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Emergency Preparedness

Federal Requirements, Resources, and Reports


Updated Guidance from CMS Related to Emergency Preparedness (May 2022)
CMS updated their guidance related to Emergency Preparedness (EP) and exercise exemption based on a facility's activation of their emergency plan. CMS regulations for EP require facilities to conduct exercises to test the facility’s EP plan to ensure that it works, and that staff are trained appropriately about their roles and the facility’s processes. During or after an actual emergency, the regulations allow for a one-year exemption from the requirement that the facility perform testing exercises. Read the guidance.

Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
The rule was published on September 16, 2016 and was 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 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.

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.


Capacity-Building Toolkit for including Aging & Disability Networks in Emergency Planning
This toolkit helps programs that support older adults and people with disabilities, through the emergency planning process of preparedness, response, recovery, and mitigation activities. It can help organizations of all types conduct more inclusive emergency planning by facilitating personal preparedness for aging adults and people with disabilities. It can also help expand organizational knowledge of the unique challenges these populations face during emergencies. The toolkit can assist emergency managers and public health officials in understanding the capabilities and expertise of community-based organizations within the aging and disability networks. Organizations that are new to emergency planning can use this toolkit as an orientation to emergency planning. Those with established emergency preparedness programs can use it as a resource to enhance their capabilities.

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 produced by the Administration for Community Living to assist in developing policies and procedures for State Long-Term Care Ombudsman programs regarding Emergency Preparedness.


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.


COVID-19 Pandemic Operational Guidance for the 2020 Hurricane Season (May 2020)
This resource from FEMA provides COVID-19 guidance for the 2020 hurricane season. In this document on page 20 it starts the discussion of evacuation sheltering of people with access and functional needs, people with disabilities, nursing home residents, etc. 

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.

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.

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NORC Resources

Long-Term Care Ombudsman Program Role in Emergency Preparedness and Response: The Basics (February 2022)
These training materials provide a basic training regarding the Long-Term Care Ombudsman program (Ombudsman program) role emergency preparedness and response. The materials may be used in initial certification training or in-service (continuing education) training. The training provides a brief explanation of emergency preparedness; basics of emergency preparedness for individuals, long-term care facilities, residents, and Ombudsman programs; the role of the Ombudsman program in emergency response; and additional resources. The training materials include a PowerPoint and a video. Ombudsman programs may customize the PowerPoint with specific state and/or local information. The content is the same in both resources; however, you may use them differently as described in the training instructions.

Emergency Preparedness and Long-Term Care Ombudsmen Report 
An electronic questionnaire was sent to all State and Local LTC Ombudsman programs on November 14, 2012, asking about training and activities around emergency preparedness and response, policies and procedures, collaborations with other agencies, and guidance provided to ombudsmen and volunteers at the state and local levels. This report details the findings of the questionnaire and phone interviews.

Emergency Preparedness Kit (September 2015)
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 to purchase for $14.00 each (plus shipping and handling). Discounts are available for bulk orders (20 or more).  Email ombudcenter@theconsumervoice.org for more information.

Emergency Preparedness - Are YOU Ready? - PowerPoint Presentation (November 2014)

​Ombudsmen and Emergency Preparedness and Response Webinar (May 2013)
This webinar covered information and resources regarding the role of the Long-term Care Ombudsman Program in advocating for and supporting long-term care residents before, during and after emergency situations.  Presenters discussed model policies and procedures to guide Long-Term Care Ombudsman processes and activities, and local ombudsmen from across the country discussed how their programs provide emergency preparedness trainings, and creative solutions they have developed around issues that arise during emergency situations. View the Recording and Slides.

Ombudsman Role in Nursing Home Closures and Natural Disasters (2000)
This Ombudsman Resource Center Document includes a toolkit for Ombudsman program representatives response and information on transfer trauma.


Are You Ready? Ombudsman Program Emergency Preparedness and Response (February 23, 2022)

View the PowerPoint slides as a PDF.

Participants learned how Ombudsman programs may better serve residents of long-term care facilities by being prepared for emergencies and how to best respond to them. Beverley Laubert, National Ombudsman Program Coordinator, Administration for Community Living, shared the federal perspective regarding the role of Ombudsman programs in emergency preparedness and response and two states discussed recent disasters and their practices before and after the disasters. NORC shared a new training resource for basic Emergency Preparedness and guidance for the Ombudsman program’s role in assisting residents. Ombudsman programs may customize this new resource with specific state and/or local information and use it during initial certification training or annual in-service (continuing education) training.

Emergency Preparedness: Ombudsman Program Advocacy and Facility Responsibilities (September 2018)

View the slides as a PDF.

Recent natural disasters have significantly impacted several states, including consumers of long-term care services and supports. During this webinar, presenters shared their experience before, during, and after a natural disaster. Also, attendees learned about CMS’ emergency preparedness rule, model policies and procedures for Ombudsman programs by the Administration for Community Living (ACL), the most common reactions of residents after a disaster and how to support them, and tips to help prepare personally and professionally.

Presenters were Louise Ryan, Ombudsman Program Specialist, Administration for Community Living/Administration on Aging (ACL/AoA); Maria Greene, Consultant, National Ombudsman Resource Center (NORC); Mike Milliken, Florida State Long-Term Care Ombudsman; Dania Vazquez , Puerto Rico State Long-Term Care Ombudsman; and Lisa Hayes, Managing Local Ombudsman, Houston-Galveston Area Agency on Aging/Houston-Galveston Area Council.

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Additional Resources

Outbreak Considerations for Long-Term Care Communities

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. 

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. 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; handle 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.

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.

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 Program Examples

View Ombudsman program examples on emergency preparedness


Information to Share with Consumers

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.

Checklist for long-term care providers

Checklist for people with medical needs living at home

Contact Information for Federal Programs



View Archive here

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.

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, Beverley Laubert, and Consumer Voice Executive Director, Lori Smetanka, for the American Society on Aging.

People living in long-term care facilities, their families and ombudsmen

Checklist for people living in long-term care facilities

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