Continuity of Care
For facilities entrusted
with the lives of
plans are complex
documents that never
By Michelle Kerr
A volatile hurricane season put long-term care disaster risks in sharp focus.
A nightmarish scene unfolded in Port Arthur, Texas, after Hurricane Harvey. Law enforcement and volunteer teams forcibly evacuated a flooded nursing home that waited too long past the window of opportunity to launch a safe evacuation. Not even two weeks later, amid the chaos of Hurricane Irma,
another crisis was brewing at a nursing home in Hollywood Hills, Fla. This time
though, help didn’t arrive in time. Eight vulnerable residents died after a few days
in the sweltering facility with no power. Six more died of related complications in
the weeks that followed.
The latter facility has since been shut down, and the operators of both facilities
are facing serious scrutiny from law enforcement as well as regulatory agencies.
It’s no surprise multiple lawsuits are already in process.
Yet neither of these incidents is entirely isolated. There are long-term care facilities
across the country that, in the event of a disaster, could be one questionable decision
or one poorly executed procedure away from finding themselves publicly pilloried.
Crisis management in skilled nursing facilities and long-term care facilities is
an incredibly complex endeavor that takes the cooperation of risk management,
the executive suite, vendors, suppliers and community partnerships.
Fortunately, there are a great many resources available to help nursing and
long-term care facilities ensure their ability to protect patients and residents as
well as staff members.
THE PLAN’S THE THING
The Centers for Medicare & Medicaid Services (CMS) published an updated
rule in 2016, “Emergency Preparedness Requirements for Medicare and Medicaid
Participating Providers and Suppliers.” Health care providers, including nursing
and long-term care facilities, were required to be in compliance with the new rule
as of Nov. 15 of this year.
So while facilities already had disaster plans in place, CMS set the bar a notch
higher and formalized certain aspects of emergency preparedness planning for the
health care industry.
“Without a doubt the rule represents new challenges to long-term care
organizations due to the sheer amount of work related to complying with
the regulation and the preparation involved,” said Diane Doherty, senior vice
president, Chubb Healthcare. But Doherty said she feels confident that most
facilities were able to meet the Nov. 15 deadline.
Still, there can be a significant gap between a facility that’s meeting minimum
compliance requirements and a facility that’s genuinely ready to weather a storm
or a sudden fire.
The foundation of a strong preparedness plan, experts agree, is a
comprehensive hazard vulnerability assessment, or HVA, which looks at every
type of emergency or disaster a facility might face and carefully addresses how
each scenario might impact a location’s ability to keep its residents and employees
safe, both during an emergency and in the days and weeks that follow.
The assessment helps pinpoint the services a facility will need by “identifying
residents who require additional assistance — the wheelchair-bound, the bed-bound, the residents on ventilators,” said
Doherty. This includes residents with
dementia as well as those who simply
need assistance ambulating.
Assessment best practices should
include the help of community
partners such as law enforcement
and local emergency management
and health department officials,
said Scott Aronson, a principal with
Russell Phillips & Associates (RPA),
an emergency management firm and
“If you didn’t ask the right
questions and don’t have the
right information, it is hard
to make a decision about the
patient lives that are in your
— Scott Aronson, principal, Russell Phillips &
• A new CMS rule holds nursing
and LTC facilities to a higher
• Drills are the best way to ensure
a facility will be ready for a crisis.
• Industry-specific free resources