Provider magazine caught up recently with Jason Belden, disaster preparedness program manager at California’s Office of Statewide Health Planning and Development, and policy and fire/life safety analyst in the California Association of Health Facilities. Below are Belden’s responses to questions on how skilled nursing facilities (SNFs), assisted living facilities (ALFs), and other providers can and should prepare for disasters. The conversation has been edited slightly for clarity.
Provider: How are SNFs and ALFs currently preparing for disasters?
Belden: In California, and many other states, we have seen a huge increase in the ideas and concepts behind disaster preparedness becoming incorporated into the day-to-day duties of administrators and leadership due to both the new regulations and real-world events that have impacted so many of our providers these past few years.
We still have work to do, especially on the assisted living side, but we feel like we are significantly more prepared to deal with all of the challenges that come with natural or man-made disasters. We have also seen a huge uptick in buy-in from local emergency planners to include our health care sector in planning and preparing for these types of events as well.
Provider: How has the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule changed these preparations – i.e., what was the biggest and/or most difficult change?
Belden: Well, for almost every provider these changes are far outside of the scope of what they have had to think of or plan for previously. The leadership of each facility is now faced with a lengthy learning process to meet these requirements, and an addition of hundreds of man hours to prepare for meeting these regulations.
Besides just the time constraints, there has been very little detailed education geared towards helping our providers meet these requirements. From learning incident command and all its concepts to working with an emergency response structure that differs with each local jurisdiction, it makes it difficult for providers to fit all of this into their normal operations.
Provider: How would you assess the current state of preparedness – i.e., what weaknesses still need to be addressed, what resources are still needed?
Belden: Well there is always going to be work that needs to be done, but we are significantly more ready than we were 5 years ago. That being said, from a provider side, we need to understand that we need to dedicate more time to preparing for any kind of event. Developing the capabilities needed to respond in an event needs to be a priority. This requires a buy in from leadership to prioritize mitigation, preparation, and training.
From the events of the past year here in California, we have learned that communication is still poorly managed in a disaster. Most of the providers affected by the fires, floods, and mudslides received little or no communication from the emergency response community to direct them on evacuation routes, staging areas, or shelter in place advice.
That has made it clear that providers need to have situational awareness at all times, participate in their local community preparedness activities, and let the responders know of the special needs that our residents have when a disaster strikes. If you need 25 ambulances in order to evacuate, then the responders need to know of those needs beforehand, not during the event.
It is not a lack of resources that concerns us, it is the inability to deploy those resources effectively and timely. That is why it is critical for facilities to understand how they fit in the greater emergency response structure and to sit at a table with those folks and let them know what kind of resources they will need in a disaster so that plans can be made to accommodate their needs.
Provider: How do preparations differ from region to region – i.e., hurricanes in Florida, tornados in Kansas, earthquakes in California, etc.?
Belden: Luckily we’ve not had any experiences with hurricanes or tornados out here, but preparations should be very similar for any provider in any region. In disaster preparedness we try to teach people to build up your capabilities to respond in a disaster.
Having a robust communication plan with emergency responders and your staff, having multiple transportation options for evacuation, knowing how to secure your building in order to shelter in place, knowing how to access and print off health records or charts quickly or even remotely, having memorandums of understanding with other providers for transfers during a disaster, and instituting an incident command system into your organizational structure are all elements that apply regardless of the type of events you may be faced with.
So even though mitigation strategies may differ based on the types of hazards you face, the capabilities are relatively consistent regardless of location.
Provider: What new technologies and/or systems have been especially effective in boosting preparedness? Is cost a barrier to adopting these?
Belden: For a system I would say the adaptation of the incident command system and structure to the nursing home environment is the biggest improvement in facilities’ ability to respond effectively in an emergency or disaster. There was a small percentage of facilities that adopted it initially, but through the new regulations we see the adoption of NHICS (Nursing Home Incident Command System) becoming more and more prevalent.
There is a reason every first responder in the country uses it to manage complex events. The cost for these types of trainings are marginal. It's the time it takes to train all of your staff that becomes the issue.
For new or emerging technologies, it would be electronic bed polling systems and mutual aid programs for SNFs. After the large fires in San Diego, the county came up with a provider run mutual aid program for every facility in the county where the providers themselves voluntarily staff up in the event of a disaster to assess open beds for evacuating facilities.
In Sacramento, the county has taken it one step further by purchasing a software system that gives every provider the ability to input bed availability with a description of the types of beds available, submit resource requests for critical supplies, and to work directly with the command center to access and utilize transportation resources.
This has been the most effective method for the response community to manage these large events. This or something similar needs to be in every state in the country. I can give you the names of the folks from those counties to discuss in detail those programs if you are interested.
Provider: What advice would you give personnel at SNFs and ALFs – or anything else you’d like to add?
Belden: Every staff member at every facility should see themselves as a first responder for your residents. It is important that we all understand that the better we are at managing these events ourselves then the better chance our residents have of making it through them without any negative outcomes. It takes a commitment from leadership to prioritize preparedness and response.
Use your preparedness efforts as a selling tool to differentiate you from your competitors and actively participate in your healthcare coalitions. Your efforts today can lead to saving a resident or staff members life tomorrow.