Emergency Preparedness Reminders for Home Health Agencies

Home health agencies have their hands full when it comes to emergency preparedness, especially with regard to hurricane survival.  The state requires that agencies prepare and maintain a written Emergency Management Plan (EMP) to assure an efficient response during a crisis. Most home health agencies prepare their EMP upon licensure and, in the absence of an accreditation requirement, rarely give it another thought. However, whether your agency is accredited and requires documented annual EMP review or not, it is a best practice to:

• Read through your plan each year and make any changes that are needed.  Plans often refer to specific individuals by name.  Make sure the ones you’ve listed are still employed by your agency and that their contact information is current.  Remember that any ‘substantive’ change or a change in telephone numbers for individuals responsible for emergency coordination must be reported to your agency’s county Office of Emergency Management and to the local County Health Department.

• Assess any assisted living facilities (ALF) or adult family care homes (AFCH) in which your patients reside.  Be sure you’re knowledgeable of the facility’s emergency preparedness plan and its intention to evacuate the residents to an alternate location.  Your agency is required to designate staff to continue to deliver care according to physicians’ orders to residents in an ALF or AFCH during and after the emergency.

• Survey your direct care staff (employed and contracted) about their availability during an emergency, their individual plans to evacuate the area (if any) and ensure you confirm at least two modes of contact. Most agencies have a requirement for staff to check in, say twice a day, during an emergency in case they don’t hear from you, and also to monitor public service announcements for agency news.  Consider adding this to your policy and training.   
  

• Review your office evacuation plan.  Most agencies maintain an evacuation binder which contains: an updated list of every active staff member with current contact information; a current census list; copies of the current medication profile and equipment list for all patients, as well as current physician, pharmacy and medical equipment supplier contact information. Obviously, if your agency serves ALF or AFCH residents, you should also have current contact information for the facility’s leadership.

The word ‘current’ is emphasized above for obvious reasons:  outdated and/or missing information on patients or staff members could result in an adverse outcome as well as liability, both of which are unnecessary and preventable.  During hurricane season, we urge agency clients to conduct sporadic checks of the evacuation binder to make sure that updated lists have been filed in a timely manner.

• Ask field staff members to review emergency preparedness information with clients at the start of hurricane season.  Make sure all patients have a copy of the Agency for Healthcare Administration’s EMP Appendix B, and that they understand the definition of a ‘sufficient’ supply of food, water and medication.  Most important is the staff member’s review of the medications and medical supply needs of current patients, and to make sure the patient has a handy copy of these lists in case evacuation is needed. At this time, personnel should assess whether the patient’s hurricane plan is adequate given changing health needs.  Special Needs Shelters are a last resort, but staff should assess whether the patient’s status now demands evacuation.

• Re-orient your staff on their roles and responses prior to the emergency; this includes field staff as well as office personnel.  Accredited agencies generally have a requirement to conduct disaster drills, and it’s important to conduct yours just prior to the start of hurricane season.  One caveat: in South Florida, we tend to focus on hurricane preparedness because of the likely threat.  However, consider a simulation of other types of emergencies, such as fires, bomb threats, chemical spills, etc.

• Conduct a drill.  Wait a week or two after your training session to conduct the actual drill.  Avoid giving instructions; instead, assess for your team’s knowledge of the overall process and readiness. Make sure to objectively document your staff’s response and effect any remediation to minimize mishaps during an actual emergency. Obviously, patient contact isn’t necessary, but a staff member should state that he or she is simulating patient calls and explain the nature of those ‘pretend’ calls.

A few counties in Florida require agencies to have a written understanding with a partner agency to assist with patient visits in the event the ‘home’ agency cannot staff a case during a crisis.  Consider this best practice as a safety net to assure you have a back-up plan and that your patients receive the care they need.

The crash landing of the “Miracle on the Hudson flight” reminded us all of the need for continued focus on emergency preparation.  Whether or not you believe the passengers’ safety was due to Divine Intervention, one thing is true:  crew member preparation and response were also critical to their survival.