Long-Term Care Survey Alert

The time to decide how to respond to storms, fires, floods ... is now.

What you don't anticipate can hurt your residents and staff when a serious storm or other calamity strikes your facility or community. That's why you need a fine-tuned emergency plan and lots of practice in implementing it so people can handle the real deal.

Lack of planning can take a toll on your surveys if you don't have the bases covered to meet your residents' basic needs during a time when "all bets are off," as Craig Ubbelohde, president and CEO of Lutheran Homes in Oshkosh, WI, puts it.

Some resources you might count on won't be available, he says. "But assistance you hadn't anticipated will come through for you." Disaster planning helps you be aware of your options so when something happens, "you can take advantage of what you do have to work with," emphasizes Ubbelohde.

Be prepared for increased survey scrutiny: Attorney Barbara Miltenberger expects to see a renewed survey focus on disaster preparation as the hurricane season cranks up. But a facility "doesn't have to be in a hurricane area to be targeted by surveyors" for shortfalls in disaster preparation, stresses Miltenberger, who is of counsel with Husch & Eppenberger in Jefferson City, MO.
Miltenberger notes surveyors have homed in on disaster preparation in Missouri, for example.

Where to start: To ensure your disaster planning leaves you a step ahead of the unexpected, follow an accepted model for disaster preparedness, such as the one providedby the Joint Commission on Accreditation of Healthcare Organizations. If a facility does that, it "should be in good stead with surveyors," says Miltenberger. The survey guidelines don't really spell out what facilities should do to be ready for a disaster, she notes.

Heed the Advice of Those Who Have 'Been There'

Plan A should be to evacuate if you anticipate a storm will leave the area without power for days, in the view of Judi Buxo, an executive with Life Care Services LLC in Des Moines, IA. Buxo has helped numerous facilities weather severe storms. "Why would you want to stay if you can find a safe alternative?" she asks.

Key points: Don't wait until a disaster to find some place willing to take residents if they become displaced, advises Ubbelohde.

In formulating evacuation plans, keep in mind that the frail elderly with cognitive problems take more time to transport to another location, advises John Fishbeck, associate director for JCAHO's division of standards and survey methods. So you want to start sooner rather than later in moving them, he emphasizes.

Plan for Emergency Power

If you cannot find an alternative to house residents or don't anticipate a long power outage, then "think through all of the important things necessary to meet residents' needs in the aftermath of a storm or other disaster," advises Buxo.

For example, where will your fuel come from? How much will you need and how will you store it? "Identify critical pieces of equipment that may seem minor now, but will make a major difference when you need to transfer fuel to generators," she says.

Key example: You'll need a "hand-cranked fuel pump" to "transfer fuel" from a large drum "to a generator or employees' cars," says Buxo. Without that, "you will have to siphon the fuel into the tanks."

Beware: Surveyors are targeting facilities' generators, says Miltenberger. And if you plan on having your generator simply power lighting, you've got more planning to do in case of a longstanding power outage.You'll need energy to power "emergency outlets in designated areas to run fans and oxygen, the refrigeration, elevators--and a lift station in areas where that's required to manage plumbing so that sewage doesn't back up from the toilets," advises Buxo.

"While laundry facilities may not seem that critical," you'll need them to wash soiled bed linens and employee and resident laundry, Buxo adds.

Nail Down Communication Abilities, Access to Supplies

You need to prepare for a way to communicate in the event of a community-wide emergency.

Buxo says that in the aftermath of hurricanes, facilities have had "luck with cell phones because the vendor actually brought portable cell towers into the area. Iridium satellite phones, which are expensive, also work well."

Keep the supplies flowing: Before a community-wide disaster strikes, "identify and form relationships with resources outside your geographical area" so you'll have medications, food and water as soon as an outside vendor can bring them in, if needed, advises Buxo.

Know What Hospitals Can Do for Your Residents

Develop "strong relationships with local hospitals" so you know what they can and cannot offer your facility during a disaster, says Buxo.

"The local community may be affected so you may not be able to get residents' lab work done ... or transport them to the hospital to receive more routine type medical care," she says.

In that case, you'll have to perform emergency triage services in the nursing facility, Buxo says.