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Emergency Preparedness

Survey and Certification Emergency Preparedness Initiative: S&C Emergency Preparedness Checklist Revision (February 2014)
The Centers for Medicare & Medicaid Services (CMS) alerted healthcare facilities that it has revised current emergency preparedness checklists in formation for health care facility planning. These updates provide more detailed guidance about patient/resident tracking, supplies and collaboration.

Federal Guidance

Emergency Preparedness and Response: Model Policies and Procedures for State Long-Term Ombudsman Programs
Preparing for and responding to emergencies that affect individuals living in long-term care facilities requires coordinating the work of many. While Long-Term Care Ombudsman programs are not first responders, they can play an important role in emergency planning and response. Ombudsman programs can resolve complaints, protect rights, and promote access to services for residents before, during, and after emergencies and disasters. This document was procuded by the Administration for Community Living to assist in developing polices and procedures for State Long-Term Care Ombudsman programs regarding Emergency Preparedness.

Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
The rule was published on September 16, 2016 and is effective as of November 15, 2016. The regulations must be implemented by affected entities by November 15, 2017. The regulations require nursing facilities to be in compliance with all federal, state and local emergency preparedness requirements.

CMS Emergency Preparedness Final Rule Crosswalk
These tables represent a visualization of the association between the CMS Emergency Preparedness Final Rule Conditions of Participation and existing regulatory and accreditation standards. This crosswalk is intended to serve as a “Quick Reference Guide” and not as interpretive guidance or instructions on how to achieve compliance. Specific questions on individual facility compliance must still be directed to AOs, surveyors, and Centers for Medicare and Medicaid Services (CMS). This crosswalk is a product of Yale New Haven Health System Center for Emergency Preparedness and Disaster Response’s (YNHHS‐CEPDR) and has not been reviewed or approved by the CMS or by any AO. 

CMS Emergency Preparedness Rule: Resources at Your Fingertips
This document provides links to numerous related resources applicable to a variety of providers and suppliers related to the Emergency Preparedness Rule.

CMS Emergency Preparedness
Additional information and resources can be found on the CMS website.

Emergency Planning Checklists

Developed by the Centers for Medicare and Medicaid Services (CMS), these checklists are designed to help individuals or organizations be better equipped for handling emergency situations when they arise by identifying how they can prepare in advance and steps to take once an emergency situation occurs. The checklists should be used as part of training programs and reviewed regularly.

Resources for Ombudsmen/Advocates

Tribal Nursing Home Best Practices for Emergency Preparedness (February 2018)
The report was developed by the Department of Health & Human Services and Centers for Medicare & Medicaid Services. In November 2016, CMS implemented a regulation requiring health care facilities that participate in Medicare and Medicaid to create emergency preparedness plans. Many tribal nursing home emergency plans provide examples of culturally sensitive planning measures that other tribal facilities can emulate. This report describes the emergency preparedness approaches of five tribal nursing homes. It compiles emergency preparedness recommendations from nursing homes that have successfully created emergency plans and shares what has worked for these facilities, including leveraging partnerships, securing funding, and implementing staff training.

Fact Sheet - Harvey, Irma, and Medicare: Information for Advocate in Texas and Florida (October 2017)
This fact sheet was put together by Justice in Aging in the wake of hurricanes Harvey and Irma and to assist advocates in ensuring residents have access to the Medicare benefits they rely upon. 

Issue Brief - Why Many Nursing Facilities Are Not Ready Emergency Situations (September 2017)
Nursing facility residents can be particularly at risk during natural disasters, as has been demonstrated yet again during Hurricanes Harvey, Irma, and Marie. The hurricanes resulted in death and injury in nursing facilities across the region, including twelve deaths in one Florida facility. These deaths and injuries, and the desire to prevent harm in the future, have directed renewed attention on emergency preparedness. This issue brief discusses existing federal and state law, and makes recommendations to address gaps in current law. 

The Disaster Assistance Improvement Program’s (DAIP) mission is to provide disaster survivors with information, support, services, and a means to access and apply for disaster assistance through joint data-sharing efforts between federal, tribal, state, local, and private sector partners. The site can also help you learn how to prepare for, respond to, and recover from disasters. You can learn to deal with immediate needs, like how to: evacuate or shelter in place; find emergency shelter; get food and water; andle emergency medical situations until help arrives; and find family, friends, and even lost pets. You can even read the latest disaster news feeds and find other recovery help to help you move forward.

Emergency Preparedness and Long-Term Care Ombudsmen

The National Long-Term Care Ombudsman Resource Center (NORC) is working to develop model practices, resources, materials and training for long-term care ombudsmen programs around the issue of emergency preparedness.  Through this project, NORC is developing information, resources and best practice tips for State and Local LTC Ombudsman Programs that will help them be prepared for, and respond to, an emergency or disaster.  Project products include the below resources:

The Emergency Preparedness Kit is available to long-term care ombudsmen and includes: a drawstring bag; flashlight; NORC Tip Sheet for Ombudsman - Being Prepared! Things Ombudsmen Should Do Before, During and After an Emergency, Smart Phone Apps, and Emergency Management Dictionary and Translations; and CMS Emergency Preparedness Checklist for People Living in Long-Term Care Facilities, their Families and Ombudsman.  Kits are available for $14.00 each (plus shipping and handling); click here to purchase.  Discounts are available for bulk orders (20 or more).  Email ombudcenter@theconsumervoice.org for more information.

Emergency Preparedness for Every Emergency: CMS Resources
With the input of the S&C Emergency Preparedness Stakeholder Communication Forum, CMS has compiled a list of useful national emergency preparedness resources to assist State Survey Agencies (SAs), their State, Tribal, Regional, local emergency management partners, and health care providers to develop effective and robust emergency plans.

OIG Report: Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007–2010
Federal regulations require that Medicare- and Medicaid-certified nursing homes have written emergency plans and provide employees with emergency preparedness training. In a 2006 report about nursing homes that experienced hurricanes, the OIG found emergency plans lacked many provisions recommended by experts. In response, the Centers for Medicare & Medicaid Services (CMS) issued guidance checklists for emergency planning of health care facilities, long-term care (LTC) ombudsman programs, and State survey agencies (SA). The OIG conducted the above study to assess emergency preparedness and response of nursing homes that experienced more recent disasters.

Emergency Preparedness: Questions Consumers Should Ask
This National Consumer Voice for Quality Long-Term Care fact sheet is intended to provide consumers with information related to emergency planning. A nursing home, assisted living, or other long-term care facility should have a comprehensive emergency. Consumers – including residents and their families - should inquire about the facility’s emergency preparedness and evacuation plans.

Alerting the Whole Community: Removing Barriers to Alerting Accessibility (May 2013)
This short paper produced by FEMA discusses how the Integrated Public Alert Warning System (IPAWS) is accommodating people with “access and functional needs” (FEMA’s term for people with disabilities).  It offers compelling evidence that, while IPAWS doesn’t solve all of the challenges, it can certainly mitigate them – particularly with greater stakeholder engagement and public awareness.

Ombudsman Home Emergency Contacts List and Information (shared by Jackie Case, former New York City Ombudsman, 2001)
Following the 9/11/01 attacks, former New York City Ombudsman Jackie Case shared that the ombudsmen (both staff ombudsmen and volunteers) in her area always kept certain information with them at all times in the event of an emergency. As a result, after the attacks, the ombudsmen were able to continue their work despite not having access to their offices and files.

Ombudsman Role in Nursing Home Closures and Natural Disasters
This Ombudsman Resource Center Document (2000) includes a tool kit for local ombudsman response and information on transfer trauma.

U.S. DHHS: "Help is on the line." 
This useful tool and poster on the U.S. Department of Health and Human Services website provides contact information for federal programs, including mental health services, and pull down lists with contact numbers for state administered programs TANF, Medicaid and SCHIP. See instructions on how to customize this poster with local contact information.

Surviving the Storm
This study published in the Journal of Gerontological Nursing assess the emergency prepardeness of long-term care facilities in Texas when responding to Hurricanes Katrina and Rita. The results of the study showed the need for improved disaster training in long-term care facilities and discusses solutions including policy changes, coordination of transportation, improved communication, and improved staffing.

FEMA Mobile App: Weather Alerts and Preparation Advice
FEMA launched a new feature to its free app that will enable users to receive weather alerts from the National Weather Service for up to five locations across the nation. This new feature allows users to receive alerts on severe weather happening anywhere they select in the country, making it easy to follow severe weather that may be threatening family and friends.

FEMA PSA: We Prepare Everyday
The Ad Council and the Department of Homeland Security’s Federal Emergency Management Agency (FEMA) have launched a new public service advertisement (PSA) to raise awareness about the importance of being prepared for emergencies. While the PSA targets all communities, We Prepare Every Day is the first in a series of videos that aim to deliver a strong preparedness message by showing people with disabilities taking charge to prepare themselves and their families for emergencies.

Yale NewHaven Health Resource Center
The Yale New Haven Health System Center for Emergency Preparedness and Disaster Response (YNHHS-CEPDR) has developed several white papers and resources to support its user community. These documents are available by emailing center@ynhh.org. Please specify which documents you would like to receive.

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Ombudsman Activities

Testimony of Maria Greene, Director of the Georgia Department of Human Resources Division of Aging Services, before the U.S. Senate Special Committee on Aging hearing on Preparing Early, Acting Quickly: Meeting the Needs of Older Americans During a Disaster, October 5, 2005.

Georgia LTCO Activities to Assist Displaced Persons
This document briefly explains the steps that the Ombudsman Program took to assist nursing home residents displaced by Hurricanes in the Fall of 2005.

Blog Post - Emergency Preparedness: When is it Enough?
This blog post was written by previous Ohio State Ombudsman, Beverely Laubert, and Consumer Voice Executive Director, Lori Smetanka, for the American Society on Aging.

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Information from Other States

Emergency Protocol Reminder - Handout for Facilities
Missouri's survey agency developed this handout for times when nursing homes loose power. This handout is to remind facilities to notify the Section for Long-Term Care Regulation as soon as possible if there is a loss of a necessary service (electricity, water, gas, phone, etc.). SLCR developed a protocol for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs that results in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important - the safety and well-being of the residents.

In 2009, the Louisiana Ombudsman Program released a video designed to promote discussion around leadership and emergency preparedness practices, using the story of a nursing home staff during Hurricane Katrina, who continued to care for their residents and themselves during that uncertain time. The video, The Big Uneasy: Katrina’s Unsung Heroes, can be online. A facilitator’s guide is also available. The Louisiana Ombudsman Program received a grant from the Louisiana Department of Health and Hospitals (using Civil Money Penalties) to fund this project.

Oklahoma Facility Emergency Action Plan - The Oklahoma Department of Emergency Management in collaboration with the Department of Health developed this model emergency action plan for long-term care facilities. This plan is designed as a resource tool to assist in the development and implementation of an emergency action plan. Also see Oklahoma's Supplement to the Emergency Action Plan for Long-Term Care Facilities, developed by the Oklahoma State Department of Health Protective Health Services Long-Term Care.

Note from the Michigan State LTC Ombudsman describing how they aided Hurricane Katrina victims.

Advice from a local ombudsman in Youngstown, OH, describing how they got financial assistance to replace residents' personal effects lost or destroyed in a flood a few years ago.

The Florida Ombudsman Program created a Hurricane Assessment and Relief form that they use in hurricane relief, which they are currently sharing with Gulf States.

Ombudsman Best Practices

A local Ombudsman Program in San Mateo County brought on board an Emergency Planner to work with facilities and train them individually on handling natural disasters.  (2011)

Information to Share with Consumers

Checklist for people living in long-term care facilities

Long-term care providers

People with medical needs living at home 

Questions Consumers Should Ask

Contact Information for Federal Programs

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