By Tom Gresham
Emergency planning and preparedness is a topic of the utmost importance in the senior living field, and it’s also one that is challenging to grasp and elusive to categorize.
After all, no emergency is the same as the one before it, and every crisis tends to defy expectations and prove vexing to the most sophisticated planning – the COVID-19 pandemic serving as a recent, extreme example.
Stan Szpytek, a retired deputy fire chief who frequently consults senior living
providers as president of Fire and Life Safety Inc., uses the phrase “it’s a normal day until it’s not” to drive home the unpredictability of most crises.
“There are many threats and perils that can impact any type of occupancy,” Szpytek said. “Organizations that provide services to vulnerable populations – either as a best practice or in the realm of regulation – they’ve got to be prepared for emergencies as well as they can be.”
Emergencies in senior living can touch on a wide variety of situations and crises – including natural disasters, intruders (including armed ones), fires, cyberattacks, power blackouts, and, of course, a pandemic, among other possibilities.
For senior living providers, the pandemic helped to drive home how crucial emergency planning and preparation is, while also providing meaningful lessons to refine and strengthen their efforts in that area. Among the most impactful lessons was the importance of actively managing an emergency rather than simply enduring it. Emergencies should no longer knock communities back on their heels.
“Senior living communities have to embrace the emergency, manage it, and not let the tail wag the dog,” Szpytek said. “COVID was a good example of that. There were many health care and senior living providers in the early stages of COVID who were just responding and reacting to the daily changes and the daily information that was coming in instead of taking the bull by the horns and managing it.”
That starts with an emergency management plan that involves stakeholders. While residents previously might have tended to simply follow a provider’s lead, they are more likely to want more details and input in the current climate and after having weathered the pandemic first-hand, said Jon Scott Williams, executive director of Fellowship Square in Mesa, Ariz.
“Residents today expect management to have a plan and to share the plan with them on a regular basis,” Williams said. “In the past, they assumed management had a plan, but now they ask for updates and with the internet they offer plans that they have heard about.”
Szpytek said he still sees some senior living communities with “tepid” and “basic” emergency management plans that often rely on assumptions about local fire, police, and rescue responses that do not anticipate the challenges of a major emergency.
“When the tornado touches down or the hurricane blasts through, whatever the circumstances are, you’re going to find out just how limited the greater community’s resources are,” he said.
“On a single focused incident, like maybe a medical emergency at a senior living community, they call 911 and they’ll be there in three minutes. But what if it’s a disaster? In a true disaster, you’ve got to realize that you’re going to be on your own for the first hours, days or longer, depending on the scope, severity and duration of the disaster.”
Tackling All of the Harzards
Providers can prepare for a range of scenarios, but Szpytek said it is important not to simply focus on the ones that seem most likely. Instead, providers must develop an approach that prepares them for any occurrence – from the common to the exceedingly rare.
“It’s one thing to say, ‘OK, we’ll be ready for anything.’ But the reality is how do we prepare for everything?” he said. “You have to have an all-hazards approach. You’ve got to be ready for anything and everything.”
The first key component to an all-hazards approach is risk analysis, Szpytek said. That starts with a hazard vulnerability assessment, he said. “You can’t just arbitrarily plan for emergencies or disasters,” he said. “You’ve got to have a process that identifies what your hazards are.”
When clear hazards are identified, senior living providers have a responsibility to address them, no matter how straightforward they might seem. For instance, Williams noted that many people in the West live in single-story structures on lots without connecting walls.
“Therefore, new residents need to be educated about communal living in a three-story building with fire sprinklers and elevators,” Williams said. “It seems simple but what people do when they burn toast or eggs in a senior community can fill a book and as you can imagine is often the wrong thing to do.”
Donald Breneman, vice president of risk management and business operations for Juniper Communities, said regular assessments are crucial to keep up with changing conditions and updated threats.
“Annual hazard assessments are essential in senior living operations, and these should not be perfunctory but instead be shared with quality management teams which include external vendors when possible to assist in high-level identification and resource support,” he said. “Juniper completes these in electronic format and shares them with team members as well as sister communities which again can be a valuable exercise for planning. Having these in a digital format allows a more comprehensive review of evolving needs.”
The second part of an all-hazards plan is having an incident command system (ICS) to manage an emergency, Szpytek said. An ICS is a standardized approach to the control and coordination of emergency responses. It is a flexible mode that focuses on managing by objectives, he said.
With an ICS as an emergency management model, Szpytek said senior living operators can be prepared to adapt to emergencies of all kinds.
“Once you identify the threats and perils and then have a system to manage them, it doesn’t really matter what the specific circumstances are,” he said.
Breneman said that no matter how thoroughly every potential hazard and consideration is evaluated for emergency planning and preparedness “when an actual crisis unfolds not all the planning is executable for any number of reasons and realities.”
“No crisis scenario is ever the same,” he said.
For example, a Juniper community had multiple contracts related to transportation readiness, but road closures during an emergency event made those resources unavailable “and furthermore what was provided was not as agreed to for transportation needs specific to this emergency.” Fortunately, Juniper found support from other resources, including other senior care communities – even direct competitors – who stepped in to provide assistance.
“I think it’s so important not to provide absolutes in emergency planning because it’s simply not the reality and the fact is that in a time of crisis the community will need to rely upon what is immediately or most reasonably available,” Breneman said.
Cindy Baier, president and CEO of Brookdale Senior Living, said relationships can play a vital role when emergencies strike. For instance, Brookdale often is able to temporarily relocate residents to another Brookdale community in the event of an evacuation, but sometimes needs to leverage relationships with hotels to secure rooms for residents and supporting staff.
“Our relationships with our vendors across the country help our communities acquire necessary equipment and supplies in a time of emergency,” Baier said.
“For example, contracts with bus vendors help Brookdale gain access to large commercial buses for evacuations and our relationships with pharmacy vendors help establish action plans to help provide medications as needed. And our relationships with our restoration vendors help damage recovery to occur promptly so that community life resumes as quickly as possible. And those same relationships help facilitate access to food and supply deliveries just before and promptly after an emergency.”
Technology’s Central Role
Emergency planning and preparation often encompasses resident security efforts. Those have evolved in recent years, particularly during the pandemic when new security efforts were implemented.
Williams said Fellowship Square was required to restrict access to its apartment buildings during COVID to help control the spread of the virus. The community’s buildings are built like hotels, so Fellowship Square installed door access devices that used the same fobs that residents carry to open the locks to their apartments.
“The residents liked the entry door fob system because of the security it affords,” Williams said. “Prior to COVID, anyone that walked up to the door could come in. But now, unless you have a fob, or you use the Wi-Fi doorbell you cannot enter any of the resident buildings. Security has improved, the residents feel much safer.”
Going a step further, the community is installing a new Wi-Fi integrated resident door locking system. Keys for the system can be made at the front desk, just as at a hotel. The locks can be locked by security with the press of a button on a mobile app during an emergency and can be unlocked in case of fire or another emergency, he said.
“The locks replace the clumsy combination door latch/deadbolt system,” Williams said. “The two locks caused confusion for residents and staff especially during an emergency. The new system provides real-time data necessary to operate the community. It uses scalable access control software, supporting intelligent wireless locksets and door controllers. The system is invaluable in case of an intruder, intruder with a weapon, fire, or other emergency.”
Williams said protecting resident privacy is more important now than ever for security purposes.
“Residents can request their names and phone numbers to be withheld from community lists,” he said.
“We have added walking paths that are handicapped accessible within the fenced grounds of our campus to protect their safety. The major driver outside of improved health is that vagrants have become a problem with recent court decisions. We observe and report vagrant activity to the local police who are quick to respond and seem to be trained to encourage the vagrants to move on. We fully prosecute anyone that trespasses on our property. It is well known that our residents store prescriptions that are in demand by drug abusers.”
Williams said Fellowship Square’s prioritizing of its Wi-Fi system has allowed for new resident safety efforts.
“Virtually every solution we have implemented is only possible because years ago we installed and are constantly improving our enterprise grade Wi-Fi system,” he said.
“We were at one conference when resident technology was being discussed when a young-minded person of 85 said if you people think I am going to move into your dumb apartments from my smart home you’re crazy. Technology must include enterprise grade Wi-Fi to make it effective, scalable and affordable.”
Senior living has seen a move toward digitization that includes emergency planning and preparedness, Breneman said. He said there are new companies that are viewing opportunities in the evolving senior care environment, but not all of them understand “the multifaceted nature of our operations.”
“Some of these companies have been of assistance in creating digital records and training experiences related to emergency preparedness and planning,” Breneman said. “However, each location and its resources are unique.”
The highly complex nature of senior living means the integration of new technology solutions into other critical systems is not always possible, he said.
“Strong consideration should be provided for selection of not only e-call systems but more importantly notification panels, etc. as to how they can or cannot integrate or have interoperability with other platforms,” Breneman said. “The ambient technology market has expanded considerably but the understanding of how and who will operate these and to what systems they must connect is essential.”
COVID Sets New Standards
Cell phones have become “a huge component” of emergency planning but do not always work in crisis situations, meaning it’s important to consider backup systems.
“It makes it difficult during a pandemic to respond to emergency situations when resources are not available – and will not come — and then everything falls to your team as well as your family members to support and adjust to the situation in the best manner possible,” Breneman said. “I think COVID created an entire training situation for almost every family member at every community.”
He said one of the positives to come out of the pandemic was improved messaging to family members and staff, including both automated and direct communications, about the status of the community. Those resources now are integrated into regular operational practices.
“Creating partner messaging that includes everyone is key to emergency preparation and planning,” Breneman said.
As is often the case, communication is key in a crisis – often tech-enabled communication.
“We believe communication with our residents and their families and with associates is of the utmost importance and take great care to provide frequent status updates during an emergency affecting the community,” Baier said.
Breneman said Juniper is “high tech and high touch” and emphasizes the caring component to messaging, whether electronic or in person.
“Messaging needs must be on-point and understandable but also might require a direct phone call (instead of text or email),” he said. “In one of our most recent crisis scenarios, the network of team members communicating about the urgency and status of events as well as the information being shared from family members and other partners was essential.”
Training and Team Members
In an all-hazards plan, Szpytek said training for all team members is critical. “They’ve got to train everyone to understand that they might be in the position to make those decisions,” he said. “There’s a lot of training drills and exercises to go into maintaining an all-hazards approach.”
As Breneman said, people make the difference in emergencies. “Actual training experience for your team members is essential to help ingrain how they respond to and implement all those critical procedures and other tasks in and around creating safety for your community, residents, family and other team members,” he said.
Training cannot leave anyone out anymore, Szpytek said, since the pandemic revealed that emergency management of any kind of emergency requires a team approach.
“It’s not just the nurses or clinicians – it’s environmental services, it’s facilities maintenance, it’s the leadership team. It’s not just one sector or one person’s responsibility within a senior living community – it’s everyone’s responsibility. So everyone needs to be trained.”
All team members in senior living communities are first responders, “whether they know it or not,” Szpytek said. “Whether a resident falls, the fire alarm sounds, there’s a report of an active shooter in the area, they’ve got to act like first responders and they’ve got to think like first responders,” he said.
Breneman said digital training tools are “wonderful” and provide consistency through standardized training components. However, there is a need for simulations of events so that people can understand their roles and how to function during “very difficult and sometimes scary situations.” Due to state requirements or regulatory needs, he said emergency plans are not always written “in a manner that creates user experience.”
“That’s why during emergency planning it’s so important to have very explicit and simple checklists to support all the team members in critical roles,” Breneman said. “These must be integrated in and around the community as much as possible to create the high level of familiarity and routinization as ‘calls to action’ in the crisis scenario.”
Training is one key component of an overall approach to emergency management that focuses on solutions and preparedness and fights the temptation to hope for the best.
“It always has to be about awareness, monitoring and surveilling situations,” Szpytek said. “One of the biggest threats to effective emergency management in any kind of organization – and we saw this with COVID optimistic bias – is thinking, ‘How bad can it really be?’ We’ve got to react to the realities.”
