should make every effort to maintain a full tank of gasoline in their cars to assist in reaching patients after the storm even if the emergency affects the distribution of gasoline in the community. R. At least one full backup copy of the Catholic Hospice data is begun in sufficient time to be completed at least 8 hours before the onset of hazardous weather. If time permits, a second copy is made. Both copies, or the one current backup copy and the usual backup from a prior day are maintained off-site in two different locations, one copy in Broward and one in Miami-Dade. S. If the tropical storm warning and/or hurricane watch is announced on the day prior to a holiday or weekend may begin early at the direction of the Executive Director /designee.

2. During an emergency, when there is a mandatory evacuation, some patients may decide to stay in their home. The procedures to notify patients that there may be a temporary disruption of services and when services can be expected to be restored are as follows: Contact will be established with those patients residing within defined evacuation zones. Evacuation plans will be reviewed with patient/families, and if necessary, will be updated in order to ensure accuracy.


The Team Social Worker will educate families and patients regarding the organization’s responsibilities before and immediately after the hurricane and/or identified threat. When patients who reside within evacuation zones or meet criteria for hospitalization refuse to evacuate or heed recommendations, the Team Social Worker will educate patients and families on the limits of the service during the storm and the availability of on-call guidance via phone. A list of patients refusing to evacuate will be compiled and distributed. While the emergency conditions in the county or local area are deemed by the Office of Emergency Management to be hazardous, such as during the passage of a tropical storm or hurricane, Catholic Hospice is unable to provide its usual array of services. Staffing during the actual emergency period will include a triage nurse and physician on-duty, scheduled for 12 hour shifts on the EMERGENCY STATUS schedule. The usual AOC schedule will prevail in the event that the triage nurse or physician needs to contact the AOC. After the emergency status in the community has been lifted by the Office of Emergency Management and it is safe to begin traveling within the community, the staff that has been scheduled for response following the storm will begin working. As quickly as possible following the emergency a determination will be made by the Executive Director or designee to return to normal status; normal staffing schedules and services will resume to all patients as quickly as possible within the limits of any remaining localized or community-wide emergency conditions. 3. The procedures for the hospice to assure that all patients needing continuing care will receive it, either from the hospice, through a special needs shelter or through arrangements made by the patient or the patient’s caregiver are as follows: The Team Social Worker will assist in arrangements for patients seeking shelter in the Special Needs Evacuation shelter or in need of admission to a hospital or nursing home, with the social worker’s primary responsibility to verify bed availability. Contact will be established with those patients residing within defined evacuation zones. Evacuation plans will be reviewed with patient/families, and if necessary, will be updated in order to ensure accuracy. The Team Social Worker will educate families and patients regarding the organization’s responsibilities before and immediately after the hurricane and/or identified threat. 4. A comprehensive emergency management plan will be developed and maintained for disasters and emergencies, including hurricanes, tornadoes, building fires, wildfires, disruption of public utility services, destruction of public utility infrastructure, floods, bomb threats, acts of terrorism, exposure to hazardous materials, and nuclear disasters. The specific procedures (or separate plans) for accomplishing this are as follows:


The following plan will be implemented in the case of disasters/emergencies that develop suddenly and unexpectedly (i.e. Bombings, Civil Disturbances, etc.) affecting all or part of Catholic Hospice’s service area. Once the Executive Director or Designee is apprised of the situation the Executive Director or Designee:

1. Determines the nature and scope of the disaster/emergency. Catholic Hospice participates with Miami-Dade/Broward Offices of Emergency Management (OEM) and will follow OEM recommendations and instructions.

2. Determines if Catholic Hospice patients and staff will be affected by the disaster/emergency.

If the disaster/emergency affects Catholic Hospice patients or staff, information will be communicated to the employees through the phone tree, e-mail and/or beepers, and the television and radio stations referenced in this Plan. If the disaster/emergency affects the integrity of the computers, the plan for data back up and storage as outlined above will be followed. All staff responsible for the patients in the affected area will report to their direct supervisor for assignments. The Team Managers will divide responsibility to ensure that all patients' safety will be maintained. This includes but is not limited to evacuation if necessary, staffing, and ordering of DME and Pharmacy. Inpatient Unit Evacuation is in place and can be implemented in phases. Relocation of staff away from the area of hazard may be undertaken by staff on the spot, moving to areas in adjacent zones. A full evacuation would be implemented if the impact of a disaster renders the Inpatient Unit inoperable or unsafe for occupancy, and would be implemented by the Executive Director or designee.

a. Transportation Agreements. (See attached) b. Receiving Facility Agreements. (See attached)

c. Complete evacuation with 4-5h of decision d. Tracking Patients

1. PCS and Social Work will be responsible for logging patients out and their disposition.

2. Change of address will be entered into the Electronic Medial Record by PCS.

3. PCS will do a mandatory ID band check 4. After patients have been moved to transport vehicles, the Team

Manager or designee will conduct a room to room search to confirm that everyone has been evacuated.

e. Patient will be provided with enough medication and medical supplies

to provide for a minimum stay of 72 hours f. Family Updates will be answered in a timely manner. Team Manager,

Social Work and Chaplain will have the responsibility of this task. They will assist in communicating with family by telephone, cell phone, e-mail, radio announcements, TV announcements, and newspaper announcements as available.


Inpatient Recovery Plan to return operations to normal functions after most emergencies are activated at the completion of the Emergency Operations Plan. The Executive Director or designee will activate the “all clear” after confirmation has been received by St. Catherine’s West Rehabilitation Hospital, Miami Dade County Inspectors and City of Hialeah that the facility is structurally sound. Epidemics and Increase Influx of Infectious Patient A. In the event that an epidemic and/or an increase influx of infectious patients, the organization will identify immediate actions needed to mitigate the impact on its patient population. The planned responses employed may include a broad range of options which may span from the temporary halting of admissions to a full activation of the organization’s emergency management plan. B. The organization will monitor local reports from the CDC, FDOH (Florida Department of Health) and the OEM (Offices of Emergency Management) in order to track potential epidemics and infections the organization may need to launch a response to. If an epidemic or infection is determined to be a potential threat to the organization’s employees and patients, the CEO or designee will: 1. Determine the nature and scope of the epidemic or infection. Catholic

Hospice will obtain guidance from the relevant authorities (FDOH,CDC) and will follow their recommendations related to the launching of contingency plans.

2. Disseminate information on the potential threat to patients and staff. Information will be communicated to the employees through the phone tree, e-mail and/or beepers, and the television and radio stations referenced in this plan.

3. Determine whether admissions will resume based on the extent to which the community is affected by the epidemic or infection and the capacity for the organization to preserve service continuity. The organization will secure the necessary resources to support new admissions to the

program and will continue to monitor the organization’s overall service capacity.

4. Launch the necessary interventions/mitigating activities needed to adequately respond to the threat with the objective of maintaining continuity of operations, including securing of vital resources (medical supplies, pharmaceuticals, vaccines, human resources, etc.).

5. Determine whether assistance is necessary from local authorities and/or contracted partners to continue the delivery of services. In the case that the threat limits the capacity of the operation, a determination will be made whether admissions need to be temporarily halted. 6. Enhance surveillance of infection trends and test efficacy of the organization’s infection control program.


7. Develop and conduct training among personnel presenting updates to the infection control program based on recommendations from the CDC/FDOH. Training will be provided on necessary protocols, including education on risk factors associated with threat and the prevention of transmission/self-care. Sudden Business Interruptions A. In the event of a sudden power outage, or catastrophic server failure, the organization will identify immediate actions needed to mitigate the impact on its patient population and business operations. The planned responses employed may include a broad range of options which may span from the temporary use of paper documentation methods to a full activation of the organization’s emergency management plan. B. The organization will back up a patient vital report to a local computer on a weekly basis. The Information Systems staff will be responsible for these reports. These reports can be replicated on individual computers in case of an event outlined above.

1. Paper documentation will be used to make entries into the patients’ medical record

2. Patient Vital records reports will be loaded onto Directors/Team Managers/ and Physician computers.

3. Each Care Manager will be responsible for reviewing and updating these reports.

4. Determine whether admissions will continue based on the extent to which the community is affected and the capacity for the organization to preserve service continuity. The organization will make every effort to

secure the necessary resources to support new admissions to the program and will continue to monitor the organization’s overall service capacity.

5. Determine whether assistance is necessary from local authorities and/or contracted partners to continue the delivery of services. In the case

that the interruption limits the capacity of the operation, a determination will be made whether admissions need to be temporarily halted.


Evacuation Special Needs Registration

1. The procedures for the hospice to make arrangements to make the list of medication, supplies and equipment available to each special needs registrant during evacuation to a special needs shelter are as follows: If the patient is to be evacuated to a Special Needs Shelter, the primary care nurse and social worker assist in preparing the patient and caregiver for evacuation including assembling the required documentation that must accompany the patient to the Shelter and educating the care giver with respect to medication administration, DME and use of provided supplies during the patient’s stay at the Special Needs Shelter.

2. The procedures for educating the patient and caregiver concerning

the medication, supplies and equipment list (in accordance with Appendix D of this document) and the need for this list and other items to accompany the patient during the evacuation are as follows: As per E1, all documentation with list of medications, equipment and supplies will be completed by Catholic Hospice nurse or social worker and will accompany patient and caregiver to the special needs shelter.

3. The resources necessary to continue essential care or services or

referrals to other organizations subject to written agreement are described as follows: (see appendix for list of contracted services)

Facility

4. Transportation arrangements to be used during an evacuation including agreements of understanding with other entities are as follows: (see appendix for list of contracted services)


E. Re-Entry

Home and Special Need Shelter 1. The procedures on how the hospice will re-establish contact with patients in the patients’ home and resume patient care are as follows:

After the emergency status in the community has been lifted by the Office of Emergency Management and it is safe to begin traveling within the community, the staff that has been scheduled for response following the storm will begin working. As quickly as possible following the emergency a determination will be made by the Executive Director or designee to return to normal status; normal staffing schedules and services will resume to all patients as quickly as possible within the limits of any remaining localized or community-wide emergency conditions. Transporting patients who have been evacuated back to their homes is a priority. The Team Managers focus on verifying the status of patients who are in hospitals and nursing homes, including those that require transportation home as well as locating, or verifying the location of, all patients who remained in their homes during the emergency. The Team Manager, in conjunction with the social worker makes transportation arrangements as needed. Information regarding the status of roads in specific areas of the community will be available from the OEM, if needed. The Catholic Hospice Liaison with OEM will be available to address any specific questions regarding travel in the community. The Team/Social Worker will assist in making contact with caregivers of those patients needing transportation back to the home from hospital or shelters. Lack of electricity in the patient’s primary residence may require alternate temporary placement but is not, of itself, reason to maintain the patient in the inpatient setting. The primary care nurse and physicians and remainder of the patient care team focus on meeting the needs of patients who remained at home during the emergency. Issues identified during the emergency are used to prioritize patient visits. The office nurse directs the interdisciplinary team members according to identified patient needs. As quickly as possible, members of the team visit each patient. In order to meet patient needs staff may be requested to extend normal working hours for one or more days following a community emergency or disaster. Immediately after the emergency has subsided the Admissions Intake Coordinator or other assigned staff, contacts all hospitals and nursing homes in the service area to determine the location of patients awaiting evaluation for admission. The Intake Coordinator contacts Admissions staff with assignments.


As quickly as travel in the community has been deemed safe and communications with staff reestablished, the Executive Director or Designee will determine the time to begin accepting new admissions. A Chaplain or Bereavement Coordinator will provide support for the staff working in the stressful environment of recovery from the emergency. This role may take the form of a support group or individual assistance, either short term during the clean-up or longer term after the immediate emergency has subsided. Information for OnePoint Patient Care Pharmacy: 954.885.3011 Emergency Cell (Pharmacist): 920.475.2840 Information for OmniCare Pharmacy: 954.660.5555 Emergency Cell-(Manager) 561.703.3874 The organization’s pharmacy providers (OnePoint and Omnicare) maintain back-up generators and equipment to preserve the continuity of their operation in the event that the community remains in an emergency status for several days following the actual crisis. Should county mandated evacuations or the actual emergency impedes access to their physical location, OnePoint and Omnicare have agreements with their pharmacies to allow access to medication inventory in order to continue service to our patents. OnePoint and Omnicare also maintain necessary electronic backups of patient data and pharmacists preserve remote access to their database in order to continue the appropriate delivery of medications. 2. The procedures on how the hospice will re-establish contact with employees and re-start patient care are as follows: The Executive Director or Designee determines that it is safe to deactivate this Comprehensive Emergency Management Plan and return to normal operations. Staff is requested to call their managers if uncertain about a return to normal operations. Contact information for informational messages about Catholic Hospice operations, during and after the emergency, is found in Section III, C, 3. In the event that phone lines are inoperable CHI may use media utilizing the emergency broadcast system to inform staff of the office status and work instructions: TV Channels - 4, 6, 7, 10, 23, & 51 & AM Radio Stations - WIOD- 610. If telephone service is inadequate or inoperable but it is safe to travel, a printed message will be posted on the north office building with any additional information. Status of Catholic Hospice operations will be posted on the website as long as it is functional and will be available on one or more of the telephone lines noted in Section 5. In the event that temporary office space is needed due to storm damage, the Director of Finance and the Executive Director will determine a location; communication to staff will occur via the television, radio stations and recorded telephone messages referenced above and the telephone call list.

Patient care documentation will be completed manually, on paper, until the computer network becomes available and community based internet service providers are functional.


3. The procedures on how the hospice will provide or arrange for prioritizing care should the emergency result in less staff being available immediately following the disaster are as follows:

Team Managers will implement the prioritized patients according to needs/risks for staff to contact once the emergency has safely subsided, as each patient has been coded as follows:

#1 Patients to be seen within 24 hours of emergency status being lifted #2 Patients to be seen within 48 hours of emergency status being lifted #3 Patients to be seen within 72 hours of emergency status being lifted

Hospice Facility Post-emergency procedures including Agency for Health Care Administration authorization for re-entry of evacuated patients to the hospice facility, obtaining necessary medical attention or intervention for hospice patients, and communicating with family members of patients or other responsible parties are as follows: Inpatient Recovery Plan to return operations to normal functions after most emergencies are activated at the completion of the Emergency Operations Plan. The Executive Director or designee will activate the “all clear” after confirmation has been received by St. Catherine’s West Rehabilitation Hospital, Miami Dade County Inspectors and City of Hialeah that the facility is structurally sound. Transporting patients who have been evacuated back to the Inpatient Unit is a priority. The Team Manager focus on verifying the status of patients who are in hospitals and nursing homes, including those that require transportation. The Team Manager, in conjunction with the social worker makes transportation arrangements as needed. Information regarding the status of roads in specific areas of the community will be available from the OEM, if needed. The Catholic Hospice Liaison with OEM will be available to address any specific questions regarding travel in the community. The primary care nurse and physicians and remainder of the patient care team focus on meeting the needs of patients during the emergency. Issues identified during the emergency are used to prioritize patient visits. In order to meet patient needs staff may be requested to extend normal working hours for one or more days following a community emergency or disaster. A Chaplain or Bereavement Coordinator will provide support for the staff working in the stressful environment of recovery from the emergency. This role may take the form of a support group or individual assistance, either short term during the clean-up or longer term after the immediate emergency has subsided.


III. INFORMATION, TRAINING AND EXERCISE

All Catholic Hospice staff is expected to be knowledgeable about this Comprehensive Emergency Management Plan prior to the beginning of hurricane season (June 1) and to provide personal emergency contact information as requested.

Employees receive education related to this Comprehensive Emergency Management Plan at orientation and annual on-going education specific to their duties as part of Plan implementation. Joint Management, annually, reviews the Plan at the beginning of hurricane season. Education is provided by CHI Education Department and community resources as needed. All staff is expected to maintain awareness of tropical storm activity via television, radio, and internet during hurricane season (June 1 to November 30).Staff is encouraged to make personal/family hurricane emergency plans in advance so that appropriate work time and attention may be devoted to preparing patients and CHI offices within the time frames provided by this plan. Staff members are reminded to include time before the emergency to prepare their families evacuation plans, to prepare their homes, to have available supplies, cash and gasoline to safely weather the emergency. When possible and with the ED/designee’s approval, staff may be given time (late start or early departure) to assist in final personal preparations for an impending emergency, but only if patient care is not compromised.

At least annually and always subsequent to any implementation of this Comprehensive Emergency Management Plan, the Plan is to be reviewed and revised as needed to continuously improve performance. Annually the Plan is submitted to the governing board for its approval and submitted to appropriate State and local regulatory organizations as required. 1. The procedures on how employees will be instructed, prior to an event, in their roles and responsibilities before, during and after a disaster and/or emergency are as follows: Initial education to Catholic Hospice Emergency Plan is provided at time of orientation. The plan is reviewed by the education department and each employee is trained as to how to access the plan through the intranet. Each employee is trained as to there responsibilities during an emergency and at the time surrounding any emergency. Call trees are maintained all year round and posted on ShareNet, our intranet. Prior to June 1st all employees participate in a hurricane drill.


2. There will be a training schedule for all employees and identification of who will provide the training. Training will include a definition of what constitutes an emergency, when the comprehensive emergency management plan will go into effect, the roles and responsibilities of essential and non-essential staff, the procedures for educating patients about the comprehensive emergency management plan and the special needs registry. The training will also include information for available staffing of special needs shelters and how they can work with the local state or county agency that manages and staffs these shelters during an emergency. The specific procedures for accomplishing this are as follows. On or before May 1st, Joint Management is provided with a comprehensive training on the Emergency Plan. This education is provided by the Compliance and Education department. The responsibilities of each department are broken out and reviewed. Documentation of understanding and completed education is maintained in the education department. Education is completed to all staff before June 1st including a tabletop hurricane drill. Results are maintained and reviewed with Joint Management. If a deficiency is identified drills will continue until deficiencies are resolved. (see appendix) 3.The hospice’s provisions for training new employees regarding their disaster and/or emergency related roles and responsibilities before, during and after an event are as follows: Disaster Policy is educated in orientation; Policy: An active/ongoing disaster evacuation plan is necessary for any organization providing care to patients in their home. In South Florida hurricane preparedness is a high priority; however, other potential disasters – severe flooding, riots, nuclear, chemical or bomb threats – may also present a need for readiness and swift response. The following Plan, although directed most specifically to preparation for a hurricane which is the most frequent hazardous emergency experienced in South Florida, will be modified as needed in the event another type of disaster should occur.

Procedure: The Executive Director or designee will be responsible for determining the existence/type of disaster and activating the plan, consistent with the directives of local and State Offices of Emergency Management.

Catholic Hospice’s Comprehensive Emergency Management Plan fosters collaborative teamwork by management and staff to equally share the accountability and responsibility to protect patients, staff and the Catholic Hospice offices to the extent possible. Accountability for hurricane preparation is shared by all management staff to participate in the execution of this plan to enhance patient and staff safety and protect the offices and property of Catholic Hospice.


The Emergency Management Plan is designed to manage the consequences of natural disasters and/or other emergency situations within Catholic Hospice’s geographic service area that will disrupt its ability to provide care and treatment for a period of time. The Emergency Management Plan follows criteria set forth by the Agency for Health Care Administration, in satisfaction of basic emergency management plan requirements of section 400.610(1), Florida Statutes, 58A-2.005, and 58A-2.026, Florida Administrative Code.

Catholic Hospice leadership, Directors and other managers, actively participate in the planning and execution of the organization’s readiness for community emergencies. This Emergency Management Plan was developed by Catholic Hospice’s Executive Director, in conjunction with the organization’s senior management team and is annually submitted to the governing board for its approval and the appropriate State and local agencies as required. During orientation process the Comprehensive Emergency Plan is educated and specific tasks by discipline are educated. A document is signed when the material is learned and kept in the employee record.


IV. APPENDICES (The Appendices that follow are provided in support of the hospice’s Comprehensive Emergency Management Plan.)


APPENDIX A: ROSTERS OF EMPLOYEES AND COMPANIES WITH KEY DISASTER RELATED ROLES Employees Primary Name/Title: Bonnie Alkema, Executive Director Work Phone Number: 305-351-7101 Cell Phone Number: 786-368-3749 Alternate Name/Title: Melinda Diaz, Senior Director of Operations Work Phone Number: 305-351-7130 Cell Phone Number: 305-790-3095 Alternate Name/Title: Rita Kathalynas, Director of Professional Services Work Phone Number: 305-351-7004 Home Phone Number: 954-540-3854 Cell Phone Number: 786-382-1155 Corporation/Owner Name: Joe Catania, President & CEO Address: 4790 N. State Road 7, Lauderdale Lakes, FL 33319 Work Phone Number: 954-484-1515 C.O.O. Name: Jim Ball Address: 4790 N. State Road 7, Lauderdale Lakes, FL 33319 Work Phone Number: 954-484-1515

Vendor Telephone Numbers Life Healthcare Hector Romero 786-367-3464 Rene Hernandez 305-826-5767 Medics Ambulance Debbie Silecchia 954-463-8400 378 SW 12th Avenue Deerfield Beach, FL 33442 American Ambulance Stacey Patasnik 954-714-8080 Vivian Robiana 786-298-0758 McKesson: Main Number: 888-822-8111 (enterals/supplements) One Point Pharmacy 954-885-3011 Fax: 954-885-3012 Eric Pimienta, Pharm.D. After Hours 954-629-9900 Pharmacist-in-Charge www.onepointpatientcare.com One Point Patient Care 11219 Interchange Circle South Miramar, FL 33025


https://mail.oppc.com/exchweb/bin/redir.asp?URL=http://www.onepointpatientcare.com/

Miami-Dade Ambulance: Ray Espinosa (305) 633-0553 ext. 2228 Non-Emergency: 305-633-0553 (no oxygen) Emergency: 305-779-0505 (with Oxygen) XRAYS- (ULTRA Mobile): Robbie Basdeo cell: 786-800-8839

305-887-7373 Fax: 305-887-7340

LABS- (Bio-Reference Labs): Owner-Carlos 305-554-9790 ext. 3305 Fax: 305-228-8387

Medline Industries Peter Sliwa- (321) 961-8823 Fax: (866) 605-5379 Vice President Homecare Omnicare David Rombro- General Manager Main Line: (954) 660-5555


APPENDIX B AGREEMENTS AND UNDERSTANDINGS

(List on this page and insert copies on following pages, and include annual update mutual agreements, memoranda of understanding, or any other understandings entered into between the hospice and any local, state, and county entities, or health care entities, and service providers that have responsibility during a disaster. This is to include reciprocal host hospice agreements, or any other current agreements needed to ensure the operational integrity of the plan.)


APPENDIX C

FACILITY EVACUATION ROUTE MAPS

(Insert copy on next page. Include primary and secondary routes.)


APPENDIX D

INFORMATION FOR HOSPICE PATIENTS

INFORMATION FOR HOSPICE PATIENTS – Registered with Special Needs Registry

Please note: The special needs shelter is intended to be a place of last refuge. The evacuee may not receive the same level of skilled care received from staff in the home, and the conditions in a shelter might be stressful. 1) It is recommended that if the special needs registrant has a caregiver1, the caregiver shall accompany the special needs registrant and remain with the registrant at the special needs shelter. 2) The following is a recommended list of what special needs registrants need to bring with them to the special needs shelter during an evacuation.

• Bed sheets, blankets, pillow, folding lawn chair, air mattress; • The special needs registrant’s mediation, supplies and equipment list supplied by the

hospice, including the phone, beeper and emergency numbers for the special needs registrant’s physician, pharmacy and, if applicable, oxygen supplier; supplies and medical equipment for the special needs registrant’s care; advance directive including the Do Not Resuscitate (FNRO) form, if applicable;

• Name and phone number of the special needs registrant’s hospice; • Prescription and non-prescription medication needed for at least 72 hours; oxygen for 72

hours, if needed; • A copy of the special needs registrant’s plan of care; • Identification & current address • Special diet items, non-perishable food for 72 hours & 1 gallon of water per person per

day; • Glasses, hearing aides and batteries, prosthetics and any other assistive devices; • Personal hygiene items for 72 hours; • Extra clothing for 72 hours; • Flashlight and batteries; and • Self-entertainment and recreational items, i.e., books, magazines, quiet games.

(3) Special needs registrants need to know the following: • It is recommended that if the registrant has a caregiver, the caregiver accompany the

special needs registrant. A special needs shelter can accommodate one caregiver at a time, and other family members, friends, etc. should go to a general population shelter.

• The special needs registrant’s caregiver will have floor space provided. The caregiver must provide his or her own bedding.

• Check with the local emergency management agency regarding service dogs in the shelter. However, check with your local Emergency Management office to see if other pets are permitted.

• Bring personal snacks, drinks, and any special dietary foods for 72 hours. It is possible only sparse meals will be provided.

• Caregivers who regularly assist the special needs registrant in the home are expected to continue to do the same care in the shelter.

__________________________ 1Caregivers can be relatives, household members, guardians, friends, neighbors and volunteers.

The following information should be supplied by the hospice to those patients registered with the special needs registry, so they will be prepared prior to an evacuation to a special needs shelter.


APPENDIX E

LETTER OF APPROVAL OF THE ANNUAL FIRE INSPECTION


APPENDIX F

SUPPORT MATERIAL

Definitions: TROPICAL DISTURBANCE: A moving area of thunderstorms in the tropics that maintains its identity for 24 hours or more; this is a common weather pattern in South Florida summers. TROPICAL DEPRESSION: An area of low pressure, rotary circulation of clouds and winds at the surface with the highest constant wind speed of 38 miles per hour. TROPICAL STORM: Counter-clockwise circulation of clouds and winds between 39 and 73 miles per hour. The tropical storm is assigned a name. HURRICANE: When a tropical storm reaches winds in excess of 73 miles per hour, it is classified as a hurricane. Hurricanes, or tropical cyclones, are counter-clockwise rotating wind systems that usually originate between June and November. AN average hurricane has a gale-force wind diameter of 200 miles and an eye of 10-15 miles in diameter. Wind velocities of 100 to 150 miles per hour are found just outside the eye, although in maximum storms (Category 5) wind velocities of over 200 miles per hour are found. Hurricane storm systems move at a forward speed of 10-20 miles per hour. Hurricanes cause damage through high winds, wave action in exposed coastal areas, and flooding from two sources- hurricane tides in coastal areas resulting from wind-driven rains, and rain accumulation (10-30 inches of more). COMMUNICATION AND WARNING OF SEVERE WEATHER (ADVISORY): A method for disseminating hurricane and storm data to the public. A small craft warning advisory is an example. SPECIAL ADVISORY: Warning given anytime there is a significant change in weather conditions or a change in the warning status.


INTERMEDIATE ADVISORY: A method of updating regular advisory information every 2-3 hours as necessary. STORM WARNING: Wind velocities 55-73 miles per hour can be expected in the advisory area. If a hurricane is expected to strike a coastal area, storm warnings will not usually precede hurricane warnings. HURRICANE WATCH: A hurricane may threaten a coastal area within 24-36 hours. Preparedness measures should be in progress. This advisory is issued by the National Hurricane Center in Miami. HURRICANE WARNING: A hurricane is expected to stike a specific coastal area within 24 hours or less. Additional/final precautions should be taken immediately. This advisory is issued by the National Hurricane Center in Miami. Hurricane conditions include sustained winds of 74 miles per hour or greater and/or dangerously high tides and waves. STORM SURGE: Strong winds associated with hurricanes create a dome of water often 50 miles across where the eye of the hurricane makes landfall. The tidal height depends on the strength of the storm, the direction from landfall, and whether it is normal, low, or high tide. The storm surge is the most dangerous part of the hurricane. Storm surges of up to 25 feet above mean sea level have been recorded. The hammering waves of a storm surge are the cause of 9 out of 10 hurricane fatalities. TORNADO WATCH: Tornadoes and severe thunder storms are possible in the advisory area. TORNADO WARNING: Conditions are right for the formation of tornadoes and/or a tornado has been reported in the advisory area.


Documents

COMPREHENSIVE EMERGENCY MANAGEMENT PLAN (CEMP) … · CATHOLIC HOSPICE, INC. Updated April 2015. COMPREHENSIVE EMERGENCY MANAGEMENT PLAN (CEMP) FORMAT FOR HOSPICES . Developed by