The Elephant in the Room: Are You Prepared for the Next Emergency?
By: Angela Rinehart and Norris Cunningham
Historically, emergency preparedness programs in long term care (“LTC”) facilities have been less prioritized with facilities understandably focusing on patient care and operations. But with the pandemic and President Biden’s nursing home reform plan, a focus on emergency preparedness is key and facilities should concentrate on, and perfect, their emergency preparedness programs now. And we don’t mean just on paper.
An emergency preparedness program describes a facility’s comprehensive approach to meeting the health, safety, and security needs of the facility, its staff, their residents, and community prior to, during, and after an emergency or disaster. The program encompasses four core elements which are briefly summarized in this article: an emergency plan that is based on a risk assessment and incorporates an “all hazards approach”; policies and procedures; a communication plan; and a training and testing program. The full emergency preparedness program must be reviewed and updated at least annually for LTC providers. The fact that other types of providers may perform program reviews every two years signals the heightened focus placed on LTC facilities’ emergency preparedness.
Requirements of the Emergency Plan
Based upon the facility and community-based risk assessments, the emergency plan ensures a facility's ability to collaborate with local emergency preparedness officials. It specifically identifies how the facility will continue to operate and ensure the safety and quality of resident care during a disaster. The plan is to account for hazards most likely to occur in a facility’s area whether man-made disasters, weather, cyber security attacks, equipment failures, or pandemics. For LTC facilities, written emergency plans must address missing residents, as well as residents’ access and functional needs. The plan too must acknowledge underlying conditions that may place residents at higher risk such as the impact that infectious disease may have on immunocompromised individuals, e.g., the COVID-19 pandemic.
The LTC facility must develop and implement emergency preparedness policies and procedures that are based on the emergency plan, risk assessment, and the communication plan. The policies and procedures must be reviewed and updated at least annually and must address a host of things such as needs during an evacuation, and much more. See 42 C.F.R. § 483.73(b).
The facility must also develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and this also must be reviewed and updated at least annually. The communication plan must include names and contact information for various persons and other sources of assistance.
Lastly, initial training of all policies and procedures to all new and existing staff is required as well as ongoing training on an annual basis. Notably, the regulation requires that LTC facilities must demonstrate that staff is knowledgeable of the emergency procedures. And this is where the rubber meets the road.
What Does This All Mean?
Experts are predicting that nursing home surveyors are going to start digging in on facilities’ emergency preparedness plans. Facilities, thus, need to take this seriously now to avoid increased penalties and tags as a result. It is common for staff members to be unfamiliar with the policies and procedures on emergency preparedness, to the extent that they would be unable to demonstrate knowledge if questioned by a surveyor. This is technically a violation of the federal regulations. Facilities should address this now with a review of their plan, policies and procedures, and in-services to retrain their staff.
Further, it will not be enough for staff to simply demonstrate knowledge of the plan by paper compliance. Facilities will need to show that they are able to implement the plan. To do this, facilities should conduct exercises to test staff proficiency of the policies that are announced. The regulation suggests mock drills, a tabletop exercise or a workshop led by a facilitator that includes group discussion.
