Long-Term Care Survey Alert

Drilling down to the details can help you weather a flood or other catastrophe.

A disaster plan provides a blueprint for what to do in a calamity, but you never really know how well it's going to work in the real deal. You can, however, take advantage of "lessons learned" from providers who have been forced to activate their plans, which The Palace Care and Rehab facility in Tennessee had to do this spring during massive flash flooding.

Lesson No. 1: Don't wait until it's too late. As flooding began to affect the area on a Saturday, the facility's administrator Rita Crabtree and her team consulted with local and federal emergency officials about when to evacuate. Crabtree remembered how some New Orleans nursing home residents drowned in post- Katrina flooding while "sheltering in place." And she feared her facility could become "land locked" by area flooding. So when water began seeping into the facility's kitchen and laundry areas on Sunday, she decided to pull the trigger.

"We had the ambulances and bus ready to go and evacuated the facility in two hours," Crabtree tells Eli. Some people in her community initially criticized the facility's decision to move residents as being premature. But Crabtree made the decision at a time when the facility could still use a bus and ambulances. "Two hours later, our parking lot was under water," she says, noting that those who initially questioned her decision now commend it. Fortunately, the facility itself did not have serious flooding.

Preparedness tips: Establish relationships pre-event with people you'll be counting on in an emergency, advised Ray Miller, a safety and risk management expert, in a presentation on disaster preparedness at last fall's annual American Association of Homes & Services for the Aging meeting. That includes people who will provide your transportation for evacuations or fuel and water if you shelter in place. Invite those individuals into the facility to meet your residents, Miller suggested.

Lesson No. 2: Have a plan for maintaining appropriate care. The Palace had 21 residents transported by ambulances to three different area hospitals for care. The facility staff accompanied 82 residents on a bus to the National Guard armory where the staff continued to care for the residents.

Simplify: The physician gave patients staying at the armory a "drug holiday" except for critical medications, says Crabtree.

Tip: The Palace staff members were able to communicate with physicians and other resources in the community during their stay at the armory. But as part of your disaster plan, work with physicians to obtain standing orders, in case the storm or other emergency breaches communication, suggests Robin Bleier, RN, LHRM-FACDONA, principal of RB Health Partners Inc. in Palm Harbor, Fla. That way you can maintain good care without violating rules and state practice acts, she says. Plan in advance for how you'll meet the special needs of residents, such as those needing dialysis, urged Miller in his presentation. For example, if you evacuate to an outof- state location, plan the route to stop by a dialysis center. Also make sure your disaster plan appendix includes an evacuation route map.

Lesson No. 3: Be prepared to improvise. "You have to be asprepared as you can" while realizing that the unexpected can happen, relays Crabtree. "We had a chance on Saturday to discuss everything and be ready to go ... when I made the call to evacuate on Sunday, but you don't always have that luxury of time."

Example: The facility staff's emergency food supply and cooking capabilities worked out well at the armory. But the staff had to shop for extra linens and pillows at WalMart to make residents as comfortable as possible at the armory, Crabtree says. "We realized we could have had those things in shrink wrap and ready to take with us."

Tips: "You develop your basic plan and then come up with 'what if' scenarios so you have a contingency plan," advises Bleier. "Ask 'what if this happens at night?' What if I'm trying to do this in a pandemic and a third of the staff aren't available to help?"