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Emergencies
are Local
As we at the
OVAR Geriatric Education Center have presented at the KAHSA and
KAHCF state nursing home association conferences this fall following
the windstorm event, specific concerns and solutions were offered
in the Q&A.
- Evacuation
resources - over-commitment of transportation providers, need
for agreements with other facilities as evacuation destinations
- Supply additional
generators for living spaces beyond safety lighting. Test generators
regularly and check for efficiency. Replace inadequate generators.
- Daily call-in
to state associations to update individual nursing home status
and resource needs
- Utility response
issues when nursing homes are not current with listings as "special
need" facility
- Regulatory
limitations on evacuation response for "receiving" nursing
homes
- Oxygen providers
and other critical suppliers were also down due to extended power
outage
- Communication
planning for concerns of families of residents and staff as well
as local media
- Adequate planning
for data storage and medication storage/security
- EMS not an
option for transport in community-wide event as they will be responding
to other emergencies
- Need outreach
with retirement living facilities and memoranda of agreement as
they will need support and response options
- Adequate training
for providing emotional / psychological support to residents and
staff
- Communication
of decision-making and incident command at community response
level communicated
to nursing home administration
- Support for
nursing home ancillary needs including garbage pick-up and laundry
back-up options.
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Useful
Guides to Improve Nursing Home Response from the Florida Health
Care Association:
- Nursing Home
Incident Command System
- Emergency Preparedness
Training and Exercise Guide for Nursing Homes
- National Criteria
for Evacuation Decision-Making in Nursing Home
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Core
Competencies for Nurses in Disasters (Gebbie
and Qureshi, 2002) We
found these competencies helpful for nursing home staff and also
applicable to community-based agencies serving seniors.
- Identify
the chain of command in emergency response
- Be
familiar with the agency's emergency plan and know where it is
located
- Know
your emergency response function and practice as an organization
- Know
how to operate any equipment specifically to be used during an
emergency and practice it
- Know
how to use all communication equipment specifically used for emergency
response, including satellite radios
- Know
the communication roles identified by the agency for emergency
response, including interagency, public communication and media,
families of residents/clients and staff families
- Know
your limits in skills, knowledge and personal preparedness
- Know
resources to access when the situation exceeds your limits
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The Direction
of Federal Nursing Home Recommendations
The Dept. of
Health and Human Services Office of Inspector General funded a post-Katrina
study of Gulf States nursing home preparedness.
The report recognized that
Medicare and Medicaid certified facilities were mandated to have written
emergency plans for all potential emergencies and to provide staff training
for preparedness policies. The Inspector General went on to accept the
recommendations of the study which go beyond existing standards:
- Strengthen
the Federal standards for certification by developing core elements
for emergency plans. Core elements include evacuation planning, planning
for sheltering-in-place, needs of special needs residents, establishing
adequate staffing guidelines and collaboration guidelines.
- Strongly
encourage communication and collaboration with state and local entities.
CMS has issued
its intention to adopt these recommendations and issue guidelines in the
near future.
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Nursing
Home Consumers and Preparedness
The National
Citizens' Coalition for Nursing Home Reform has issued a consumer
fact sheet of questions
consumers should ask about nursing home preparedness which is
supported by the CDC. Questions include:
- What
are plans for evacuation or shelter-in-place?
Are there sufficient staff on all shifts in case of evacuation?
- What
are staff training procedures and are they practiced?
- What
contracts are in place for transportation and housing in an evacuation?
- Is
the plan coordinated with local and regional resources?
- What
emergency supplies do facilities maintain for food, water oxygen,
etc.?
- What
identifying information will accompany residents in an evacuation?
- How
will resident records and resident equipment / medication accompany
the resident in evacuation?
- How
will family members be notified in an evacuation?
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Useful
Resources to Enhance Emergency Response
The Winter
2007-2008 edition of the journal, Generations, was specifically
dedicated to articles about emergency response and issues of concern
for older adults, ranging from community-based older adults to nursing
home residents. Many of the articles contained in the journal are
relevant to concerns expressed this year as we have presented trainings
and attended LTC subcommittee meetings. Articles included are:
- Emergency
Preparedness and Response: Health and Social Policy Implications
for Older Adults
- Connecting
Future Evacuation to Current Recovery: Saving the Lives of Older
People in the Next Catastrophe
- The Story
of the Senior Center: Meeting Immediate Needs
- Nursing
Homes and Assisted Living Facilities: Planning and Decision Making
for Sheltering in Place of Evacuation
- The Vulnerable
Geriatric Casualty: Medical Needs of Frail Older Adults During
Disasters
- Rapid Needs
Assessments for Older Adults in Disasters
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Upcoming
Trainings
Two upcoming
Kentucky regional trainings are scheduled for the Spring and offer
comprehensive sessions targeting Long Term Care facilities and other agencies
that will be providing care for older persons in the event of a disaster
or emergency. Special topics to be covered include
- Legal Issues
Effecting LTC in an Emergency
- Continuity
of Care - Facilitating Staff Personal Readiness
- Collaborating
with Your Emergency Manager and Responders
- Special
Needs of Older Adults in Emergencies
- Issues of
Cognitive Impairment and Emergencies
Northern Kentucky
will dedicate a portion of its training to creating a manageable emergency
plan with pull-out templates. London will focus on sheltering in place.
Dates of
Upcoming Trainings
- Northern
Kentucky Area, March 19, 2009 training
information, Boone County Public Library, Burlington registration
- Cumberland
Valley, May 27, 2009, Laurel County Health Dept., London
For more information,
please contact Diana Lockridge at (859) 257-2658 or DianaL@uky.edu
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