Emergency/Disaster Preparedness at a Glance for Texas Long Term Care Facilities 2012 Healthcare Hurricane & Disaster Preparedness Summit 4/11/12

Transcription

1 Emergency/Disaster Preparedness at a Glance for Texas Long Term Care Facilities 2012 Healthcare Hurricane & Disaster Preparedness Summit 4/11/12 Sonia Thomas, RN, BSN, SMQT Facility Surveyor/Liaison Texas Department of Aging and Disability Services (DADS) Regulatory Services Division, Region 6 Sonia.thomas@dads.state.tx.us

2 Greetings from: Mark Kendall, LBSW, SMQT Texas Department of Aging and Disability Services, (DADS) Regulatory Services Division Regional Director, Region 6 Phone: mark.kendall@dads.state.tx.us 2

3 DADS Mission To ensure the health, safety, and welfare of individuals in long-term care facilities in the state of Texas.* *Not verbatim

4 DADS REGIONAL MAP in Texas Region 6: Gulf Coast Counties Served Austin, Brazoria, Colorado, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Walker, Waller, Wharton

5 Region 6 - Facility Totals February 2012 Nursing Homes 153 Assisted Living Facility (ALF) 422 Adult Day Care (ADC) 38 Intermediate Care Facilities for the Intellectually Disabled (ICF-ID) 123 Home & Community Support 1580 Services Agencies (HCSSAs)

6 Objectives To emphasize the importance of comprehensive and detailed emergency preparedness and response plans To identify the critical value of staff training Core Regulatory requirements of emergency disaster/plans

7 Objectives New Safety Operations/Emergency Operations Rules DADS s Role in the Disaster Response Provider Liabilities/Responsibilities

8 Emergency Preparedness Response Plans - WHY? The failure to plan is a plan to fail. Alan Lakeeein

9 Emergency Preparedness Response PLANS - WHY? Disasters can occur at any time. (Hurricane season: June 1 - November 30.) Special Needs population

10 Common Misconceptions During Disasters RE: FIRST RESPONDERS

11 Common Misconceptions During Disasters RE: HOSPITALS

12 WHY? Because of Lessons Learned Evacuation: I-45 North, Rayford, Sawdust exit

13 DADS Licensing Regulations Facilities must comply with the Texas Administrative Code (TAC) requirements for their specific program types for a written disaster plan. Nursing (a-f) ICF/ID 90.50(a- g) Assisted Living 92.62(d) Adult Daycare 98.64(a) (f) HCSSAs (a p) Freestanding Hospice (additional) (w)(2)(a-g) The Texas Administrative Code are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

14 Top 10 Deficiencies/Violations for Fiscal Year 2011 DADS Region 6 Disaster/Emergency Plans were cited by DADS surveyors for the following facilities: 1. Adult Day Care Ranked #5 2. Assisted Living Facilities - Ranked #5 3. HCSSAs Licensure Violations - Ranked #8, #9, #10 4. Free Standing Hospice Licensure Violations Ranked - Ranked #8, #9, #10 5. Nursing Homes Life Safety Code Ranked #10

15 Top 10 Adult Day Care (ADC) Violations Fiscal Year Region 6 SAFETY-DISASTER PLANS: TAC 98.42(a), TAG 0058 The facility failed to have a written plan covering all the procedures to follow in an inside or outside disaster.

16 Top 10 Assisted Living Facilities (ALF) Care Violations Fiscal Year Region 6 Safety Operations: TAC 92.62(d) The facility failed to ensure that a written emergency plan was provided which addressed the eight core functions of emergency management.

17 Top 10 Home Health State Violations Region 6 - FY2011 Emergency Preparedness Planning & Implementation - Level A & B (1)(C) The agency failed to develop a continuity of operations business plan to address emergency financial needs, essential functions for client services, critical personnel, and how to return to normal operations as quickly as possible.

18 TOP 10 Home Health State Violations Region 6 - FY2011 Emergency Preparedness Planning & Implementation - Level B (1)(D) The agency failed to include a risk assessment that identifies the disasters from natural and man-made causes that are likely to occur in the agency s service area.

19 TOP 10 Hospice State Violations Region 6 - FY2011 Emergency Preparedness Planning & Implementation - Level A & B (1)(L) The agency failed to complete an internal review of the plan at least annually and after each actual emergency response, to evaluate its effectiveness and to update the plan as needed.

20 Top 10 Life Safety Code Deficiencies for Nursing Homes Fiscal Year Region 6 LIFE SAFETY CODE STANDARD: NFPA 101, TAG 0144 The facility failed to inspect and test its generators as required by NFPA 99

21 In an Emergency, the Generator is your Life Preserver (note Fuel spill or leak)

22 All below are normal Code requirements, but double check with a storm in the Gulf Generator Check List Visual inspection of generator condition Generator Spare Parts must be on site Generator instruction manual (two sets) 24 hour fuel supply as minimum Battery back-up lighting at generator Generator at sufficient elevation in case of flooding Check of all emergency lighting for working bulbs

23 CRITICAL CONSIDERATIONS for GENSET SYSTEMS for DADS Life Safety Code Surveyors CODES NFPA 37 Standard for the Installation and Use of Stationary -Combustion Engines and Gas Turbines 1998 NFPA 70 National Electrical Code 1999 NFPA 99 Standard for Health Care Facilities 1999 NFPA 101 Code for Safety to Life from Fire in Buildings and Structures 2000 Edition NFPA 110 Standard for Emergency and Standby Power Systems, 1999 Edition

24 New Rules For Emergency Preparedness and Response Plans for Nursing Facilities Adult Day Care ICF-ID HCSSAs

25 Definitions Emergency situation Emergency Plan Receiving facility Sheltering in Place

26 Administration A facility must: Develop and implement Maintain a current accessible copy Evaluate, sign and date

27 EVALUATE THE PLAN After emergency response Physical changes to the facility At least annually After information changes Document compliance

28 Emergency Preparedness and Safety Plans must include: A risk assessment Description of the population Description of the services needed by the residents Section for each core function Fire safety plan Training of Staff

29 RISK ASSESSMENT Disaster type Likelihood Potential Impact on facility/agency Potential Impact on Community Warning time Risk Priority

30 Sample Table for Risk Assessment Disaster Likelihood Potential Impact on Facility/Agency Potential Impact on Community Warning Time Risk Priority (minimal, (either highly likely, likely or possible (either catastrophic, critical, limited or negligible) (either catastrophic, critical, limited or negligible) 6-12 hours, hours, or > 24 hours (either catastrophic, critical, limited or negligible) Hurricane High Critical Critical >24 hours High during hurricane season June 1 through November 30

31 Hurricane Ike Landfall Houston/Galveston 9/13/08

32 a TORNADO

33 a TORNADO Before Greensburg KS, on May 4, 2007 After

34 a TROPICAL STORM

35 a FLOOD

36 FIRES CAUSED BY LIGHTING, ARSON, ETC. or a thunderstorm with a risk for harm to persons or property

37 FIRES

38 Fires Caused by a Facility Incident On 4/2/11, just before 3:30 pm, emergency crews were dispatched to the Blue Ridge Health Care Center in Raleigh, NC Because quality of life and quality "of care require safety from fire." 38

39 Terrorist Attack, a Hazardous Material Spills, Oil Refinery Fires/Accidents

40 Extreme snow and ice conditions for an area

41 Core Functions of Emergency Management at a Glance Direction and control Warning Communication Sheltering Arrangements Evacuation Transportation Health and medical needs Resource management

42 Core Function #1 Direction and Control Emergency preparedness coordinator (EPC) Alternate EPC Local emergency management coordinator (EMC)

43 Who is the Emergency Management Coordinator The Mayor and the County Judge

44 DADS Licensing Regulations Nursing Assisted Living ICF-MR Adult Daycare HCSSAs Facilities must coordinate with the Local Emergency Management Coordinator. Free Standing Hospice 92.62(d) 90.50, (d) (1) (C) 98.42(a) (d) (4)(C) (w) ((2)D)(v) for sheltering Keep a copy of each contact.

45 Core Function #2 Warning How the EPC is notified Who the EPC will notify Monitoring of local news and weather reports

46 Core Function #3 Communication Primary/alternate mode of communication Current list of telephone numbers Residents' responsible parties Potential evacuation locations Staff Location of the lists 1/2

47 Communication cont. Procedures to notify facility staff receiving facility residents, representatives, and others Resident information Maintain communication Facility staff Receiving facility Vehicle drivers

48 Core Function #4 Sheltering Arrangements Shelter-in-place implementation decisions Access to medications, records, food, water, equipment and supplies Responding facility staff Staff family members Notifying DADS regional office Receiving facility Mark Kendall DADS Regional, Director, Region 6

49 Core Function #5 Evacuation Decisions to evacuate residents Evacuation destinations and routes w/map Agreement with a receiving facility

50 DADS Licensing Regulations Facility plans must include evacuation routes with maps including destinations and routes. Nursing ICF/ID Adult Daycare (d) (5)(A) 90.50(a)(4) (d)(5)(d) The Texas Administrative Code are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

51 Evacuation Routes

52 Evacuation Staff must accompany residents Ensuring total evacuation Accounting for residents Accounting for residents in other locations Continuity of care Repatriation to area Entering the building

53 Evacuation Notifying the local EMC Notifying DADS regional office Evacuating Return after evacuation Mark Kendall DADS Regional, Director, Region 6

54 Transporting Residents Staff Core Function #6 Transportation Staff family members Pets Access to oxygen, medications, records, food, water, equipment, and supplies needed during an evacuation.

55 Transportation continued Transporting Oxygen Medications Records Food Water Equipment Supplies

56 Core Function #7 Health and Medical Needs Residents with special medical needs Identification Assure needs are met

57 Core Function #8 Resource Management Procedures Checklists Medications Records Food and water Equipment and supplies Staff assignments Medications Secure Proper temperatures

58 Training Inform/train staff of responsibilities Annual training on responsibilities Responsibilities change - re-train Annual drills.

59 Emergency Preparedness & Response Emphasizes Training WHY? Incorrect information Consistency w/direction and Control Staff expertise levels; available staff Unexpected Contingencies

60 Order of Evacuation

61 DADS Licensing Regulations Regulatory Requirements for Staff Training on Emergency Preparedness plan. Nursing (e) (1-3) ICF/MR 90.50(a) (3) Assisted Living 92.41(a)(4)(vi) Adult Daycare 98.64(e) (1-3) HCSSAs (i) Freestanding Hospice (w)(2)(g)(i-v) The Texas Administrative Code are standards that are adopted and regulated by the Texas Department of Aging & Disability Services (DADS)

62 Similarities of all Disaster Plans CORE Requirements Risk Assessment HCSSAs Adult Day Care ICF-ID Nursing Facility Includes power outage Maintain a current written accessible copy Designate a Coordinator In each house/day program Central location & w/ personnel supervisor Fire Safety Plan Free-Standing Hospice only Annual review + 30 days after ea. Emergency, 30 days after changes Annual review and when necessary After remodeling & construction After remodeling & construction After remodeling /additions

63 Similarities of all Disaster Plans CORE Requirements Coordination with EMC HCSSAs Adult Day Care ICF-ID Nursing Facility As required by EMC guidelines Training Initial & periodically Within 3 days of hire, annually Within 5 days of hire, annually 30 days after hire, annually 1 Unannounced Annual Drill ** Fire Safety Plan Free Standing Hospice -actual or Planned drill Free Standing only Hospice Registration with 211 Assistance with No No

64 Similarities of all Disaster Plans CORE Requirements HCSSAs Adult Day Care ICF-ID Nursing Facility Contract with the evacuation site Evacuation route in plan Free-standing hospice only No map In each house/day program Include a map Include a map Include a map Quarterly Drill Free Standing hospice only Notify DADS Evac/Sheltering Free standing hospice only Free Standing Hospice only - 7 core Functions 8 core functions 8 core functions 8 core functions

65 Assisted Living Facilities (ALF) Regulatory Requirements for Written disaster plan 8 core requirements Disaster Plans Coordinated with Emergency Management Coordinator Should address man made, technological and local disasters Emergency/Evacuation Training on hire Regulatory Reference: (d)

66 Home and Communities Support Services Agencies (HCSSAs) HCSSAs Agency personnel must identify clients needing evacuation assistance & registration with Regulatory Reference: (g) ( 1-2) No requirement to evacuate or transport a client during a disaster Free Standing Hospice In addition to (a) -(p) must comply with regulatory reference at (w) (2) (A) (G) 7 Core functions of emergency management Must evacuate or transport clients when appropriate in response to disasters

67 HIPPA Privacy Decision Tool for Emergency Preparedness Planning Available at: rstanding/special/emergency/decisiontoolintr o.html This tool is for advance planning purposes.

68 New Emergency Preparedness Rules - ICF-ID Must develop a plan w/ core functions Designate Emergency Preparedness Coordinator Address Training of staff & reporting fires Effective: 3/21/11 Regulatory reference: TAC $90.50 Provider Letter issued 3/21/2011

69 New Emergency Preparedness Rules - Adult Day Care Must develop an plan w/ core functions Designate Emergency Preparedness Coordinator Address Training of staff, fire drills & reporting fires Effective: 8/1/11 Regulatory reference: TAC $98.64 Provider Letter issued 7/22/11

70 New Emergency Preparedness Rules - Nursing Facilities Must develop an plan w/ core functions of emergency management Designate Emergency Preparedness Coordinator Addresses Administrative procedures, Training of staff, and reporting fires Effective: 8/1/11 Regulatory reference: TAC $ Provider Letter issued 7/22/11

71 New Emergency Preparedness Rules - HCSSAs Must have a written preparedness & response plan w/ based on a risk assessment identifies service disasters Designate personnel that must be involved Agency must offer registration assistance with 2-1-1: Effective: 8/2011 Regulatory reference: TAC $97.256

72 New Emergency Preparedness Rules - Free Standing Hospices In addition, to meeting the requirement at TAC $97.256: Must evacuate or transport clients when appropriate in response to disaster Seven (7) core functions of emergency management Regulatory reference: TAC $403 (w)(2)(a)-(g) Provider Letter issued 8/24/11

73 Provider Responsibilities Procedures for notifying DADS by telephone, within 24 hours after evacuation Procedures for notifying DADS regional office of location of Evacuation decision (IMMEDIATELY) Return to facility after evacuation - within 48 hours Mark Kendall DADS Regional, Director, Region 6

74 Provider Responsibilities Be prepared. Have a back up plan to the back up plan. Follow the Local Emergency Coordinator s orders on evacuation and re-entry Update FIVES Be in contact with DADS, as needed. FIVES

75 Facility Information Vacancy & Evacuation Status DADS FIVES PROGRAM

76 Responsibility of Each Facility Use FIVES to update vacancy data. Identify potential partners able to accept evacuees. Make sure of resident transfer arrangements with those partners. Update your evacuation status.

77 DADS FIVES PROGRAM Click on the above link and follow the instructions. Facilities must use their 6 digit provider number.

78 Registration through the System for NF s, ALF s and HCSSAs Register It s the law Provider Letter Registration with the Texas Information and Referral Network 2-1-1; to ALF s and NF s HCSSAs : Assist with registration

79 DADS Message to Providers of LTC Facilities Coastal facilities must evacuate inland. Have a backup plan in case primary plans fails. State resources are intended for use only when primary and backup plans fail.

80 Stay up to date with Automatic Updates and Alerts Go to this web site: 80

81 DADS ROLE IN DISASTER RESPONSE Pre- Disaster A provider may request to exceed licensed capacity by 20% by contacting: Carol Ahmed, Director of Survey Operations Phone: carol.ahmed@dads.state.tx.us Mark Kendall, Regional Director, Region 6 Phone: mark.kendall@dads.state.tx.us Mark Kendall DADS Regional, Director, Region 6

82 Protocol for Region 6 DADS- Hurricane /Disaster Evacuation Evacuation: Fax blast alerts will be sent to all facilities/agency providers regarding the need to evacuate (NF, HH, Hospice, ICF-ID) Sheltering in Place: DADS staff will call all NF s and ICF-ID if no mandatory evacuation is called and facilities shelter in place

83 Protocol for Region 6 DADS- Hurricane/Disaster Evacuation No Surveys or non-priority complaints Only Priority One status investigations

84 Protocol for Region 6 DADS- Hurricane /Disaster Evacuation Assist with Special Needs shelter activity coordination Post Disaster

85 Frequently Asked Questions Question: A facility is reluctant to evacuate for fear of trauma to the residents. The facility is in a mandatory evacuation area. Are there any options?

86 Frequently Asked Questions Question: Do residents have the right to refuse evacuation, as is the case where they can refuse treatment? If so, what is an administrator s liability if anything goes wrong?

87 Frequently Asked Questions Question: Where can I find Long Term Care facilities (all types) that offer Ventilator Care? See the attached list in the meeting packet of facilities that care for ventilator dependent residents in Texas (revised 12/31/11)

88 Frequently Asked Questions Question: Now that the storm has passed, we would like to continue to remain in the facility, however there is a large hole in the roof. If we can get assistance with repairs, we can continue to serve our residents. Who can we contact for help?

89 Frequently Asked Questions Question: I am very dissatisfied with the care my family member received when they evacuated to X facility. Who can I talk with about this concern?

90 Frequently Asked Questions Question: Have you heard anything about the status of facility X is it safe to return to the facility now?

91 Frequently Asked Questions Question: I have enough beds and resources to take in an additional 25 residents. Who do I contact to give this information out?

92 Frequently Asked Questions Question: During disaster can facilities (all types) exceed licensed bed capacity? If so, for how long?

93 Questions Roundtable participants will include Dotty Acosta - DADS ALF/ADC Program Specialist Yolanda Chavez - DADS HCSSAs Program Specialist Alan Garms - DADS ICF-ID Program Manager Thomas Davis - DADS LSC Program Manager Sonia Thomas - DADS Facility Surveyor/Liaison

94 To obtain presentation

95 THANK YOU for your attendance and participation.

96 Emergency/Disaster Preparedness at a Glance for Texas Long Term Care Facilities 2012 Healthcare Hurricane & Disaster Preparedness Summit 4/11/12 Pre/Post Test QUESTIONS 1. Nursing Facilities, Adult Day Care, Free Standing Hospice In-patient Unit, ICF-ID The new rules from the Texas Department of Aging & Disability Services for disaster plans for NF s, ADC, Home Health, Hospice, and ICF-ID require a risk assessment, a description of the population, description of the services needed by the residents, a section for each core function, training of staff, and a fire safety plan. 2. The disaster plan must be reviewed annually, 30 days after each emergency, 30 days after changes (remodeling, additions to the facility), and 30 days after information in the plan changes. The plan requires a signature by the facility coordinator and dated. Documentation of compliance must be maintained. (except Free Standing Hospice) 3. Disaster plans require detailed comprehensive plans and procedures. 4. The disaster plan must be written, current and accessible to all staff at all times. It must include a plan for maintaining contact with facility staff, resident s responsible parties, a receiving facility, and DADS during a disaster. Notification of the decision to evacuate must be made to DADS regional office immediately. Notification of the return to the facility after evacuation must be made to DADS regional office with 48 hours. 5. Written contracts or memorandum of understandings must be signed and dated for transportation, the sheltering facility, along with back up plans. 6. A facility s plan must designate the emergency preparedness coordinator (EPC) who is the facility staff person with the authority to manage the facility s response to an emergency situation in accordance with the plan; identify the alternate EPC, who is the facility staff person with the authority to act as the EPC if the EPC is unable to serve in that capacity, and documents the name and contact information for the local emergency management coordinator (EMC) for the area in which the facility is located as identified by the office of the local mayor or county judge. 7. Nursing Facilities, ALF, Free Standing Hospice In-patient Unit, ICF-ID, ALF It is the responsibility of each facility to: Use FIVES to update vacancy data; identify potential partners able to accept evacuees; make sure of resident transfer arrangements with those partners and update your evacuation status. 8. Nursing Facilities and Assisted Living Facilities Registration with the Texas Information and Referral Network -211 is required as of 9/1/ HCSSAs only If the agency identifies a client who may need evacuation assistance, the agency must provide assistance to the client to register with the Texas Information and Referral Network Effective August Nursing Facilities Generator spare parts are not required to be kept at the facility. They can they be kept with a supplier off-site. True/False