• Training plans must specifically address each one of the
agency’s identified risks
• The training plan must be written and must extend to all
staff members – at least one training each year
• The training plan must have a means of demonstrating
staff knowledge and retention
• Training must be rooted in applicable policies/procedures and
how they will be implemented
• Gaining a basic understanding of the
Emergency Preparedness Rules
• Performing the Risk Assessment
• Developing Policies and
• Implementing the Communication
• Training and Testing Requirements
Emergencies vs. Disasters
• EMERGENCY = A hazard impact causing
adverse physical, social, psychological,
economic or political effects that challenges
the ability to respond rapidly . . . requiring
stepped-up capacity and capability to meet the
outcome . . . requiring a change from
routine management to incident
• DISASTER = An emergency with greater
magnitude, longer duration and generally
Policies and Procedures
• E0013 – Policies and procedures based
on the emergency plan, risk assessment
and communication plan
• Policies and procedures must be
• Can be incorporated into the standard
manual set, but the agency must be able to
demonstrate that they are kept in a central
E-Tags to Know
E-Tag HHA Hospice Tag Requirement
E-0001 Y Y Establishment of the Emergency Program (EP)
E-0004 Y Y Develop and Maintain the EP Program
E-0006 Y Y Maintain Annual EP Updates – Risk Assmnt w/all hazards + strategies for
addressing emergency events
E-0007 Y Y EP Program Patient Population – Types of emergency services, continuity of
operations, delegation of authority and succession planning
E-0009 Y Y Process for Collaboration – Coordination and collaboration with local, tribal,
regional, State and Federal emergency officials/offices
E-0013 Y Y Development of EP Policies and Procedures – Based on the overall plan, risk
assessment and communications plans with at least annual review
E-0015 Y Y Subsistence Needs for Staff and Patients – Food, water, medical supplies,
meds, alternate energy sources for maintaining temperature, lighting, fire
detection systems, sewage and waste disposal
• Process to assess and document hazards
• Those that are likely to impact the geographic
region or community
• Those that present gaps and capacity challenges
• Hazard Vulnerability Analysis
Scoring the Risks
• Measure the probability – High, Moderate or
• Measure the vulnerability and potential
disruption – High, Moderate or Low Risk?
• Measure your agency’s level of preparation –
Poor, Fair or Good
• Each level for each category has a score from 1
to 3 (Green to Red)
• The total score indicates the priority that
should be placed on risk assessment and
Assessing Patient Risk
• For home health agencies –
Needs to be done as a part of the comprehensive
• For both home health and hospice –
! How will clinical information and patient care requirements be
! Consider evacuation requirements
! Limitations on patient mobility
! Limitations on transport of life-saving equipment
! Special needs/limitations – language barriers, diet, intellectual
High Risk Patients
• No available caregiver or family present – patient
cannot be left alone for extended periods
• Bedbound or chair bound patients with
physical assistance needs
• Unable to administer meds – self-injections of
• Wound care patients who are unable to
perform dressing changes
• Infusion patients – IV therapy or feedings
Moderate Risk Patients
• Patients with assistive devices or stable in the
use of medical equipment – able to manage
for a short period of time
• Stable with administration of meds
• Patients with reasonably managed chronic
• Patients for whom a visit can be postponed
for up to 3 days without jeopardizing safety
Low Risk Patients
• Patients with family and/or caregiver support systems in place
who can manage for longer than three days
• Patients with less complicated wound care or other care needs
• Patients for whom the patient or a caregiver is already
managing and administering medications
Sharing Medical Information
• Plan for sharing medical record
information to ensure continuity of
• Must include the means for sharing
information about the general
condition and location of patients
Patient Preparedness (see attached handout)
Be prepared for 96 hours—food, water, medications
• Vial of Life—Code Status, Med Profile, Physicians, Emergency Contact numbers
VIAL of LIFE sticker on front window, Refrigerator
• Emergency Preparedness for People Receiving Home Care
Review this pamphlet with pt / caregiver
• FEMA Communication Model: Instruct on how to use flags
Keep in closet closest to front door
• VACCINES: Flu and Pneumonia up to date. Most elderly die of pneumonia during a
pandemic due to weakening of the immune system.
• Emergency Supplies: See handout for more comprehensive list. Lighting in home to
prevent falls during a power outage—especially important
• Emphasize the IMPORTANCE of a 7 DAY Supply of MEDICATIONS
• Protect your FEET—Keep a pair of sturdy shoes/socks in a zip lock bag under bed.
• Secure list of FINANCIAL accounts, insurance policies, Titles, VA Info—CD, Thumb Drive, etc
• Emergency Exits
Notify Power Company in advance on oxygen, vents, pumps for infusions, etc.
OASIS—code TRIAGE for clinical risk (i.e. likelihood of clinical exacerbation)
code DISASTER for enhanced risk with outside emergencies
(i.e. assess pt. independence with meds, oxygen, competent caregivers, etc.)
Clinician Preparedness (see attached in Handouts)
Be prepared for 96 hours (changed by FEMA)
• Secure Yourself First
• Secure your Family
• Report to Agency Command Center in your respective county via phone, text, internet or
in person at the designated area.
• Secure your Patients
• Cell phone chargers, Battery Chargers or Solar Chargers
• FEMA communication flag kit
• GMRS 2 way radios—2-10 mile range. Have an Agency Designated Channel & back up.
• Keep a copy of your clinical license on you. This will help get you across police lines.
• Keep your gas tank at least ½ full AT ALL TIMES
• Stay Healthy! Vaccinations—stay up to date (Flu, Tetanus, Shingles, Pneumonia)
CAR SUPPLIES: (see handout for more complete list)
• Water – High Energy Bars – Shelter (Blanket/Tarp)—zip bag with clean clothes
• Car stock of Basis First Aid bandages, etc. incl BIO-HAZARD BAGS
• Emergency money in low denominations (no change is given in disasters)
• Long Life Flashlight, back up batteries, solar charger / hazard light
• First Aid Kit WITH Protective Gear—N95 masks may be expired! Alcohol Hand Sanitizer
• Extra-Sticky Post-it Notes and a pencil to leave messages—Sharpie
• Box of plastic gloves and pair of work gloves (Protect your hands)
• Portable radio with fresh batteries, crank or solar
EP Testing Requirements
• The agency must conduct at least
one full-scale exercise annually
• When community-based testing is not
feasible an individual full-scale test
can be substituted
• An additional exercise must be done
and can include a table-top exercise
led by a facilitator with clinically
relevant emergency scenarios
In Closing . . .
• Remember that your agency must be ready by November 15th.
• Perform the risk assessment using an easy to use template.
• Develop your plan based on the risk assessment results.
• Make sure that your policies and procedures address the E-Tag
requirements that are applicable to your agency.
• Develop and document the communication plan.
• Train the staff.
• Make sure that the elements of the emergency plan are tested and
that the testing process is documented.
• Document the analysis of your Drill or Disaster
Of all the webinars I have attended since learning of the Medicare Requirements, this was the best to boil down the basics. I received permission to use some of their slides for this presentation. For a complete copy of this FREE WEBINAR please contact Kinnser.
Training and Testing
In order to TRAIN and TEST any given scenario, it is IMPORTANT for ALL STAFF to KNOW and UNDERSTAND all the components REQUIRED. The 4 CORE items are interwoven into each other.
In BOTH cases, our JOB is to MAXIMIZE the BEST OUTCOMES for our Agency Staff / Patients and Community
We all have the Medicare Regs, and after studying several webinars, we like the way Kinnser spelled them out in simplicity. We put the complete list of the “E-Tags to Know” in our handouts. Each E-Tag is designated if needed for HH or Hospice
Here is E-Tag E-0039 The GOAL is to be SURVEY Ready in Policies and Procedures. I like putting the E-TAG number right at the top of our policy page so Surveyors have ready access!
As we teach then train our policies, we need to review and update our Policies This policy is referring to TRAINING and TESTING
What I think our BIGGEST Challenge is the GAP of after we process internally within our Agency—Safety of the Building, Staff, Patients—TO WHOM do we report: Patient Status including pts we have not been able to contact, as well as Employees we have not been able to contact. (We can bring this up later so as NOT to distract)
This is a 3 STEP process: FIRST: Measure the PROBABILITY, SECOND: Measure the VULNERABILITY to our Agency/Staff/Patients THIRD: Measure our level of the AGENCY PREPAREDNESS Talk about the Survey Requirements and NOT overdoing up front. As we come to understand and train on the highest priority risk, then periodically add in other risks.
The purpose is to look at the TOTAL by SUBJECT and determine how likely the “event’ is going to take place and how “prepared” we are as an Agency to provide care to get good outcomes as best we can. The higher the numeric value—the more focus we should give preparing for that event.
We put this worksheet with formulas in your electronic handouts. (Formula= Probability x level of Vulnerability x Preparedness level) We put this worksheet with the formulas “built in” in our handouts.
This would include pts who Must have Assistance to Evacuate. Include patients with mental / memory deficits
Part of Training is learning how to Communicate the High Risk Patients or Employees.
Put only pertinent information on this log. KEEP This Simple. When I was the TRIAGE nurse at a Trauma Center in the Midwest, I needed the most PERTINENT INFORMATION with the HIGHEST Priority (Remember You have the medical record completed by your scribe) In your handouts we gave you a Red and a Yellow log. No green log is needed, as you will have that list on your Agency Patient Roster. You will need to report Green numbers to the local health dept. (reduce paperwork and use your current Patient Roster. List Special Needs—Adaptive Equipment, Oxygen, Diets, Translator Services, Mobility, Mental Capacity of the Patient. etc.
Also included in your handouts, is this Instruction page, and the PATIENT NO CONTACT Log that also must be reported. Also in the handouts is an AGENCY Employee Contact Tracker.
Don’t forget to employ your aides and office staff to help scribe, make calls to employees, etc.
One MISSION of HOME HEALTH is to reduce the SURGE to Medical Facilities where we can. One of those is helping our patients and families and caregivers to be prepared. Of course we will need to send pts to the Hospitals, SNFs etc, but if we can reduce the facilities from becoming OVERWHELMED by utilizing field clinicians and educated caregivers we are a significant contributor to higher outcomes.
Our DUTIES as Home Health and Hospice Agencies is to help EDUCATE AND PREPARE our Patients and Families to FORMULATE a DISASTER PLAN in their homes. Try to LOWER your patient’s risk and vulnerability by educating pt and caregivers.
The more our Clinicians are Educated, Trained and Safe the better outcomes we will have with our patients and in the community at large. Engage the clinicians/Staff in Policy development. Important to test communications. “THIS IS A TEST” to see how fast and who responds Text experiment.
Multiple agencies or groups involved Often a mock disaster
IMPORTANT TO EVALUATE your DRILL or an ACTUAL DISASTER—see handouts for an Evaluation
Table-top exercises – TTX Key staff and other constituents -- simulated scenarios Utilizes informal assessment of plans, policies and procedures -- identifies gaps that should be addressed
It is important to Develop a BUSINESS RECOVERY PLAN—It is in the best interest of your company, employees, patients and the community that you stay in business.