EMERGENCY PREPAREDNESS PACKET FOR HOME HEALTH

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EMERGENCY PREPAREDNESS PACKETFOR HOME HEALTH AGENCIESPrepared byThe National Association for Home Care & Hospice228 Seventh Street, SE Washington, DC 20003 2008, Permission is granted by the National Association for Home Care & Hospiceto reproduce for educational and training purposes.

Table of ContentsI.IntroductionII.Emergency Preparedness Work GroupIII.Expert Review CommitteeIV.Position Paper on the Role of Home Health in Emergency PlanningV.Hazard Vulnerability AssessmentVI.Home Health Agency Emergency Preparedness AssessmentVII.Incident Command SystemVIII. XYZ Home Health Agency Emergency Preparedness PlanIX.Abbreviated Admission Tools-Items to Consider for Admission-Abbreviated Assessment-Abbreviated OASIS AssessmentX.Memorandum of UnderstandingXI.Patient, Family, and Staff Emergency Preparedness PlanXII.Business Continuity PlanAPPENDICIESFirst Aid Kit –Appendix AEmergency Supply Kits – Appendix BSupply List – Appendix C

I.The National Association for Home Care &Hospice (NAHC) Emergency PreparednessWorkgroup was established to develop an all hazards emergency preparedness plan to beused by home care and hospice providers.Members of the workgroup are representatives from several State home care and hospiceassociations and represent all segments of the country. In addition to the workgroup, anexpert review panel was convened to review the final materials developed.The materials developed consist of templates of tools to assist in emergency preparednessfor agencies, patients and their families, and agency staff. In addition, the incident commandsystem has been outlined and included to instruct homecare and hospice providers of stateand local emergency response structures.A common element the members of the work group share is the difficulties they haveexperienced when promoting the role of home care to local and state emergency planners.Both state association representatives and home care providers have had to be very proactiveto ensure home care and hospice is represented at planning meetings. Furthermore, there isno consensus from community and state planners on how home care and hospice providersshould function during an emergency. We have heard home care agencies will be expectedto do such things as deliver medications or provide transportation for patients to shelters andto staff inpatient facilities. These expectations are not only an inefficient use of valuableresources, they do not take into consideration how home care and hospice providers willcontinue to care for their existing patients and the possible surge of new patients.In light of the confusion surrounding the role of home care in emergency planning, the taskforce has included in the emergency preparedness materials a position paper defining therole home care will play in emergency planning and response.In May 2007, NAHC requested the Centers for Medicare and Medicaid Services (CMS) togrant regulatory waivers for home care and hospice providers in order to facilitate effectiveand efficient planning and response. The CMS’ initial response to our request did notprovide regulatory relief as a proactive measure. However, in October 2007 the CMS Survey& Certification Group issued a letter to State survey agencies that included a FrequentlyAsked Question (FAQ) document that uses an all hazards approach to address allowabledeviations from provider survey and certification requirements during a declared publichealth emergency.1

PMSR/itemdetail.asp?filterType none&filterByDID 99&sortByDID 4&sortOrder ascending&itemID CMS1204638&intNumPerPage 2000NAHC continues to pursue additional regulatory relief provisions.Following is a list of tools and materials the work group has developed:1. Position Paper on the Role of Home Health in Emergency Planning2. Hazard Vulnerability Assessment3. HHA Emergency Preparedness Assessment4. Incident Command System5. HHA Preparedness Plan6. Items to Consider for Admission7. Abbreviated Assessment8. Abbreviated OASIS Assessment9. Memorandum of Understanding10. Patient emergency Preparedness Plan11. Family Emergency Preparedness Plan12. Staff Emergency Preparedness Plan13. Business Continuity PlanAPPENDICIESFirst Aid Kit –Appendix AEmergency Supply Kits – Appendix BSupply List – Appendix CThe National Association for Home Care and Hospice would like to thank the members ofthe Emergency Preparedness Workgroup and the Expert Review Committee for contributingtheir time and expertise to this project.Note: The term “home care” used through out this packet includes home health, hospice andprivate duty agencies.2

II.The National Association for Home Care and HospiceEmergency Preparedness Work GroupMary Carr - mkc@nahc.orgAssociate Director for Regulatory AffairsNational Association for Home Care and Hospice202-547-7424Rachel Hammon – Rachel@tahc.orgDirector of Clinical Practice and Regulatory AffairsTexas Association for Home Care512-338-9293Joie Glenn - joieg@nmahc.orgExecutive DirectorNew Mexico Association for Home and Hospice Care505-889-4556Kimberle Hall - khall@nebraskahomecare.orgExecutive DirectorNebraska Association of Home and Community Health Agencies402-489-1117Beth Hoban – bhobanhi@msn.comPresident, Prime Care Services Hawaii, Inc.808-531-0050Representing the Healthcare Association of HawaiiNeil Johnson - njohnson@mnhomecare.orgExecutive DirectorMinnesota Home Care Association651-635-0607Rose Ann Lonsway - rlonsway@speakeasy.netPresident, Ohio Council for Home CareExecutive DirectorHome Care of Lake County440-350-2419Shaun Meyer - smeyer@pchsgrant.comPresident, Nebraska Association for Home and Community Health AgenciesDirector of Home CareHi Line Home Health308-352-72603

Cindy Morgan - cindymorgan@homeandhospicecare.orgAssociate Vice PresidentAssociation for Home Care and Hospice of North Carolina, Inc919-848-3450Janice Roush - Janice@homecaremissouri.orgProjects CoordinatorMissouri Alliance for Home Care573-634-7772Helen Siegel - hsiegel@hcalliancema.orgDirector of Regulatory & Clinical AffairsHome Care Alliance of MA617-482-8830Jo Sienkiewicz - jfs@homecarenj.orgDirector of Education and Clinical PracticeEmergency Preparedness CoordinatorHome Care Association of NJ, Inc.609-275-6100Alexis Silver - asilver@hcanys.orgDirector of Development and Special ProjectsEmergency Preparedness CoordinatorHome Care Association for New York State518-810-0658Michael Steinhauer – michael@thesteinhauergroup.comPrincipleThe Steinhauer Group, LLC608-277-1707Representing the Wisconsin Homecare AssociationSherry Thomas - sherrythomas@homeandhospicecare.orgSenior Vice PresidentAssociation for Home Care and Hospice of North Carolina, Inc919-848-34504

III.The National Association for Home Care and HospiceEmergency Preparedness Review CommitteeRobert (Brit) CarpenterChief Executive OfficerThe Visiting Nurse Association of Texas1440 West Mockingbird LaneDallas, TX 75247214-689-2308britc@vnatexas.orgBarbara CitarellaPresidentRBC, Limited48 West Pine RoadStaatsburg, NY tricia R. JonesDirectorMemorial Medical Center Homecare1201 Frank StreetPO Box 1447Lufkin, TX Jeanie StokerDirectorAnMed Home Health Agency1926 McConnell Spring RoadPO Box 195Anderson, SC g -5

IV.THE ROLE OF HOME HEALTH AND HOPICEINEMERGENCY, DISASTER, AND EVACUATION PLANNINGThe terrorist attacks on New York City and Washington, DC, on September 11, 2001, thehurricanes that struck the Gulf States in 2005, along with preparations for an impendinginfluenza pandemic have dramatically underscored the vital role of all aspects of the healthcare delivery system, including home care, in addressing emergency situations.On November 25, 2002, President Bush signed into law the “Homeland Security Act of2002” (Public Law 107-296). The Department of Homeland Security’s primary mission isto help prevent, protect against, and respond to acts of terrorism within our nation’scommunities. Title V of the law -- Emergency Preparedness and Response, directs theSecretary of Homeland Security (Secretary) to carry out and fund public health-relatedactivities to establish preparedness and response programs. The Secretary is directed toassist state and local government personnel, agencies, or authorities, non-federal public andprivate health care facilities and providers, and public and non-profit health and educationalfacilities, to plan, prepare for, prevent, identify, and respond to biological, chemical,radiological, nuclear event and public health emergencies.Since the enactment of the “Homeland Security Act of 2002, tens of billions of dollars havebeen provided for first responders, including terrorism prevention and preparedness, generallaw enforcement, firefighter assistance, airport security, seaport security and public healthpreparedness. After many proactive initiatives on the part of home care providers, homecare and hospice are just beginning to be included in emergency planning on both thenational and local level. Unfortunately, plans for home care and hospice providers during anemergency are often based on misconceptions of the role they should play.The institutional bias towards health care planning and delivery in our nation, both inemergencies and non-emergencies, has left home care poorly defined for many. This hasbeen evident by some State and local emergency plans that expect home care providers tofill-in resource gaps such as augmenting hospital staffs or provide transportation for patientsand non-patients to community shelters.Home care and hospice agencies can be a fundamental foundation that can support thetraditional hospital health care system during a time of disaster. However, they should beable to function utilizing their inherent strengths and existing care delivery structure.Home care and hospice agencies already perform activities necessary for effectiveemergency planning, such as, assisting hospitals when at surge capacity; providingcommunity wide vaccination, participate in community out reach programs to disseminatepublic health information, and educating patients on disease management. In addition, theirability to deliver health services to individuals in non-structured environments withoutadditional training makes them ideal as key responders in times of crisis. For example,6

during hurricanes Katrina and Rita home care and hospice professionals were instrumentalin caring for patients housed in shelters and non-traditional health care facilities.With respect to preparedness and response to disasters affecting the public health, it iscritical that home care and hospice agencies’ infrastructure be strengthened, and that thespecial qualities and abilities of these health care providers be utilized. As a serviceperformed primarily in individual homes and the community, home care and hospice areessential to disaster preparedness and response efforts.Today, home care is the only “system” that is oriented to the community in a broad enoughway to provide a massive infrastructure. Through the home care and hospice agencies inthis country, it is possible to put a nurse in every zip code. In fact, in many counties in thisnation, the public home care agency is the sole community provider. The home careclinicians are well acquainted with their communities to the point that they can be quicklydeployed.The home care clinicians of today are trained in community health service. They are able toassess the patient’s symptoms as well as the environment in which they reside. Theyconduct patient and safety assessments, skilled care and treatment, educate patient andfamily, monitor and instruct on infection control practices in the home, and assist withmedical and social supports that are critical to the process of healing the sick and protectingthe well. Today, these skills are essential to serve and protect our communities’ health.Home care providers need to be classified as essential heath care workers and be providedsuch considerations as gas vouchers, official identification cards or papers, access torestricted areas, and access to alternate communication systems.As such, home care providers should be included in emergency and preparedness responseprograms and be allowed greater self- determination regarding their contribution toemergency planning and response initiatives. To utilize home health and hospice providersas only support systems for other health care providers during emergencies would not be anefficient use of a valuable resource.7

Types of Home Care AgenciesEmergency planners must understand the various structures that home care is deliveredwithin to recognize the full scope of assistance home care agencies can provide duringdisaster planning and response efforts . Home care services are usually provided by homecare organizations that include home health agencies; hospices, homemaker and home healthagencies; staffing and private duty agencies.Home Health AgenciesThe term “home health agency” often indicates that a home care provider is Medicarecertified. A Medicare-certified agency has met federal minimum requirements for patientcare and management and therefore can provide Medicare and Medicaid home healthservices. Individuals requiring skilled home care services usually receive their care from ahome health agency.HospicesHospice care involves a core interdisciplinary team of skilled professionals and volunteerswho provide comprehensive medical, psychological, and spiritual care for the terminally illand support for patients' families. Hospice care also includes the provision of relatedmedications, medical supplies, and equipment. Most hospices are Medicare certified andlicensed according to state requirements.Homemaker and Home Care Aide AgenciesHomemaker and HCA agencies employ homemakers or chore workers, HCAs, andcompanions who support individuals through meal preparation, bathing, dressing, andhousekeeping. Personnel are assigned according to the needs and wishes of each client.Some states require these agencies to be licensed and meet minimum standards establishedby the state.Staffing and Private-duty AgenciesStaffing and private-duty agencies generally are nursing agencies that provide individualswith nursing, homemaker, HCA, and companion services. States vary on whether theyrequire these agencies to be licensed or meet regulatory requirements. Some staffing andprivate-duty agencies assign nurses to assess their clients' needs to ensure that personnel areproperly assigned and provide ongoing supervision.Medicare certified home health and hospice agencies are more likely to accept patients thatare rapidly discharged from hospitals and skilled nursing facilities during an emergency.Medicare certified agencies are usually structured as either: hospital based and fall underthe direction of the hospital; free-standing and self directed; or public health or governmentbased agencies and are directed by local and State governments.Non- Medicare certified agencies such as homemaker and home care aide agencies andstaffing and private duty agencies will also have a role in emergency planning, however maynot be able to provide skilled services to the degree of a Medicare certified agency.NAHC wishes to thank Barbara Citarella of RBC Ltd. for her contribution to this document8

V.Hazard Vulnerability AnalysisThe Hazard Vulnerability Analysis tool is designed to so agencies can evaluate their level ofrisk and preparedness for a variety of hazardous events. A hazard vulnerability assessment isusually the first step in emergency planning for an organization. The tool lists events thatmight be encountered by an agency, and can be individually tailored. Included are theinstructions on how to use the tool along with a list of possible hazards that would requiredisaster planning.9

Hazard Vulnerability Level of vulnerability/Degree of disruptionHigh Moderate Low(3)(2)(1)Ice SnowFloodingEarthquakeHurricaneHazardousMaterial AccidentFireTornadoVolcanoCivil DisturbanceMass CausalityEventTerrorist AttacksPandemic/InfectiousDiseaseElectrical failureCommunicationsFailureInformation SystemFailureWater ered Air reHigh(1)

HAZARD VULNERABILITY ANALYSISInstructions List potential hazardous events for your organization. Evaluate each event for probability, vulnerability and preparedness. Probability, Vulnerability, and Preparedness are rated on a three level scale from high tolow. Probability and Vulnerability are ranked with a score of “3” for high, “2” formoderate and “1” for low. Conversely, for the Preparedness category, a score of “3”represents a low ranking for preparedness while a score of “1” represents a high level ofpreparedness. A score of “2” represents a moderate ranking for preparedness. When evaluating probability, consider the frequency and likelihood an event may occur. When evaluating vulnerability, consider the degree with which the organization will beimpacted, such as, infrastructure damage, loss of life, service disruption etc. When evaluating preparedness, consider elements, such as, the strength of yourpreparedness plans and the organization’s previous experience with the hazardousevent. Multiply the ratings for each event in the area of probability, vulnerability andpreparedness. The total values with the higher scores will represent the events most inneed of organization planning for emergency preparedness.Using this method, 1 is the lowest possible score, while 27 is the highest possible score.NOTE: The scale for preparedness is in reverse order from probability andvulnerability where by “low” 3 and “high” 1. The organization should determine which values represent an acceptable risk level andwhich values require additional planning and preparation.11

Potential HazardsNatural Disasters Hurricanes Tornadoes Heavy thunder storms Flash flooding Flooding Mud/rock slides High winds Hail Severe winter weather Avalanche Extreme high heat Drought Wildfire Earthquake Volcano eruption Tidal wave/TsunamiMan-made Disasters War (conventional, biological, chemical or nuclear) Toxic material emission/spill (from a train or nearby plant) Riot or other civil disorder Nuclear plant melt down or other nuclear disaster Terrorism FireTechnological Failures Electrical Communications IT system Heating /coolingOther Disease outbreak Community infrastructure breakdown (bridges collapse, Dam breaks, etc.) Utility failure Transportation failure12

VI.The Home Health Agency Preparedness AssessmentThe Home Health Agency Emergency Preparedness Assessment can be broken down byassessing the agency’s preparedness according to general categories for consideration. Theagency identifies specific tasks to be completed under each category in order to mitigate theaffects of any adverse event that might interfere with normal operations. Below are severalcategories for consideration when determining what tasks are to be employed and by whom. Administrative considerations: Supplies consideration: Utility considerations: Record protection Financial Communication Surge capacity Staff Patient education TransportationFollowing are two examples of a home health agency emergency preparedness plan.Example “1” is a detailed checklist for agencies that are ready to implement acomprehensive emergency preparedness plan. Example “2” is a less detailed checklist andcontains fewer, but important, activities under each category. This checklist will assistagencies that are in the beginning stages of developing plans for disaster preparedness.13

HOME CARE EMERGENCY PREPAREDNESS AESSESSMENT(Example 1)DateDateName or Title of Individual (s)Completed ReviewedResponsible for CompletionAdmini

Director of Education and Clinical Practice Emergency Preparedness Coordinator Home Care Association of NJ, Inc. 609-275-6100 Alexis Silver - asilver@hcanys.org Director of Development and Special Projects Emergency Preparedness Coordinator Home Care

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