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Prepare for disaster before disaster strikes

December 4, 2012
by Vivian A. Marinelli, PsyD
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Vivian A. Marinelli

Hurricane Sandy was yet another wake-up call to hospitals and long-term care (LTC) organizations to have a written disaster plan in place. Some facilities that chose not to evacuate in advance ended up evacuating during the height of thestorm, making it more dangerous and difficult. This brings to light the importance of having a disaster recovery plan and knowing when to use it. Would your facility be able to survive a disaster?

The healthcare community moved emergency preparedness to the forefront after 9/11. Hurricane Katrina motivated LTC facilities to take a harder look at how prepared they were during times of crisis. Many residents in nursing homes are dependent on life-saving equipment that requires power. Hurricane Katrina also highlighted the need to prioritize restoration of utilities to those types of facilities first.

Seven years later, Hurricane Sandy has shown us that while much progress has been made, there is still more to do. In a recent report, the Health and Human Services Office of Inspector General noted that there are still gaps in LTC disaster plans (Gaps Continue to Exist in Nursing Home Preparedness; 2012). If your organization hasn’t yet closed the holes in its disaster plan, doing so should be at the top of your priority list for 2013.


Federal regulations for nursing home emergency preparedness require that Medicare- and Medicaid-certified nursing homes have “detailed written plans and procedures to meet all potential emergencies and disasters such as fire, severe weather, and missing residents.” Additionally, federal regulations state that facilities must “train all employees in emergency procedures when they begin to work in the facility, periodically review the procedures with existing staff, and carry out unannounced staff drills using those procedures.”

Milwaukee Catholic Home (MCH), Milwaukee, is geographically far away from a hurricane threat, but the staff is still prepared for tornadoes, flooding and fires, which the Midwest has seen its share of in recent years. The organization operates a continuing care retirement community that includes 120 independent living apartments and 24 assisted living suites, as well as skilled nursing, memory care and a rehab center.

“Disaster planning and practice drills may seem tedious and time consuming,” said Patrick Shaughnessy, administrator of MCH’s Health and Rehabilitation Center. “But when disaster strikes and everyone knows what their role is and steps up to the plate, you will be more than happy that you practiced.”

Even long-term care facilities in areas not prone to natural disasters such as flooding, hurricanes and tornadoes should continue to practice their emergency plan. A major power outage or fire could wreak havoc anywhere. “When lives are on the line, especially the frail and elderly, you can never be too prepared,” Shaughnessy said.


When developing an effective emergency response plan, most organizations will benefit from specialized guidance for their specific industry. Best practices have demonstrated that the minimum critical elements of an effective disaster program should include:

  • Identifying hazards specific to the facility
  • Risk assessment specific to the facility
  • A robust emergency/disaster plan that addresses how to mitigate, prepare, respond and recover from hazards and risks specific to the facility
  • An organization-wide employee training program on the disaster response plan
  • Drills and exercises to test the disaster plan
  • Schedule of regular updates to the disaster plan

In 2009, the Centers for Medicare and Medicaid Services (CMS) published an updated emergency preparedness checklist as a “recommended tool” for healthcare facilities. In addition to the Federal regulatory requirements for nursing home emergency response plans, the checklist suggests that the following critical areas should also be included within emergency response programs:

  • Collaboration and communication with local emergency management agencies
  • Collaboration with suppliers and vendors that have been identified as part of a community emergency response plan
  • Transportation resources for relocation assistance
  • Tracking of resident identification
  • Necessary provisions

For nursing homes, it is important to keep in mind that additional resident care factors that need to be included in the planning:

  • Resident medical concerns (physical and psychological)
  • Resident-specific needs (i.e., feeding tubes, oxygen, wheelchairs, hearing aids and batteries, eyeglasses)
  • Prescriptions and coolers for medications that need refrigeration
  • Medical records
  • A plan to address the impact of the event on residents, physically, mentally and emotionally


Too often, administrators focus most on plans to shelter in place rather than evacuate. When it’s necessary to evacuate your facility, a well-prepared administrator will have prior agreements with host facilities rather than trying to identify them at the last minute.