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Community-Wide Emergency Planning Involving Long-Term Care

May 1, 2006
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How to work with community resources-an approach developed by the Joint Commission on Accreditation of Healthcare Organizations by Marianna Kern Grachek, MSN, CNHA, FACHCA
BY MARIANNA KERN GRACHEK, MSN, CNHA, FACHCA Community-wide emergency planning involving long-term care
The Joint Commission approach to enhancing community support of long-term care during disasters
The devastating loss of life caused by Hurricane Katrina, recent dire government warnings about the threat of an avian influenza pandemic, and an impending new hurricane season have prompted nursing homes and other healthcare organizations to examine their emergency-management plans and their role in community-wide disaster preparedness. As Katrina demonstrated, even those facilities with solid plans face daunting challenges when the major parts of a community's infrastructure for medical care-water supply, sewage system, and electricity-are significantly damaged. And what happens when the transportation necessary to evacuate a frail population is disabled because of the magnitude of the disaster?

The goals of emergency planning are to enable organizations and communities to care for themselves in the initial phase following natural or man-made disasters and to build on existing relationships so that each organization's exposure to risk is minimized. This article explores the challenges of emergency planning and the strategies that can help long-term care organizations develop comprehensive emergency plans to meet real-world circumstances.

Emergency Planning
Requirements from private accreditors such as the Joint Commission on Accreditation of Healthcare Organizations and state and federal regulators have long mandated that nursing homes plan for emergencies. The Joint Commission, which has been actively involved in disaster preparedness for more than 30 years, increased its focus on emergency management two years before the September 11, 2001, terrorist attacks, and has worked even more closely with emergency-management experts and healthcare organizations since then to make this issue a priority. The resulting modified accreditation standards and overall guidelines, developed by multiple roundtables of experts, today better reflect the need for nursing homes and other healthcare organizations to be involved in community-wide planning, as opposed to confining planning solely to the single organization.

The Joint Commission's Management of the Environment of Care (EC) standards require long-term care organizations to develop a management plan that ensures an effective response to emergencies, implement that plan, and help execute the plan by conducting emergency-management drills. These standards also require long-term care organizations to participate with the community in establishing priorities among potential emergencies, defining the organization's role in the community's emergency-management program, and linking with the community's command structure.

While recent attention has focused on the emergencies created by Hurricane Katrina, Joint Commission standards emphasize the need to consider a variety of natural or man-made events that suddenly or significantly disrupt the environment of care or change demand for the organization's services. This broad approach could encompass, for example, damage to the organization's buildings and grounds caused by severe windstorms, tornadoes, hurricanes, or earthquakes; loss of utilities (power, water, telephones) because of floods, civil disturbances, accidents, or emergencies within the organization or in its community; or a bioterrorist attack, building collapse, or airplane crash that might occur in the community.

Long-Term Care'Specific Challenges
Nearly half of all nursing home residents (47.7%) have some form of dementia, and more than half of those age 85 and over (53.6%) have dementia, according to a 2001 report from the Agency for Healthcare Research and Quality (Available at: www.meps.ahrq.gov/papers/rf5_99-0006/rf5.htm). These facts create special challenges for long-term care organizations during an emergency.

For example, plans to address an influenza pandemic may include frequent handwashing by residents or wearing masks to prevent the spread of the infection through coughing or sneezing. However, a person with a cognitive impairment such as dementia may not be able to reliably carry out these standard precautions. Hurricane Katrina also showed that vulnerable populations such as nursing home residents can be at particular risk because they are so dependent on the good judgment of caregivers and organizational leadership. An immobile or cognitively impaired resident cannot independently escape rapidly rising floodwaters or even realize that such a danger is imminent.

Therefore, when working with community leaders to plan for emergencies, it is important for nursing home leaders to detail the special needs of their residents. Areas of consideration might include:

Communication. How will communication with residents be conducted during the chaos of an emergency? Those with dementia may not understand what is happening or may not react well to changes in routine. Also, how will information be shared with these residents' families?

Basic personal care functions. Nursing home residents may not be able to adequately feed or hydrate themselves and will also need special assistance with toileting or other hygiene needs during an emergency and its aftermath.

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