6/1/2017

1

DEVELOPING AN EFFECTIVE AND COMPLIANT EMERGENCY PREPAREDNESS PROGRAM

FOR LONG TERM CARESESSION #1

THIS IS HOW!

Research of Response

Best Practices from across the industry

CMS / AHJ Requirements

THIS IS WHY

6/1/2017

2

AGENDA: The First Steps

Develop your Emergency Preparedness Team

Assess your Current Program to the 2016 CMS Final Rule

Hazard Vulnerability Assessment (HVA)

Mitigation Plans

“THIS IS WHY → THIS IS HOW”

Centers for Medicare and Medicaid Services:Emergency Preparedness Requirements

Dec. 2013CMS Proposes New Regulations for All

Providers & Suppliers

Sept. 16, 2016“FINAL RULE”

CMS Adopts New Regulations Effective

November 16, 2016

Nov. 15, 2017

Implementation (“Compliance”)

Date

6/1/2017

3

Federal Regulation RequirementsCFR 483.75 (m) F517

Disaster & Emergency Preparedness

The facility must have detailed written plans and procedures to meet all potential emergencies

and disasters, such as fire, severe weather, and missing residents.

OLD CMS Regulation: Basic

Federal Regulation Requirements

The facility must train all employees in emergency

procedures when they

begin to work in the facility.

Periodically review the procedures with existing staff,

and carry out

unannounced staff drills using those procedures.

OLD CMS Regulation: Basic

6/1/2017

4

NEW CMS Regulation: Comprehensive

The regulation focuses on 4 Core Elements of Emergency Preparedness:

Annual Risk Assessment & Emergency Planning (all-hazards approach)

Policies and Procedures

Communication Plan

Training and Testing

Emergency Power

Integrated Health Systems

NEW CMS Regulation: Comprehensive

6/1/2017

5

Applies to Medicare and Medicaid Providers

Does NOT apply to Assisted Living

Does NOT apply to Independent Living

But if you are a CCRC, AL, or IL, your residents deserve an emergency

preparedness program too!

NEW CMS Regulation: Comprehensive

Emergency Preparedness

Establish Team Leader

Establish Team Membership (may be an existing team)

Multi-disciplinary: include clinical, admin & support

Scalable to the organization – could be 2-3 or a larger group

Meet regularly:

Monthly: until program is up and running

Quarterly: for continued sustainability

Include community partners, as necessary and appropriate (Emergency Management, Police, Fire, EMS, Regional EM, Healthcare Coalitions, etc.)

STEP 1: Develop Your Emergency Preparedness Team

6/1/2017

6

Emergency Preparedness

STEP 1: Develop Your Emergency Preparedness Team

Emergency Preparedness

STEP 1: Develop Your Emergency Preparedness Program Team

6/1/2017

7

STEP 2: Conduct Assessment of Your Current Program

Your Emergency

Preparedness PROGRAM

How to Conduct an Assessment?

STEP 2: Conduct Assessment of Your Current Program

6/1/2017

8

Emergency Power

LTC Facilities that have on-site fuel sources must have a plan for how it will keep emergency power systems operational during the emergency, unless it evacuates.

STEP 2: Conduct Assessment of Your Current Program

STEP 2: Conduct Assessment of Your Current Program

17 Provider Types: are they in your organization???

6/1/2017

9

Integrated Health Systems

LTC Facilities that are part of a system may elect to be part of the system’s “unified and integrated emergency preparedness program”; however, the program must:

Demonstrate that each facility actively participatesDevelop and maintain, taking into account the uniqueness of each individual facility (services, residents, circumstances, etc.)Must demonstrate each individual facility is capable of actively using the unified and integrated emergency preparedness program (Training, Testing, and Live Events Documentation)Must have facility-specific Hazard Vulnerability Assessments (HVAs) and may also have a Regional HVA

STEP 2: Conduct Assessment of Your Current Program

Hazard Vulnerability Assessment

(HVA)

Systematic approach to recognizing hazards that may effect the ability to care for residents.

The risks associated with each hazard are analyzed to prioritize planning, mitigation, response and recovery activities.

STEP 3: The Annual Risk Assessment

6/1/2017

10

Why Conduct an HVA?Because it’s REQUIRED to be done annually.

STEP 3: The Annual Risk Assessment

All images © from their source

Why Conduct an HVA?Because events happen, what is YOUR risk?

STEP 3: The Annual Risk Assessment

6/1/2017

11

Why Conduct an HVA?

Because it assists you in developing your program:

Preparedness Plans (what emergency response plans should be in place for known hazards)

Exercise / Drill Plans (what should the focus be for the year)

Mitigation Plans (can infrastructure be hardened to mitigate hazards, or equipment purchased, etc.)

STEP 3: The Annual Risk Assessment

How to Conduct an HVA

Pick a model

Assemble a Multidisciplinary TeamLeadership, Clinical, Facilities, Safety

Include local Emergency Management

Engage Local, Regional, and State Emergency

Management partners.

Conduct an Internal and Exterior Tour

Review External Hazards.

Review Internal (Facility) Hazards

Complete the HVA

Develop Mitigation & Preparedness Plans

STEP 3: The Annual Risk Assessment

6/1/2017

12

How to Conduct an HVA

https://asprtracie.hhs.gov/

Pick a HVA Model

STEP 3: The Annual Risk Assessment

How to Conduct an HVA

Kaiser Permanente 2014

STEP 3: The Annual Risk Assessment

6/1/2017

13

How to Conduct an HVA

Kaiser Permanente 2017

STEP 3: The Annual Risk Assessment

How to Conduct an HVA

RPA 2017

STEP 3: The Annual Risk Assessment

6/1/2017

14

Probability

Impact

Preparedness

Internal Response

External Response

STEP 3: The Annual Risk Assessment

National (Broad)

State (Regional)

Local / Town (External)

Facility (Internal)

STEP 3: The Annual Risk Assessment

6/1/2017

15

6/1/2017

16

6/1/2017

17

STEP 3: The Annual Risk Assessment

34

6/1/2017

18

35

36

6/1/2017

19

37

Coastal Facility

3 2 1 2 1 1 2 28%

3 2 2 4 3 3 2 50%

6/1/2017

20

39

Thunderstorms

Earthquakes

Tidal Waves

Temperature Extremes

Drought

Wildfires

Dam Inundation

Volcano

Natural Hazards

6/1/2017

21

Natural Hazards

LONG TERM CARE FACILITY (250 beds)

(Evacuation: May 2006 / Recovery: Sept. 2006)Source: Boston Globe.com

Natural Hazards

6/1/2017

22

Superstorm Sandy 2012Natural Hazards

Natural Hazards

June 2012 Mid-Atlantic and Midwest Deracho

6/1/2017

23

Winter Storm Knife, Buffalo, NY November 2014

Natural Hazards

46

6/1/2017

24

Electrical Failure

Generator Failure

Transportation Failure

Fuel Shortage

Natural Gas

Water Loss

Sewer Loss

Fire Alarm Loss

Med Gas Loss

HVAC loss

IT Loss

Technological Events

Electrical Failure

Generator Failure

Transportation Failure

Fuel Shortage

Natural Gas

Water Loss

Sewer Loss

Fire Alarm Loss

Med Gas Loss

HVAC loss

IT Loss

Technological Events

6/1/2017

25

Internal Spills (Large, Medium or Small)

Radiological

Chemicals

Mercury

Events Involving Hazardous Materials

Technological Hazards

A CSX train with 112 cars loaded with hazardous materials, oil and grain derailed in Painesville, OH

Technological Hazards

6/1/2017

26

Missing Resident

VIP

Labor Action

Civil Disobedience

Forensic Admission

Human Hazards

6/1/2017

27

Missing Resident

VIP

Labor Action

Civil Disobedience

Forensic Admission

Human Hazards

Active Shooter (Exercise)

Human Hazards

6/1/2017

28

STEP 3: The Annual Risk Assessment

6/1/2017

29

STEP 3: The Annual Risk Assessment

How to develop Mitigation Plans

Develop following your HVA AnnuallyMay be carry over year-to-year

Determine “Top Relative Risks” Using the HVA as a tool, what risks are rated high

Could be “Top 10” or any > 50% Risk, etc.

Review what can be done to minimize the risk?Infrastructure Improvement

Equipment Purchases

Planning

Training

Collaboration with other Partners

STEP 4: Mitigation Plans

6/1/2017

30

STEP 4: Mitigation Plans

6/1/2017

31

Helping you: Conduct Assessment of Your Current Program

QUESTIONS

6/1/2017

32

AGENDA: The Foundation

Plan Activation & Incident Command

Communications Plans

Full Building Evacuation Plans

Surge /Influx Plans

NEXT SESSION

THANK YOU

Scott AronsonPrincipal

Nick GabrieleVice President