Long-Term Care Survey Alert

Think through these "what ifs" before it's too late.

When a disaster strikes, staff and residents will be looking for well thought-out answers on how they will survive the ordeal--not questions that no one thought to raise beforehand.

Plot out how your facility will manage these common problems in the aftermath of a serious storm or other community-wide emergency.

1. How will you deal with potential intruders looking to take your scarce resources or to exploit the residents by taking their belongings or medications, etc.? Consider having security manage the premises 24 hours a day--"even if it's volunteers keeping vigilance over community access and forcing people to sign in," advises Judi Buxo, an executive with Life Care Services LLC in Des Moines, IA. Buxo has helped numerous nursing facilities weather severe storms, including Katrina. But you should make arrangements with volunteers and resources in the community before civil unrest occurs.

Tip: Ask people to wear name tags to identify themselves and cut off all entrances except a main one to keep true tabs on who's entering the building, suggests Buxo.

2. Who will care for residents if your employees are affected by the storm event or other disaster? "Think through staffing patterns that meet the residents' needs, but also allow for the associates" to sleep, eat and meet their hygiene needs, says Buxo. "Consider allowing families and pets to join the community," she advises. "Set up child care services" and find a way to pay staff in cash. Remember: Cash will likely be the only means for securing many goods and services during an emergency event, Buxo stresses. Your facility will thus need a cache of cash on hand for emergencies.

3. What are the community leaders' expectations of long-term care facilities in the event of a disaster, including a widespread flu outbreak in a community? For example, are hospitals assuming they can discharge their less critical patients to home or long-term care facilities to free up beds for critical victims? asks John Fishbeck, with the Joint Commission on Accreditation of Healthcare Organizations.

Tip: Being part of community-wide disaster planning can help your facility in the event of a storm or other disaster. For example, during the 2005 hurricanes in the Gulf Coast region, "hospital personnel could use their ID badges to get what little fuel" was available, but not so nursing assistants from long-term care facilities, observes Fishbeck. By working with community planners, you can preempt that type of problem so staff can get to work.

4. How will you dispose of the facility's garbage in order to prevent a sanitation problem or food poisoning if residents get hold of spoiled food? During a prolonged power outage, you will need to remove food from personal refrigerators in residents' rooms before the residents eat spoiled food and become ill, adding to the facility's medical problems, advises Buxo. In the aftermath of Katrina, her facility used an 18-foot truck moved to the premises as a receptacle to store the facility's garbage.

Another good question: Do you know when your facility can disclose protected health information for public health emergency preparedness purposes?