Florida Health Care Association 2013 Annual Conference

Transcription

1 Florida Health Care Association 2013 Annual Conference The Westin Diplomat Resort & Spa Session #1 Don't Wait for a Hurricane Come Practice with the Experts! Monday, August 5 8:30 to 10:30 a.m. Atlantic 1 Upon completion of this presentation, the learner will be able to: identify at least three hazard vulnerabilities a nursing home must address when preparing for a hurricane; describe at least two preparedness strategies for long term care facilities in the areas of plant operations, clinical care and communications; and demonstrate how to access the emergency preparedness tools available on the FHCA website and links to regulatory requirements from the Agency for Health Care Administration. Seminar Description: With the majority of Florida's LTC facilities located on or near the coast, hurricanes pose a significant threat to the lives of residents and staff. Join a team of experts who will present musthave information and valuable insights into hurricane preparedness, with a focus on sharing the "what-if situations" that became reality over the past decade. Each expert panelist will present compelling information from their unique perspective, followed by a discussion-based tabletop exercise where attendees will work through a hurricane scenario in groups. "Hurricane Helga" will challenge your thinking in terms of every facet of operations, from physical plant to clinical care, with a healthy dose of crisis communication and staffing challenges thrown into the mix. You'll pull from the experts' strategies, plus your own critical thinking and past experience, to work through the scenario's challenges. This session is for administrators, clinicians, plant operators and owners who want to learn the most crucial planning strategies for safety during a hurricane. Presenter Bio(s): Robin Bleier, RN, HCRM, President, RB Health Partners, Inc., is a featured state and national presenter, a special topics advisor to the FHCA Quality Foundation, Chair of the FHCA Emergency Preparedness Council, Co-Chair of the FHCA Risk Management Development Group and a vested long term care advocate through her volunteerism and affiliation with numerous professional committees. Robin has worked in health care since 1982 and in long term care since Robin has been a state and national MDS/Medicare educator since the Balanced Budget Act in She helped create the first multi-day educational program in Florida which was conducted at the Florida Risk Management Institute.

2 Tracy Greene, NHA, is the Administrator of Woodbridge Rehabilitation and Health Center in Tampa, Florida. Tracy has worked in skilled nursing facilities in several different roles, including Social Services Director, Administrator and Regional Vice President. Over her career, she has been involved in 5 evacuations of nursing homes in Florida, from the Keys to the Tampa Bay area. Tracy serves as the Co-Chair of the FHCA Quality Foundation Emergency Preparedness Council. Ginny Hazen currently serves as a Section Chief for the Broward County Emergency Management Division. She has worked for Broward County government for the past 13 years, primarily in the Human Services Department. She has a bachelor s degree in psychology from Florida State University and a master s degree in nonprofit management from Florida Atlantic University s School of Public Administration. Ginny s career spans over 30 years in health and human services, including working for Development Disabilities and Mental Health institutions, the Alcohol Drug Abuse and Mental Health program office of the Florida Department of Children and Families and several community service provider agencies. She has been involved in emergency planning for nearly half of her career in these agencies. Joe Mello is Florida Power & Light Company's Regional Manager for Small/Medium Businesses in Broward and Dade Counties, where he oversees customer service for more than 425,000 electric customers, among them nursing homes and other healthcare facilities. During times of hurricane restoration, Joe and his team focus heavily on the restoration status of nursing homes in his service area. In recognition of Joe s commitment to the safety of the skilled care facility residents during disasters, he was awarded with the FHCA Associate Member of the Year Award in Joe holds a bachelor s degree in business management from Florida Atlantic University.

3 What keeps you up at night? FHCA Annual Conference August 5, 2013 Hollywood, FL Don t Wait for a Hurricane. Practice with the Experts! (A Discussion-Based Exercise) Speakers Tracy Greene, NHA Woodbridge Rehabilitation & Health Center Joe Mello, Regional Manager Florida Power & Light Company Ginny Hazen, Section Chief Broward County Emergency Management Robin Bleier, President RB Health Partners, Inc. Chair, FHCA-QF Emerg. Preparedness Council 1

4 Today s Objectives Share lessons learned from real experiences Increase understanding of the hazard vulnerabilities and clinical risks a nursing home must address Increase understanding of Emergency Management s role during disaster events such as hurricanes Discuss preparedness strategies for LTC facilities Describe how to access emergency preparedness tools & resources on the FHCA website LESSONS LEARNED: WHEN WHAT IF BECOMES A REALITY Tracy Greene, NHA THE EFFECTS OF EVACUATION ON NURSING HOME RESIDENTS WITH DEMENTIA 2012 Report from the Center for Gerontology and Healthcare Research (CGHR): 3 year study of 21,255 nursing home residents living along the Gulf Coast 2

5 THE EFFECTS OF EVACUATION ON NURSING HOME RESIDENTS WITH DEMENTIA Death rate among seniors within 30 days of evacuation jumped 218%. Resident deaths also increased within 90 days after evacuations to 158%. 50%-70% of residents living in nursing homes suffer from a form of dementia. THE EFFECTS OF EVACUATION ON NURSING HOME RESIDENTS WITH DEMENTIA After dozens of nursing home residents died in the wake of Hurricane Katrina in 2005, evacuations increased 400% through Hurricane Gustav in Alternatives to evacuations include: Moving in with family members Sheltering in place Transferring to a local hospital HURRICANE SANDY 6,300 residents were evacuated from 30 nursing homes, many of which were flooded or powerless buildings in the days after the storm. Nursing homes in the state of New York have no requirement to specify where their patients will be taken in an evacuation. 3

6 HURRICANE SANDY With phones inoperable, many relatives did not know where loved ones had been taken for weeks. Medical records and medications that were supposed to accompany displaced residents never arrived. HURRICANE SANDY CMS said it expects to issue new disaster planning requirements for nursing homes this year. May require nursing homes to model their evacuation plans around a federally authored checklist. Plans include better systems for tracking displaced patients and making their medical files available electronically to the facilities that receive them. BEST PRACTICES Ensure you have a thorough plan. Educate your staff on your plan. Form a partnership with your local Emergency Management office. Be prepared- disasters don t just include hurricanes. 4

7 Florida Power & Light Company Hurricane Response Overview Joe Mello Regional Manager/FHCA Storm Coordinator Proprietary & Confidential Information An overview of FPL s electric system How FPL is strengthening our infrastructure How FPL identifies community priorities How FPL restores power How FPL communicates with our stakeholders 14 FPL overview FPL Facts (1) 4.6 million customer accounts 591 substations 6,700 miles of transmission power lines 67,500 miles of overhead and underground distribution power lines 1.1 million distribution poles 878,900 transformers 35 counties covering 27,000 square miles 90 percent of customers within 20 miles of the coast FPL Command Center Control Centers Our service territory covers more than half of Florida 15 (1) As of December 31,

8 LTC Areas of Vulnerability 16 An overview of FPL s electric system How FPL is strengthening our infrastructure How FPL identifies community priorities How FPL restores power Nuclear plant preparation How FPL communicates with our stakeholders 17 We re investing in the strengthening of our infrastructure Committed to Reliability Infrastructure Strengthening Pole Inspections Line Clearing FPL s plan is preparing the infrastructure to better withstand severe weather 18 6

9 Since 2006, FPL has strengthened 361 major circuits serving critical facilities and community needs Adopted National Electrical Safety Code extreme wind criteria Critical infrastructure Strengthening Projects Direct impact on health, safety, welfare and security of community (e.g. hospitals, 911, police/fire, EOCs) Community projects Major thoroughfares with grocery stores, gas stations, etc. We work with local municipalities to identify the critical needs of their communities 19 Since 2006, FPL has inspected 940,000 poles 85 percent of our pole population Pole Inspections Committed to inspecting our 1.1 million poles every eight years Test for strength and loading; repair and replace as needed Completing our first eightyear inspection cycle in 2013 Since 2006, we have reinforced or replaced 46,500 poles that no longer meet FPL s strength and loading standards 20 FPL s interactive, online System Improvement Map communicates reliability work to customers 21 Customers can view system improvements in their neighborhoods by visiting 7

10 An overview of FPL s electric system How FPL is strengthening our infrastructure How FPL identifies community priorities How FPL restores power How FPL communicates with our stakeholders 22 FPL works with local governments to identify community priorities well ahead of hurricane season Collaboration on Critical Infrastructure Identify critical facilities necessary to support the community Help to quickly bring the community back to normal Balance critical infrastructure and customer needs FPL Service Territory Meetings with 27 County EOCs in early spring to identify Critical Infrastructure 23 Ensure that FPL and local government restoration priorities are aligned Critical infrastructure is fairly consistent among counties Critical Infrastructure Categories Direct impact on the health, safety, welfare and security of the community Hospitals 911 centers Police/Fire Emergency Operations Centers (EOC) Indirect impact Radio/TV Fuel supply FPL power plants Water management facilities 24 8

11 An overview of FPL s electric system How FPL is strengthening our infrastructure How FPL identifies community priorities How FPL restores power How FPL communicates with our stakeholders 25 FPL s restoration process begins 96 hours before the storm makes landfall Analyze damage forecast Assemble restoration team Contact suppliers and vendors Communicate to customer groups Pre-Landfall 26 FPL has a proven plan to restore power to the greatest number of customers safely and as quickly as possible Restoration Process 27 9

12 And the restoration continues until the last customer has his lights back on. 28 An overview of FPL s electric system How FPL is strengthening our infrastructure How FPL identifies community priorities How FPL restores power How FPL communicates with our stakeholders 29 Communication with federal agencies is important before and after a storm Federal Agencies Federal stakeholders may receive notification of emergency via , in person, or by phone from FPL Magnitude of event will dictate level of government contact If normal communication channels are down, satellite phones will be utilized to contact key officials 30 Federal agencies are critical to providing emergency assistance to the communities affected 10

13 FPL knows information is critical and uses many different channels to connect with local leadership Local Leaders FPL External Affairs reps maintain open one-on-one communication channels with local officials communications network informs local community leaders and large commercial customers FPL may invite officials to visit staging sites and participate in media briefings 31 FPL s communication with local leaders is on-going via , phone and Internet Dedicated government update Web page is activated during severe storm events to keep local leaders informed FPL Government Update Web site 32 FPL is committed to working closely with Emergency Operation Centers and maintaining open communications Emergency Operation Centers (EOC) Lake City FPL representatives are assigned to Emergency Operations Centers across Florida FPL Storm riders are stationed at EOC locations that can withstand hurricane-force winds FPL coordinates special crews to assist EOCs Search & rescue Road clearing State EOC Sarasota Punta Gorda Ft. Myers = Regulatory Affairs = External Affairs = County EOC = Regional EOC Daytona Melbourne Stuart Palm Beach Ft. Lauderdale Ft. Lauderdale Hollywood Miami 33 Every effort is made to keep officials informed as the storm makes landfall 11

14 Emergency Operation Centers are an important communication channel for both local officials and FPL customers FPL reps may participate in EOC briefings and media advisories Provide FPL news releases Share restoration reports and maps Report community needs to FPL EOC Communications FPL reps assigned to EOCs have access to the most current restoration information 34 FPL provides ongoing restoration updates through our storm center, mobile web site and social media Communications 35 FPL.com/Storm FPL s interactive, online outage map keeps customers informed about power outages Power Tracker 36 Customers can receive outage updates or report at outage by visiting 12

15 FPL encourages customers to get ready and stay safe every storm season Are You Prepared For The Storm Season? Develop or review your emergency evacuation plan Update your contact information, especially your phone number, at Complete all tree trimming and landscaping before June 1 st Assemble your seven-day disaster supply kit Review insurance policies Prepare a list of vendors to provide disaster recovery services Review hurricane plan with employees 37 Visit for hurricane season tips for your home and business Working with Local Emergency Management Ginny Hazen, Section Chief Broward County Emergency Management Importance of Relationships with Emergency Management & Health Dept Some County EM s hold conference calls with nursing facilities and health dept. beginning 120 hours out (5 days) GIS maps of nursing facilities and where they are located within evacuation zones Per experience in Wilma, inland still needs consideration Can be added to notification systems, e.g. Code Red 13

16 The 5 Qualities of a Solid Emergency Plan Mutual Aid Agreements (evacuation outsidezone A and B) Transportation Agreements ( vendor contract, vehicle usage agreement, facility-owned vehicles) Vendor Agreements (food, water) Two Hazard Drills (annual) Fire Safety Plan Approval Letter Florida Requirements & Recommendations County EM requirements may differ! Supply Type Dietary: Non-perishable food & supplies Drinkable water supply Essential supplies Florida Requirements Fla. Admin. Code (FAC) One week supply -- s. 59A-4.110(4), FAC Storage for 3 gal. per resident per day during & immediately following a disaster (defined as 72 hrs. following the loss of normal support utilities) -- s. 59A-4.133(18), FAC, for NHs built after hour supply -- s. 59A-4.126(2)(b), FAC and AHCA Planning Criteria, AHCA , March 1994 Recommendations 7 10 days recommended 7 10 days recommended 7 10 days recommended How are Evacuations Called by a County? With storm coming from east: Zone A (barrier islands) evacuated first, then Zone B (East of US 1) Boats are evacuated first, due to impending bridge lockdown 12 hours before evacuation, notifications are made public that evacuation is being considered 14

17 How are Evacuations Called by a County? Shelters are opened hours before the arrival of tropical storm force winds Takes hours to evacuate, then bridges are locked down Ambulance availability is an issue; prioritized from east to west different companies needed Evacuation planning is determined at the county level be sure to be in communication with your Emergency Management Office LTC Disaster Planning: Assumptions & Special Considerations Robin Bleier, RN, HCRM President, RB Health Partners, Inc. Chair, FHCA Emerg. Prep. Council Key Planning Assumptions LTC residents (patients) have high acuity levels and many have Alzheimer s disease or suffer from other types of dementia or mental conditions Residents cannot evacuate without assistance Evacuation is a hazard! Sheltering in place is preferred LTC facilities may be overlooked as preparedness & response planning partners 15

18 Key Disaster Planning Considerations for Nursing Homes #1 Facility profile what are the characteristics of your patients/residents? #2 Risk identification and management how vulnerable are your residents? how vulnerable is your building? how will you manage the associated risks? #3 Continuum of healthcare and support systems for nursing homes who are your care partners? what are their roles during disasters? #4 Comprehensive & integrated planning does your plan address potential care & service gaps? is it all-hazards? is it integrated into the community s prep. & response system? 46 #1 Facility Profile - Your Residents Residents Characteristics Demographics (age, mobility, ADLs) Medications & Therapies Treatments (e.g., dialysis) Care requirements (e.g., dementia) Dependence on external care providers (e.g., hospice) 47 #2 Risk Identification & Management Clinical Risk Considerations LTC residents have high acuity levels and complex co-morbidities Many have Alzheimer s disease or suffer from other types of dementia Depression and other mental health conditions Decompensation will occur -- residents may require a clinical response to emergent situations 48 16

19 Risk Identification & Management (continued) Management of Residents Risk Levels Identify the types of residents served (e.g., diabetes or Alzheimer's disease) Is the resident terminal or a hospice patient? Is the patient s health is worsening -- why? Is it due to an underlying illness? How will you identify and monitor those at risk for dehydration? Consider the what if s e.g., AC failure 49 Risk Identification & Management (continued) Physical Plant & Location Risk Factors Construction standards (year built) Utilities / Generator Location (e.g., surge/flood zone) Proximity to hazards (e.g., chemical) Access issues getting to your campus Other factors 50 #3 Continuum of Healthcare & Support Systems for Facilities During Disasters A Nursing Home is a complex system There are many dependent and inter-dependent support services and providers Internal and external This complex system is a continuum support services and providers are connected When one is not functioning, what are the consequences? 51 17

20 The Continuum Model Central Supply Staffing Food & Water Transp. Med. Equip. & Supplies Nursing Home Medications Treatments Electricity - Utilities Ancillary Services (e.g., labs) Phones Medical Services (physicians & extenders) Sewage Info. Tech. (IT) Hurricane Impacts: Essential Systems Reduced or Off-Line Transp. Central Supply Staffing Food & Water Med. Equip. & Supplies Green = OK Yellow = Reduced Red = Off-line Phys. Plant & Maint. Laundry & Housekeeping Phys. Plant & Maint. Laundry & Housekeeping Nursing Home Medications Treatments Electricity - Utilities Ancillary Services (e.g., labs) Phones Medical Services (physicians & extenders) Sewage Info. Tech. (IT) #4 Comprehensive & Integrated Planning Plans are comprehensive when they address: Dependencies & inter-dependencies (the continuum) Service gaps & replacement strategies External and internal factors Planning is integrated when it: Reflects roles & responsibilities of other key partners Complements the local community s broader plan Includes your facility s participation in community training and exercise programs 54 18

21 Planning Factors Nursing Home External Planning Factors: Information, resources, supports, or systems external to the Nursing Home, which contribute to a decision or a course of action to sustain the continuum of care. Internal Planning Factors: Information, resources, supports, or systems internal to the Nursing Home, which contribute to a decision or a course of action to sustain the continuum of care. 55 External Planning Factors Hazard analysis Hazard duration Scope of Impact Service providers Facility location Local emergency declaration County emergency management plan (CEMP) Communications (interoperability) Healthcare system Transportation Access to staffing resources Medical equip. & supplies Pharmacy services Utilities Host site availability Other factors 56 Internal Planning Factors Delineation of roles & responsibilities Integration with other plans (e.g. your fuel provider) Training & exercise Ability to shelter-in-place Ability to evacuate Staffing availability (short & long term) Resident acuity levels & clinical care needed Physical structure Medications, medical supplies & equipment Laundry Sanitation Food Water (Essential Supplies) Generator Finance & Admin. Records / IT Communications (residents, family, staff, the public) Recovery planning Other factors 57 19

22 Example: The Influence of Internal & External Factors Consideration of these factors influence actions ( stay or go for example) Emergency Management Guide for Nursing Homes, page Evacuation Stay or Go? Evacuation Risk Factors Evacuation is a hazard (e.g., transfer trauma) Residents cannot evacuate without assistance Transportation concerns: time ~~ distance ~~ vehicle type Receiving facility concerns: staffing & care levels Morbidity and mortality issues must be considered & addressed Care gaps may develop 60 20

23 Second Guessing your Course of Action? Why did you shelter-in-place? Was this in your plan? Did the hazard outweigh the risk of evacuation? What was the risk of sheltering-in-place? Was this a reasonable decision based on what you knew? Did you decide based on the best interest of your patients? Was it the right thing to do? Disaster Planning. Does this look ready to you? Discussion-Based Exercise 21

24 Discussion Based Exercise Team Resource Packet: Team Instructions Facility Profile Key Disaster Planning Considerations External & Internal Planning Factors Continuum Model Saffir Simpson Scale of Categories Hurricane Planning Checklists Sunny Day Rehab & Nursing FACILITY PROFILE Welcome to Sunny Day Rehab & Nursing Center in Palm Beach, Florida. Sunny Day is a 120-bed facility nestled into a heavily wooded residential area of the community, near the Overflow River. It is a one-story, 55,000 square foot cement block building built in The facility is located 4.0 miles from the beach. Its elevation is 6.0 feet. The facility is fully shuttered, has a 10 year old 150 kw generator, and a back-up system for the post-acute care unit. The facility layout is an H design and has two sides of resident rooms, 60 beds on each side. The two sides are divided into three resident care units. The North side consists of 60 beds, primarily post-acute care residents with 15 beds dedicated to pulmonary care (15 residents with a tracheostomy with 9 of the 15 requiring ventilator care.). The remaining beds on the North side are separated by a large dining room, rehabilitation services, and offices and include long term care residents. The South side consists of 60 beds subdivided into two units. The larger unit has 40 beds with residents at various levels of cognitive and physical impairment. The smaller unit has 20 beds that are part of a secured dementia care unit which has a large multi-purpose room attached to a porch. All facility beds are dully certified for Medicare and Medicaid. The current census is 117 beds. Hurricane Helga 66 22

25 Pre-Landfall Scenario National Hurricane Center Statement (48-24 Hours to Landfall) Hurricane Helga is 500 miles SE of Palm Beach, Florida moving NW at 10 mph Helga is a Category 4 hurricane with a wind speed of 135 mph & may strengthen in the next 24 hours Hurricane force winds extend out 75 miles from the center with TS winds extending out 150 miles in all directions Florida s southeast coast is under a hurricane watch and projected to be under a warning & should expect the onset of TS/hurricane force winds within the next 24 hours Landfall is projected within 20 miles of the Broward-Palm Beach County line 23

26 What is a Cat 4 Storm? Saffir-Simpson Scale for Damage Potential Category Winds mph mph 3 -Major mph 4 Major mph 5 Major greater than 157 mph

27 Hurricane Helga Projected Impacts Extended power outages several days to several weeks in some areas Fuel shortages Extreme and catastrophic damage Roadway washouts and flooding Healthcare systems and support services reduced or unavailable for a sustained period Staff may be absent or unable to get to work Groups A & B: Discussion Questions 1. Discuss the scope & severity of the threat the hurricane presents to your facility, residents, and community. What do you anticipate will be the impacts on your continuum of care? 2. Identify and discuss internal and external planning factors, given the scenario. What are the most important factors and why? 3. Describe your course of action during the next hours (pre-landfall). What are your priorities and why? 74 Post-Impact Scenario ~~ Groups C & D ~~ 25

28 National Hurricane Center Statement Post Impact (Landfall 48 Hours) Hurricane Helga made landfall 12 hours ago in Palm Beach County, FL causing major damage along the east coast of FL Wind speeds exceeded 145 mph with gusts to 175 mph The area received from inches of rainfall Storm surge of 8-12 ft. has been reported in Palm Beach County Surge flooding has extended 6 miles inland through inland rivers and tributaries Several tornadoes have been reported in the area Helga is now moving in a NNW direction Hurricane Helga Impacts (Landfall 48 hours) Facility power is out no info on for how long Generator is running rough, and fuel provider is not available Cannot reach the caterer, pharmacy, or transportation provider Facility has lost a portion of the roof and a number of windows have been broken out Higher acuity residents decompensating at a rapid rate Hurricane Helga Impacts ~ continued (Landfall 48 hours) Two residents died during the peak of the storm Communications is limited information that landlines and cell towers are down Water pressure is low due to a collapsed water tower in the community Closest hospital has had to evacuate due to structural damage A number of staff have not shown up for work 26

29 Groups C & D: Discussion Questions 1. Discuss the scope & severity of the hurricane s impact. What are the resulting critical gaps in the continuum of care, current and projected? 2. Based on your current situation, discuss relevant internal and external planning factors. What are the most important factors and why? 3. Describe your course of action for the next hours (post-landfall). What are your priorities for restoring the continuum of care? 79 Remember 2004? 2004 Hurricanes 81 27

30 Forecasted Area of Impact FINAL POINTS: Key Elements for a Successful Outcome Know your partners! Maintain situational awareness Identify key issues Recognize time sensitivity Gather and analyze data Plan for foreseeable contingencies Stay ahead of the curve Know your facility, staff, and patients Involve and inform staff, patients, and families Have a long-term recovery plan Remember: It s not over until conditions are stable & all residents & staff are safe Do you know the name of your EM contact? FHCA s Role in Emergency Preparedness Emergency Preparedness Council Resources & tools to help members ( Training Sessions FPL training and at Annual Conference During an Event Special Member Alerts Daily 11am Disaster Calls, immediately following an event ESF8 Partner Liaison to the Florida Department of Health 84 FHCA Disaster Team 28

31 Thank You. Questions? PPT & Handouts on the web: Robin Bleier: April Henkel: 29

32 7/3/2013 Broward Emergency Management Health Care Program Purpose The Comprehensive Emergency Management Plan (CEMP) and its review by local emergency management agencies is intended to establish policies, procedures and organizational structure for facilities response to emergencies. 1

33 7/3/2013 Background o 1995 Broward County began reviewing health care plans o Review mandated in Chapter 252, Florida Statutes (FS) o Agency for Health Care Administration (AHCA) has agreement with Emergency Management agencies o All 67 Counties required to review and approve plans o Plan review process, a preparedness tool for health care facilities Agency for Health Care Administration( AHCA) o State Regulatory agency for all health care facilities o Comprehensive Emergency Management Plan (CEMP review criteria established in Chapter 9G 20 of Florida Administrative Code o AHCA issues all facility licenses o Conducts site inspections o Sets plan review fee and administrative fee o Requires new facilities to submit CEMP to local emergency management agencies 2

34 7/3/2013 Key components of plan review o Mutual aid Agreement (evacuation) o Transportation Agreement ( contract, vehicle usage agreement) o Vendor Agreement (food, water) o Two hazard drills (annual) o Fire Safety Plan Approval Letter Licensed Facilities in Broward County o June 11, 2013 update: 393 health care facilities by plan types o Assisted Living Facilities (ALF) 285 o Hospitals 24 o Nursing Homes (NH) 35 o Ambulatory Surgical Centers (ASC) 26 o Adult Daycare Centers (ADC) 17 o Intermediate Care Facilities for the Developmentally Disabled (ICF) 6 3

35 7/3/2013 Plan Reviews October 2011 September 30, 2012 Nursing Homes ALFs Hospitals Daycare Centers Ambulatory Surgical Centers Intermediate Care for Developmentally Disabled Month Approved Plans 2011 October November December January February March April May June July August September Total

36 EXERCISE SCENARIO ~~ PRE-LANDFALL ~~ Your team is responsible for Sunny Day Rehab (see Facility Profile below). A storm scenario for Hurricane Helga has been presented. Your team must now complete certain tasks/assignments for your facility. Identify someone to take notes for your team (a recorder), highlighting your course of action, problems, and concerns addressed. Your team will be asked to report on these. As you work through your course of action in response to the scenario, use the planning considerations discussed today to discuss the following: 1. Discuss the scope & severity of the threat the hurricane presents to your facility, residents, and community. What do you anticipate will be the impacts on your continuum of care? 2. Identify and discuss internal and external planning factors, given the scenario. What are the most important factors and why? 3. Describe your course of action during the next hours (pre-landfall). What are your priorities and why? Facility Profile: Sunny Day Rehab & Nursing Center Welcome to Sunny Day Rehab & Nursing Center in Palm Beach, Florida. Sunny Day is a 120-bed facility nestled into a heavily wooded residential area of the community, near the Overflow River. It is a one-story, 55,000 square foot cement block building built in The facility is located 4.0 miles from the beach. Its elevation is 6.0 feet. The facility is fully shuttered, has a 10 year old 150 kw generator, and a back-up system for the postacute care unit. The facility layout is an H design and has two sides of resident rooms, 60 beds on each side. The two sides are divided into three resident care units. The North side consists of 60 beds, primarily post-acute care residents with 15 beds dedicated to pulmonary care (15 residents with a tracheostomy with 9 of the 15 requiring ventilator care.). The remaining beds on the North side are separated by a large dining room, rehabilitation services, and offices and include long term care residents. The South side consists of 60 beds subdivided into two units. The larger unit has 40 beds with residents at various levels of cognitive and physical impairment. The smaller unit has 20 beds that are part of a secured dementia care unit which has a large multi-purpose room attached to a porch. All facility beds are dully certified for Medicare and Medicaid. The current census is 117 beds.

37 National Hurricane Center Statement: Hours to Landfall Hurricane Helga is 500 miles SE of Palm Beach, Florida moving NW at 10 mph Helga is a Category 4 hurricane with a wind speed of 135 mph & may strengthen in the next 24 hours Hurricane force winds extend out 75 miles from the center with TS winds extending out 150 miles in all directions Florida s southeast coast is under a hurricane watch and projected to be under a warning & should expect the onset of TS/hurricane force winds within the next 24 hours Landfall is projected within 20 miles of the Broward-Palm Beach County line Hurricane Helga: Projected Impacts Extended power outages: several days to several weeks in some areas Fuel shortages Extreme and catastrophic damage Roadway washouts and flooding Healthcare systems and support services: reduced or unavailable for a sustained period Staff may be absent or unable to get to work

38 EXERCISE SCENARIO ~~ POST-IMPACT ~~ As you work through your course of action in response to the unfolding scenario, use the planning considerations discussed today to discuss the following: 1. Discuss the scope & severity of the hurricane s impact. What are the resulting critical gaps in the continuum of care, current and projected? 2. Based on your current situation, discuss relevant internal and external planning factors. What are the most important factors and why? 3. Describe your course of action for the next hours (post-landfall). What are your priorities for restoring the continuum of care? Facility Profile: Sunny Day Rehab & Nursing Center Welcome to Sunny Day Rehab & Nursing Center in Palm Beach, Florida. Sunny Day is a 120-bed facility nestled into a heavily wooded residential area of the community, near the Overflow River. It is a one-story, 55,000 square foot cement block building built in The facility is located 4.0 miles from the beach. Its elevation is 6.0 feet. The facility is fully shuttered, has a 10 year old 150 kw generator, and a back-up system for the postacute care unit. The facility layout is an H design and has two sides of resident rooms, 60 beds on each side. The two sides are divided into three resident care units. The North side consists of 60 beds, primarily post-acute care residents with 15 beds dedicated to pulmonary care (15 residents with a tracheostomy with 9 of the 15 requiring ventilator care.). The remaining beds on the North side are separated by a large dining room, rehabilitation services, and offices and include long term care residents. The South side consists of 60 beds subdivided into two units. The larger unit has 40 beds with residents at various levels of cognitive and physical impairment. The smaller unit has 20 beds that are part of a secured dementia care unit which has a large multi-purpose room attached to a porch. All facility beds are dully certified for Medicare and Medicaid. The current census is 117 beds.

39 National Hurricane Center Statement: Post Impact Landfall to 48 hours Hurricane Helga made landfall 12 hours ago in Palm Beach County, FL causing major damage along the east coast of FL Wind speeds exceeded 145 mph with gusts to 175 mph The area received from inches of rainfall Storm surge of 8-12 ft. has been reported in Palm Beach County Surge flooding has extended 6 miles inland through inland rivers and tributaries. Several tornadoes have been reported in the area Helga is now moving in a NNW direction Hurricane Helga: Projected Impacts Facility power is out no information on for how long Generator is running rough, and fuel provider is not available Cannot reach the caterer, pharmacy, or transportation provider Facility has lost a portion of the roof and a number of windows have been broken out Higher acuity residents decompensating at a rapid rate Two residents died during the peak of the storm. Communications to outside facilities is limited information that landlines and cell towers are down. Water pressure is low due to a collapsed water tower in the community. Closest hospital has had to evacuate due to structural damage. A number of staff have not shown up for work