Emergencies in skilled nursing facilities can happen at any time and not only involve events such as natural disasters like hurricanes, tornadoes, or floods, but situations such as emerging infectious diseases, man-made disasters (i.e., crime, biological/chemical threats, cyberattacks, etc.), or even a local utility failure can test a facility’s ability to effectively respond to such an emergency.  As we recognize National Emergency Preparedness Month in September, now is a good time to ensure that you are prepared for the unexpected and compliant with the expected when it comes to emergencies.

Why Emergency Preparedness Matters More Than Ever

If the past few years have taught us anything, it’s that emergencies are rarely “one-size-fits-all.” A hurricane requires very different logistics than a pandemic. A localized power outage requires a different response than a statewide evacuation. Nursing homes sit at the intersection of healthcare, hospitality, and community service, making them uniquely complex to prepare.  

Preparedness has three main benefits for skilled nursing facilities: ensuring resident safety and well-being, building staff confidence, and maintaining regulatory compliance. Beyond compliance, families want to trust that their loved ones are safe in your care and that you are well-prepared to take action should an emergency happen.

Risk Assessment and Hazard Vulnerability

The foundation of any emergency plan is a clear understanding of risk.  Risk and hazard vulnerability assessments should be conducted to identify all potential hazardous scenarios that could occur within your facility and surrounding area.  Consider all types of emergencies whether natural disasters such as hurricanes, tornadoes, winter storms, extreme heat, floods, or wildfires, as well as man-made disasters such as active shooters, arson, bomb threats, chemical/biological attacks, or civil unrest. Don’t forget about technological risks that could cause disruptions in care and/or operations like power outages, gas leaks, cyberattacks, or water supply disruptions. Of course, we cannot forget about infectious diseases that have the potential to cause outbreaks such as COVID-19, influenza, norovirus or other emerging pathogens.

Develop a Comprehensive Emergency Plan

CMS requires all Medicare and Medicaid-certified nursing homes to maintain an all-hazards emergency preparedness program.  The official CMS Emergency Preparedness Rule overview explains the regulation and links to guidance and updates, while Appendix Z of the State Operations Manual provides the interpretive guidelines surveyors use. Both of these resources help you in the development of your specific emergency preparedness plan. 

A strong emergency preparedness plan includes policies and procedures to address communication, evacuation, shelter-in-place, continuity of operations, collaboration agreements, and training in the forms of drills or exercises. For this plan to be effective, however, it must be a living, breathing document that adapts as changes occur.

Communication Is Everything

As the saying goes, “Communication is key,” and never more so than when dealing with emergencies before, during, and after an event. Facilities need to have plans in place to address how to communicate needs or actions within the facility, contingency plans for if the regular routes of communication are disrupted, and methods to disperse information to families and coordination with local emergency management, public health, and law enforcement. Communicating your emergency plans to residents and families is vital to showing transparency and readiness and building trust.

Evacuation vs. Shelter-in-Place

The decision on whether an evacuation is called for, or if residents and staff need to shelter-in-place depends on the nature of the emergency and instructions from facility, local, state or national leadership. Both scenarios require advanced thought and preparation to ensure that processes are in place and transitions can flow seamlessly with minimal confusion. Securing transportation contracts, establishing destination agreements, creating tracking systems, assigning staff roles, ensuring backup medications, supplies, or delivery options are in place are vital when considering evacuation or shelter-in-place plans, along with plans for heating, cooling, and sanitation needs.

Infection Control Preparedness

The COVID-19 pandemic underscored the importance of infection control in emergencies and how prepared facilities were for such a novel infection at that time. New thoughts and considerations emerged in regards to stockpiling PPE, isolation and cohorting residents, telehealth, testing, vaccinations, and treating residents when an infectious outbreak occurred. By having plans in place, facilities can be prepared for any potential infectious disease in an effort to reduce risk and transmission and protect residents and staff.

Training, Drills, Culture, and Collaboration

For a plan to work, it must be taught and trained to ensure that staff and residents know and understand what steps may be taken for a particular emergency. As part of CMS’s core elements, training and testing must occur.  Training and education is an ongoing process, ensuring that all who are taught know their role and what actions to take in a particular emergency. Part of that training includes performing drills and exercises to allow hands on experience or discussion about potential scenarios that could occur, what actions to take, and what to do after the emergency is over.

Trainings and exercises may happen at the facility level such as a fire drill, involve collaboration with local and/or state officials such as a table-top exercise for flooding in the area, or participation in a full-scale emergency exercise for realism. After every drill or a real event is over, a debrief should be conducted to discuss what worked, what didn’t, and what needs improvement. These discussions should involve staff input, be documented and the plan updated accordingly. By practicing, performing, and learning from these drills and exercises, staff become more confident of the actions to be taken and embrace that culture of safety.

Collaboration with local and state officials, EMS, hospitals, suppliers and government is vital to ensuring that a facility’s emergency plan is encompassing and achieving the goals of the plan. Transportation arrangements, coordination of transfers, safety protocols, and supply deliveries begin by building and maintaining relationships with these partners in order to provide the guidance and resources needed in a time of an emergency.

Preparedness Is Peace of Mind

Emergencies will occur. Knowing your emergency plan and taking the actions needed to confidently execute the plan will build and promote trust between you, your staff, residents and their families. We all want peace of mind even when the world outside is uncertain. Having a solid emergency preparedness plan is just one piece of that puzzle. Our residents expect and deserve to feel safe and cared for in times of calm or crisis. Let us be prepared to help them along the way.

The Compliance Store can help. We offer dozens of tools carefully crafted to help your facility initiate, document, and improve your emergency preparedness plans. For more information, contact us online or by calling (877) 582-7347.