First Steps in Emergency Management for Home-Based Care

In September of 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule for the Condition of Participation (CoP) on emergency preparedness requirements for Medicare and Medicaid certified agencies.

The new Appendix Z of the Medicare State Operations Manual is specifically designed for emergency preparedness. It focuses on specific principles of protecting access to healthcare during disasters or emergencies through an all-hazard approach that: Preserves human resources, secures business continuity, and guards physical resources.

Using this approach, agencies and organizations will be accountable for creating an emergency preparedness plan that effectively and comprehensively incorporates the elements of:

• Risk assessment and planning
• Policies and procedures that execute the emergency plan
• Communication guidance that complies with state and federal law
• Training and testing for emergency preparedness

“E” tags will be generated during survey visits for emergency preparedness violations, in the same way that “G” tags are generated for home health and “L” tags are generated for hospice.

Your organization will have an emergency plan for you to follow, and you should make sure you know how to access it and your role in an emergency response.

Understanding your organization’s specific plan is critical in ensuring that you are prepared for any emergency!

Risk Assessment

Unique to the home-based care environment is the fact that each setting is different from the next. That means you will need to be prepared for anything and know how to react.

Your organization must perform an assessment to identify the potential hazards that you may face, and it must be incorporated into the emergency preparedness plan.

Additionally, your agency must identify potential emergencies that would affect employees and clients with vulnerabilities and create plans to address them. The Centers for Disease Control and Prevention (CDC) published a guide that offers some advice. It says that all agencies should:

• Develop preparedness plans with the issues and needs of older adults in mind.
• Cite appropriate legal authorities.
• Define the categories of disasters and emergencies and how they might affect older adults.
• Ensure attention to all special needs during each phase of the emergency response.

Emergencies

There are many potential hazards that you face because you work in the home setting, and you must know and understand them. However, the emergencies that would require the emergency preparedness plan to be activated include:

• Mass casualty
• Hazardous waste spill or exposure
• Power or communications failure
• Disease outbreak or pandemic
• Natural disasters including:
  • Earthquakes
  • Tornadoes
  • Hurricanes
  • Typhoons
  • Tsunamis
  • Avalanche
  • Volcano
  • Flooding
  • Mud and rock slides
  • Wildfires
  • Any type of severe weather such as thunder storms, high winds, hail, winter storms, and extreme heat, drought, or cold

Planning

A key part of planning for such emergencies includes identifying the likelihood of occurrence and the types of risks presented by each. Your organization’s emergency plan should contain a list of the emergencies and natural disasters that are most likely to occur in your area and instructions about what to do when they occur.

The Emergency Preparedness Plan

Your organization will use risk assessment, communication needs, and training and testing requirements to aid in the creation of an emergency plan.

An emergency preparedness plan is created by your employer so that you will know what to do when an emergency occurs, and coordinates the different actions that are to be carried out within an organization during an emergency.

This plan is made for your specific region and work setting. It usually encompasses considerations regarding:

• Administrative duties
• Supplies, including food and water
• Communication
• Staffing
• Power supply
• Utilities
• Finances
• Record keeping and protection
• Client education
• Transportation
• Service capacity

The emergency preparedness plan should be stored where it is easily accessible to all employees in an emergency, and it will be organized in such a way that classifies and prioritizes clients for the emergency response, taking into consideration the impact the assigned designations will have.

Those organizational policies and procedures will guide your practice and strive to keep you and those you care for safe.

Be sure you understand them and know how to react in potentially uncomfortable, dangerous, or emergency situations, and take extra time to discuss your concerns as they arise with your supervisor.

The Response

During an emergency, your administration will establish a command center and a chain of command. The communication plan that your organization creates must be coordinated within the organization and with outside healthcare providers, local and state health departments, and emergency management agencies across the system of emergency support.

With the activation of the emergency plan, you will follow the policies and procedures and perform the tasks indicated by the plan concerning:

• Initial steps
• Administrative support
• Supplies
• Utilities such as water and power
• Record protection
• Documentation
• Billing
• Continuity of services
• Communication
• Caseload
• Staffing
• Education
• Transportation

The initial steps that you should take during an emergency are important because they set the stage for successful management of the emergency.

A Team Effort

Emergency preparedness and management are critical components of your responsibility as a professional in home-based care. You must know and understand the precautions to take, use good judgment, and follow your agency’s emergency plan.

Remember that this plan will identify the specific types of emergencies that might affect your agency and a specific plan for those emergencies.

You need to know the steps to take in the event of an emergency to ensure continued care and maintain the safety of all, including special populations. The emergency preparedness plan is there for you to use to effectively fulfill your role during any emergency response.

There may be government resource limitations, and you and your clients should work together during any crisis. It takes a team effort to effectively plan, respond, and recover!