By Joanne Kaldy
While plans, procedures and practices, supplies, equipment, and technology all play a role important role in disaster management, it really is all about relationships. No facility or organization can adequately manage or recover from a disaster without the help and support of internal and external partners at all levels and in every area.
“A lot of operators know they need to make plans, but they struggle with understanding their expertise and when to reach out for support or assistance,” said Daniel Wicker, regional safety manager for LCS, adding, “No matter how much you know, it is important to get experts and other stakeholders involved.”
Know What You Know…And Don’t
“We start by identifying each property’s capabilities and vulnerabilities,” said Wicker. “Then we take all of this and build on it. We take a three-pronged approach looking at national, local, and internal capabilities that enable us to address widespread disaster planning.”
While about 80% of emergencies can be handled internally, said Wicker, it is important to know all the external players and have relationships with them. A local organization has about a 50-50 chance of experiencing an event well beyond their scope to manage without external help, he Wicker. Adding external support to the layers makes predictability easier. “We make sure we have experts in the field instead of counting on someone who is capable of doing something but it’s not their main skill or field.”
A community-wide assessment should answer such questions as: What kind of disaster are we capable of handling right now? What expertise do we have in-house? Can we get any expertise we need locally, or will we need national support? What relationships do we currently have with partners such as other assisted living facilities in the area, hospitals, and transportation companies? Do we have generators and the fuel to run them? How are they maintained and updated?
A hazard vulnerability assessment is also important to determine what perils are likely to affect your community. “Historically, much planning has been done in an arbitrary way. In my experience, 80% of emergency management from planning through recovery involves getting your ducks in a row,” said Stan Szpytek, president of Fire and Life Safety Inc. This doesn’t have to be a heavy lift once you know your capabilities, inventory, vulnerabilities, and partners.
All Hazards Plan
After assessing strengths, vulnerabilities, and capabilities, the next step is an all-hazards plan. “You need a methodology in place to manage events, and an all-hazards plan to identify and assess disasters that can impact a facility and embraces an incident command system to manage an emergency,” said Szpytek. Having knowledge of potential events and integrating this information into management provides an all-hazards approach. “It’s all about leadership and management,” he said.
Denis Rainey, vice president of operations at ALG Senior, added, “When people talk about disasters, they often jump to hurricanes, but you need to have a plan that considers all possible disasters including fires, floods, bomb threats, and active shooters.” Even if such disasters are unlikely, it is important to have a plan to deal with them. “I’m a big fan of checklists,” said Rainey. These can help make sure things don’t fall through the cracks in the midst of a chaotic, stressful situation.
Once you know what you’re facing, you can put the details in place. For instance, you store water and other supplies in buildings and warehouses, ensure you have appropriate generators (and fuel) and that these are well maintained and in working order at all times.
Key Connections
There are several aspects of disaster management that require outside relationships. Among these:
- It’s not just enough to have vans or buses. Wicker said, “You need vehicles suited to transport frail, disabled elders. We send a spec sheet and engage with prospects who can fulfill those requirements You need to make sure that any vendor you engage can meet your needs.”
- As with transportation, it’s important to connect with hotels that can accommodate your residents in the event of an evacuation. This means easy access to rooms and bathrooms, food and beverage service capabilities, and space for team meetings and medical care (such as basic exams, medication administration, and injections).
- Other assisted living communities. Especially in areas with the high risk of hurricanes, floods, or wildfires, communities identified as evacuation partners should be outside of the risk zone. “We have mutual aid agreements with other communities with whom we share our capabilities in an emergency to get the best possible outcomes. We actually require our communities to have 10 others to reach out to for mutual aid,” said Wicker.
- Much like assisted living partners, you should have relationships and agreements with hospitals outside of the risk area that can house residents and provide care for possible medical emergencies in the event of a disaster. Any agreements should be detailed and documented well in advance. Nothing should be assumed or left to chance.
- Not only can these help provide spiritual support for residents and staff during a disaster, but churches may be able to help provide meals and even serve as an emergency shelter. Consider inviting church leaders to your buildings so they can meet your residents and start thinking about working together.
- Animal Shelters/Boarding Facilities. If your residents have pets, it will be important to work with them to ensure their animals are safe during a disaster. It may be viable to make residents and their families responsible for pets. However, there are likely to be situations where they can’t provide care, so it is a good idea to have a viable plan B for pets. Arrange in advance to take animals to shelters or boarding facilities outside of the risk area.
- Health Care Coalitions. “Every state has one of these,” Szpytek said. These are groups of local health care and responder organizations that collaborate on ways to improve emergency preparedness and protect the health and safety of their communities in the face of a disaster. They provide an opportunity for collaboration and connections. More information about these can be found in a Public Health Emergency handbook from the Dept. of Health and Human Services at here.
- Utilities Companies. Make sure the electric, water, and gas companies know you have vulnerable elderly residents in your buildings and that you need to be prioritized for service restoration after a disaster. Don’t assume they know who you are and what you do.
- Law Enforcement and Fire Department. Have relationships with these entities so you can alert them to keep an eye on your building if you must evacuate. They also can work with you to identify safety measures such as how to keep residents’ units and possessions safe and make sure any drugs and medications are secured.
- Recovery and Restoration Companies. It is important to know what companies offer recovery and restoration services in your area. “It’s a good idea to have a relationship with one and have two to three backups,” said Szpytek. This requires some investigation and research to find reputable companies you’ll be able to count on and trust. “You need to know in the blink of an eye who to call. There are many unsavory companies out there that throw some equipment and tools into a truck and call themselves a restoration company,” he said. These companies may not only come with an outrageous price tag; they can put your residents at risk. In addition to finding reputable companies, you need to find out how they will work with your insurance company and what repairs and restoration efforts will be covered.
- Local Government. Identify local officials you may need a connection with during a disaster. This might include the mayor, city council representatives, head of waste management, state and federal legislators, and others. If your county or municipality has an emergency management director, this will be an important contact. This individual and their office can help with training and disaster management exercises and ways to ensure a successful, coordinated response to an emergency.
- Kevin O’Neil, MD, chief medical officer of ALG Senior, said that his organization has a certified provider network. “We have regular meetings with the and we review data and quality goals.” They also set a transitions of care workgroup with these providers, and this will help ensure smooth transitions if residents must be hospitalized or move to another setting before, during, or after a disaster.
Making these connections takes time and effort, but the return on investment can be significant. “When I came here, I knew I didn’t have expertise to do this on my own. I needed a network,” Wicker said. He reached out and started going to area Health Care Alliance meetings and joined a local disaster management council. He went to hospitals and met with emergency management personnel there, and he took every opportunity to get to know the key players who he might need to connect with during a disaster. “Fast forward five years, and I have a group of people in my contact list I know and can contact at any given time,” he said.
Wicker urges every community to make and maintain these types of connections. “When your name and face are recognizable, people are more likely to help and to respond quickly when you reach out.” Szpytek agrees. He said, “The last thing you want to do is exchange business cards during a crisis. Establishing relationships in advance is essential and commonsense.”
Rainer noted, “I have never had someone tell me no when I asked for help in these situations. People want to provide support and assistance if they can.” If you plan and establish relationships before there is an issue, these ‘asks’ will be easier, as you will know precisely who to direct each specific request to.
Families as Partners
While it is common to involve family members in medical care and decisions, community leaders often don’t think about engaging them in disaster management.
Families may have skills, capabilities, and resources that are invaluable during or after a disaster. For instance, a resident’s children might own a restaurant and could bring in food and related supplies. Others might have plumbing, electrician, or contractor companies or capabilities. Consider seeking this information when a resident moves in and/or holding regular family night events to address disaster planning and ask for volunteers. Keep a list with current contact information and each person’s capabilities or expertise and update it at least annually.
This is a give and take relationship. While you may be asking for families’ help, you can offer them a safe haven during disasters. Rainer said, “We serve as a shelter if needed for families of residents and staff.” They also set up a kindergarten and day care in some rooms for children of staff and resident family members. Rainer recalled, “We had a hurricane go through Florida several years ago and he went to check on one building. He encountered 42 residents, 40 family members, five dogs, and three cats. “We have to take care of each other,” he stressed.
Don’t wait until a pending disaster to get to know families. “We need to make this an ongoing priority. These individuals are important to our residents and our building.” It is essential to include them in activities beyond emergency preparedness and have a relationship with them before there is a crisis. O’Neil observed, “Families are a key part of our team. I’ve always been impressed with the contributions they make and the volunteerism they offer.”
Training the Team
“We’ve done a good job of training leadership on emergency management principles, but we have to do a better job of training staff,” said Szpytek. This is partly because leaders won’t be at the facility at 3 a.m. when there is a fire in the laundry room or on Sunday afternoon when a pipe bursts. “We focus on an all-hands-on-deck approach,” he said. This means involving CNAs, kitchen and housekeeping staff, and others and preparing them to be “big picture thinkers” during a disaster who can make quick decisions and identify and pursue priority objections.
This training, Szpytek stressed, needs to be more than a couple of videos. “It requires hands-on and classroom training, multimedia and multidimensional education, and tabletop exercise and live drills,” he said, adding that in Arizona they do a drill on each shift once a quarter.
It is important to make sure staff and residents alike understand the importance of fire and other drills. “If you don’t let people know how these drills can keep them safe in a disaster, they may take them for granted and not give them their full attention,” said Karren Ganschinietz, a long-time CNA and member of the National Association of Health Care Assistants board of directors. “Staff also need other information such as how to use a fire extinguisher, where the gas lines are, where the water shut-off valves are, and how to evacuate residents quickly if there is a fire or other emergency,” she said.
Szpytek stressed, “We have to protect our careforce. They need to be safe so they can be of assistance to others. They need to recognize the risks and perils and know how to respond accordingly.” O’Neil agreed, noting, “We have a great employee assistance program that includes mental health resources. We also have a relationship with a primary care group that offers mental health services.” He stressed that it is essential for staff to get help and relief if they are feeling stressed, anxious, or depressed when a disaster strikes.
