Topic Collection Cover Page

Homecare and Hospice
Topic Collection
October 4, 2021

Topic Collection: Homecare and Hospice

Having agency, patient, and employee emergency preparedness plans in place is critical for home healthcare providers, hospice providers, and their clients. The scope of homecare is as broad as the nature of the needs (e.g., persons who need aid with activities of daily living, postsurgical patients, patients receiving home medications, and chronically ill patients who depend on oxygen, ventilators, or other power-dependent equipment). The majority of hospice patients are supported in the location they call home, however inpatient services are also available within free-standing buildings, hospitals, or long-term care or residential facilities.

Disasters, particularly pandemics, may overwhelm agencies with demand. The aftereffects of some disasters may make it difficult for providers to reach their clients, and clients may lose power or water (or both). The resources in this Topic Collection include reports, toolkits, and guidance specific to homecare and hospice for providers and patients. Materials addressing individuals with disabilities and others with access and functional needs may be found in the ASPR TRACIE Access and Functional Needs Topic Collection.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads


American Red Cross. (n.d.). Disaster Preparedness for Seniors by Seniors. (Accessed 2/27/2019.)
This document provides essential preparedness information for seniors and potentially those in home care situations regarding making a plan, getting a kit, and being informed during an emergency.
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Carr, M., Hammon, R., Glenn, J., et al. (2008). Emergency Preparedness Packet for Home Health Agencies. National Association for Home Care and Hospice.
This document is the product of a large national workgroup and includes tools and templates that can be customized and used by hospice and homecare providers in developing all hazards emergency preparedness plans.
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Centers for Disease Control and Prevention. (2021). Emergency Preparedness for Older Adults, Including COVID-19.
This webpage includes links to information to assist older adults with preparing for emergencies and disasters.
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This rule establishes consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, in order to increase patient safety during emergencies and establish improved response during natural and man-made disasters.
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HHS emPOWER Program. (2020). HHS emPOWER Map.
The HHS emPOWER Map provides monthly de-identified totals of Medicare claims submitted for one or more of the fourteen types of life-maintaining or saving electricity-dependent durable medical and assistive equipment (DME) and certain implanted electricity-dependent cardiac devices, at the national, state, territory, county, and ZIP Code levels. Users have the ability to create unique aggregations by geography and export the data, as well as the ability to access historical HHS emPOWER Map datasets for further analysis. When combined with real-time severe weather and hazard maps, the HHS emPOWER Map gives communities the power to anticipate, plan for, and address the needs of this population prior to, during, and after an incident, emergency, or disaster.
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This handbook was written to help Michigan home care agencies develop and evaluate their emergency preparedness plans. Beginning in Chapter 3 it helps users define plan elements, assess their agency's level of preparedness (with the included checklist), develop a plan that addresses specific needs and populations, and test and evaluate the plan.
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National Hospice and Palliative Care Organization. (2017). Emergency Preparedness for Hospice Providers.
This document provides a general overview of disaster response/ emergency preparedness specific to hospice care. It addresses requirements in the CMS Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers specific to hospice providers.
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Education and Training


This webinar reviews the Centers for Medicare and Medicaid (CMS) Emergency Preparedness (EP) Rule requirements for home health and hospice.
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This slide presentation from Maryland provides a general overview of the elements of emergency operations plans for home care providers.
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George Washington University, School of Nursing. (2007). Nurses on the Front Line: Preparing for Emergencies and Disasters. (Requires free registration.)
This six-hour course can help nurses in various settings (e.g., homecare, long-term care facilities) prepare for emergencies.
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This downloadable PowerPoint presentation briefly reviews the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness (EP) Rule requirements and provides guidance and suggestions for assessing community and patient risk, policy and procedural requirements, and preparing patients and clinicians for emergencies and disasters.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). HHS emPOWER Program Web-Based Training. (Free account required.)
The HHS emPOWER Program Web-Based Training is a free, publicly accessible course designed to help partners better understand the HHS emPOWER Program and integrate its tools into their emergency preparedness, mitigation, response, and recovery.
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General Resources


Gibson, H. (n.d.). Before It's Too Late: Planning for an Emergency. (Accessed 4/15/2020.) Caregiver.com.
This article provides a general overview for seniors and caregivers about emergency preparedness. It includes a list of supplies and suggestions for ensuring equipment will be accessible and durable in the event of an emergency.
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* Health Care Association of New York State and New York State Association of Health Care Providers. (2016). Patient and Family Emergency Preparedness: A Resource Toolkit for Home Care and Hospice. Community Health Care Services Foundation, Inc.
This online document is a compilation of other resources that agencies may find useful to provide to their patients and their families prepare in advance for any type of emergency situation such as utility failures.
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* Maryland Department of Health and Mental Hygiene and Maryland-National Capital Homecare Association. (n.d.). My Emergency Preparedness Guide: A Guide for Home Care Patients And Their Families. (Accessed 1/10/2019.) City of Baltimore.
This fact sheet provides information on preparing for emergencies for home care patients and their families, including knowing who to call; having contact information and medical/prescription information ready to take with you, if needed; and what to put into an emergency preparedness kit.
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Guidance


This ASPR TRACIE fact sheet provides information on the types of oxygen therapy and the types of oxygen supplies generally available. It also provides information on the typical sizes and length of use of various oxygen storage methods.
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This ASPR TRACIE tip sheet provides information on general durable medical equipment (DME) categories and focuses on electricity-dependent DME that may be affected by disasters and emergencies, including power failures. It also includes information to assist healthcare system preparedness stakeholders plan for populations who rely on DME.
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This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Home Health Agencies.
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This document combines excerpts from the Final Rule and the recently released Interpretive Guidelines from CMS to provide a consolidated overview document of requirements for Hospice providers.
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* Centers for Disease Control and Prevention. (2016). Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies. U.S. Department of Health and Human Services.
This planning guide is geared towards long-term care, homecare, and hospice providers and is comprised of six sections: situational awareness, continuity of operations, facility or agency operations, crisis standards of care, staffing, and fatality management.
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This handbook can help homecare providers develop emergency plans. It also features New York-specific state regulations and resources.
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Home Care Association of New York State. (n.d.). Primer on Home Care Emergency Preparedness in New York State. (Accessed 1/7/2019.)
This guide can help homecare agencies and programs in the State of New York (from certified home health agencies to "consumer directed personal assistance models") comply with state department of health regulations when developing their emergency preparedness plans. It lists critical elements of a plan and homecare-related challenges and how to overcome them. While a significant portion of the primer is specific to New York, it does contain a three-tier level of prioritized services that may be helpful for agencies across the country to use.
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Li, K. (2013). Smart Home Technology for Telemedicine and Emergency Management. (Abstract only.) Journal of Ambient Intelligence and Humanized Computing. 4:535-546.
This article covers the use of home-based ambient assisted living technology and linkages with healthcare organizations to monitor medical emergencies.
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National Hospice and Palliative Care Organization. (2017). Emergency Preparedness for Hospice Providers.
This document provides a general overview of disaster response/ emergency preparedness specific to hospice care. It addresses requirements in the CMS Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers specific to hospice providers.
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Rebmann, T., Citarella, B., Alexander, S., et al. (2011). Personal Protective Equipment Use and Allocation in Home Health during Disasters. American Journal of Infection Control. 39:823-31.
The authors share results from a literature review they conducted on personal protective equipment usage and planning considerations for home health agencies.
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Texas Department of Aging and Disability Services. (2012). Emergency Preparedness.
This webpage includes links to Texas-specific minimum requirements for written disaster plans for the following facilities: nursing homes, adult day care facilities, homecare agencies, and hospice providers. It also includes emergency plan components and can be tailored by other states.
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* The Association for Home and Hospice Care of North Carolina. (2007). Emergency Preparedness Handbook.
This handbook was designed to help home and hospice care agencies, staff, and patients develop their disaster plans. It provides an introduction to a variety of hazards for providers, discussion scenarios, forms, and templates.
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The first speaker provided an overview of emPOWER and highlighted new data, tools, and resources. Subsequent speakers (from Los Angeles County and the Virginia Department of Health) shared their experiences using the tool and how patients (including those with electrical dependent DME such as ventilators or oxygen concentrators could be contacted/assisted.
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This booklet can help those who use electrically-powered medical devices plan for and respond to power outages.
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Wyte-Lake, T., Claver, M., and Dobalian, A. (2016). Assessing Patients' Disaster Preparedness in Home-Based Primary Care. Gerontology. 62(3):263-74.
The authors conducted 32 semi-structured interviews of Veterans Health Administration Home-Based Care Program staff to explore “ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities.” They found that assessments were incomplete and not standardized across practitioners; not all practitioners understood how to assign risk for their patients; and health and functional limitations are the primary contributors to patients’ lack of preparedness.
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* Wyte-Lake, T., Claver, M., Dalton, S., and Dobalian, A. (2015). Disaster Planning for Home Health Patients and Providers: A Literature Review of Best Practices. (Abstract only.) Home Health Care Management & Practice. 27(4).
The authors conducted a literature review that examined home healthcare disaster preparedness on three levels: organization, provider, and patient. The results highlighted gaps between best and promising tools and policies and adopted policies and differences in approaches to triage, evaluation, education, and classification between organizations.
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Homecare and MERS/Pandemic Influenza


Staff who are coordinating homecare and isolation or quarantine of people who are being evaluated for or are confirmed to have MERS-CoV infection can use this guidance to assess the suitability of the home care setting and provide guidance to the patient and household members.
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* Rebmann, T., Citarella, B., Subramaniam, D.S., and Subramaniam, D.P. (2011). A Home Health Agency's Pandemic Preparedness and Experience with the 2009 H1N1 Pandemic. American Journal of Infection Control. 39:725-31.
The authors present the findings from a pandemic preparedness survey administered to home health agencies after the 2009 H1N1 pandemic. Gaps listed included surge capacity, availability of personal protective equipment, and lack of drill participation.
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Santa Clara County Public Health Department. (n.d.). Home Care Guide: Providing Care at Home during Pandemic Flu. (Accessed 10/3/2019.) Center for Infectious Disease Research and Policy.
This guide can help people create a plan for and recognize the signs of influenza and care for themselves or others sick with the virus. It is available in several languages.
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This rule establishes consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, in order to increase patient safety during emergencies and establish improved response during natural and man-made disasters.
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This resource provides the Joint Commission’s revised emergency management standards for home care agencies, which were implemented to align with the Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness (EP) Rule requirements.
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Lessons Learned


Alfano-Torres, M. (2017). Palliative in Practice During a Natural Disaster. The Center to Advance Palliative Care.
This blog post describes a palliative care physician’s experience and role working in the hospital setting during Hurricane Irma. She found that her clinical skills, as well as experience helping people make difficult medical decisions under stressful conditions, were valuable to the care of patients throughout the hospital.
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ASPR TRACIE interviewed Sheryl Pierce to learn more about the changing role of homecare and hospice agencies in community resilience.
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Calma, C. and Baxter, A. (2017). Top Lessons Irma, Harvey Taught Home Health Agencies. Home Health Care News.
This article shares lessons earned by home care providers following their experiences during the 2017 hurricane season. Topics discussed include communication and coordination; patient triage and mapping; and ways organizations provided support to non-clients in need.
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Kennedy, J. and Kennedy, T. (2017). Hospice Lessons Learned: Surviving the 2017 Hurricanes and Wildfires. National Hospice and Palliative Care Organization Newsline.
This article includes lessons learned for caring for patients and staff during hurricanes and wildfires. Lessons pertaining to preparedness, response, and recovery are discussed.
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McGrady, E., Blanke, S.J., and Swanson, C. (2014). Hospice Patient Evacuation: A Case for Using a Checklist for Safe Disaster Response. (Free registration required.) American Journal of Hospice and Palliative Care. 31(3): 260-8.
This study was conducted to provide lessons learned from the experience of a small, rural hospice care organization to an actual crisis that required evacuation of the facility. A process improvement framework using the emergency response certification guidelines was used to provide details of the incident, analyze the effectiveness of disaster planning and response in response to an actual crisis, and discuss the post-event review, lessons learned, and process improvement.
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This article reviews lessons learned from the New York State home care community’s response to Hurricane Sandy in 2012.
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* Rebmann, T., Citarella, B., Subramaniam, D.S., and Subramaniam, D.P. (2011). A Home Health Agency's Pandemic Preparedness and Experience with the 2009 H1N1 Pandemic. American Journal of Infection Control. 39:725-31.
The authors present the findings from a pandemic preparedness survey administered to home health agencies after the 2009 H1N1 pandemic. Gaps listed included surge capacity, availability of personal protective equipment, and lack of drill participation.
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Rebmann, T., Citarella, B., Subramaniam, D.S., and Subramaniam, D.P. (2011). Assessing the Infection Prevention Components of Home Health Emergency Management Plans. American Journal of Infection Control. 39:849-857.
The authors reviewed 41 home health emergency plans, identified ten domains, and suggest that planners use the information as an assessment tool for evaluating their own plans.
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The first speaker provided an overview of emPOWER and highlighted new data, tools, and resources. Subsequent speakers (from Los Angeles County and the Virginia Department of Health) shared their experiences using the tool and how patients (including those with electrical dependent DME such as ventilators or oxygen concentrators could be contacted/assisted.
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* Wyte-Lake, T., Claver, M., Dalton, S., and Dobalian, A. (2015). Disaster Planning for Home Health Patients and Providers: A Literature Review of Best Practices. (Abstract only.) Home Health Care Management & Practice. 27(4).
The authors conducted a literature review that examined home healthcare disaster preparedness on three levels: organization, provider, and patient. The results highlighted gaps between best and promising tools and policies and adopted policies and differences in approaches to triage, evaluation, education, and classification between organizations.
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Plans, Tools, and Templates


This emergency power planning checklist is for people who use electricity and battery dependent assistive technology and medical devices, including: breathing machines (respirators, ventilators); power wheelchairs and scooters; and oxygen, suction or home dialysis equipment.
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American Red Cross. (n.d.). Disaster Preparedness for Seniors by Seniors. (Accessed 2/27/2019.)
This document provides essential preparedness information for seniors and potentially those in home care situations regarding making a plan, getting a kit, and being informed during an emergency.
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This slide presentation from Maryland provides a general overview of the elements of emergency operations plans for home care providers.
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Carr, M., Hammon, R., Glenn, J., et al. (2008). Emergency Preparedness Packet for Home Health Agencies. National Association for Home Care and Hospice.
This document is the product of a large national workgroup and includes tools and templates that can be customized and used by hospice and homecare providers in developing all hazards emergency preparedness plans.
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* Centers for Disease Control and Prevention. (2016). Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies. U.S. Department of Health and Human Services.
This planning guide is geared towards long-term care, homecare, and hospice providers and is comprised of six sections: situational awareness, continuity of operations, facility or agency operations, crisis standards of care, staffing, and fatality management.
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Centers for Disease Control and Prevention. (2021). Emergency Preparedness for Older Adults, Including COVID-19.
This webpage includes links to information to assist older adults with preparing for emergencies and disasters.
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HCA Education and Research. (2012). Home Care Emergency Preparedness: A Handbook to Assist Home Care Providers in Emergency Preparedness Planning. Home Care Association of New York State.
This handbook can help homecare providers develop emergency plans. It also features New York-specific state regulations and resources.
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* Health Care Association of New York State and New York State Association of Health Care Providers. (2016). Patient and Family Emergency Preparedness: A Resource Toolkit for Home Care and Hospice. Community Health Care Services Foundation, Inc.
This online document is a compilation of other resources that agencies may find useful to provide to their patients and their families prepare in advance for any type of emergency situation such as utility failures.
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HHS emPOWER Program. (2020). HHS emPOWER Map.
The HHS emPOWER Map provides monthly de-identified totals of Medicare claims submitted for one or more of the fourteen types of life-maintaining or saving electricity-dependent durable medical and assistive equipment (DME) and certain implanted electricity-dependent cardiac devices, at the national, state, territory, county, and ZIP Code levels. Users have the ability to create unique aggregations by geography and export the data, as well as the ability to access historical HHS emPOWER Map datasets for further analysis. When combined with real-time severe weather and hazard maps, the HHS emPOWER Map gives communities the power to anticipate, plan for, and address the needs of this population prior to, during, and after an incident, emergency, or disaster.
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Institute of Medicine of the National Academies. (2013). Out-of-Hospital. Crisis Standards of Care: A Toolkit for Indicators and Triggers.
This section (starting midway through the document) of the Institute of Medicine's widely referenced Crisis Standards of Care (CSC) contains detailed planning information for crisis situations which is broadly applicable to much of homecare disaster planning. The functional checklist at the end of the section may be of particular utility. (See also the ASPR TRACIE Topic Collection on Crisis Standards of Care.)
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* Maryland Department of Health and Mental Hygiene and Maryland-National Capital Homecare Association. (n.d.). My Emergency Preparedness Guide: A Guide for Home Care Patients And Their Families. (Accessed 1/10/2019.) City of Baltimore.
This fact sheet provides information on preparing for emergencies for home care patients and their families, including knowing who to call; having contact information and medical/prescription information ready to take with you, if needed; and what to put into an emergency preparedness kit.
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Maryland Emergency Preparedness Network. (2018). Provider Resources.
This webpage includes a link to an Emergency Preparedness Resource Guide for Home Care Providers, which includes sections on emergency planning and business continuity planning. There are also links to fillable forms that support the Emergency Preparedness Resource Guide.
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This handbook was written to help Michigan home care agencies develop and evaluate their emergency preparedness plans. Beginning in Chapter 3 it helps users define plan elements, assess their agency's level of preparedness (with the included checklist), develop a plan that addresses specific needs and populations, and test and evaluate the plan.
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Mississippi State Department of Health. (n.d.). Facilities Preparedness. (Accessed 3/12/2024.)
This website provides comprehensive downloadable emergency operations templates that can be customized and used by home health and hospice providers.
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Montgomery County Advanced Practice Center for Public Health Emergency Preparedness and Response. (2007). Emergency Preparedness Checklist for Case Management and Home Care Services.
This checklist was created to ensure that clients receiving home care and case management services in Montgomery County (MD) develop an emergency plan and stock a 72 hour (or longer) supply of nine essential items (e.g., water, food, hygiene items, and clothes). The checklist can be replicated by others, and can also be added to a client's chart.
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This checklist can help home care and hospice staff analyze workplace hazards and carry out safety protocols (e.g., standard and COVID-19 infection prevention, respiratory protection, cleaning and disinfection).
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South Carolina Department of Health and Environmental Control. (2013). Patient/ Client Evacuation Planning: A Tool for Emergency Preparedness.
This tool can help home health, hospice and other agencies assist their patients/clients in developing an appropriate emergency evacuation plan by enabling staff to maintain an information record of summary medical information and specific patient needs during an emergency.
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Though it includes Louisiana-specific information, this template can be adapted by home health agencies in other states to develop emergency operations plans. It is an update of the content in the 2015 Louisiana Model Home Health/Hospice Emergency Plan and includes information relevant to compliance with the Centers for Medicare and Medicaid Services (CMS) Emergency Preparedness (EP) Rule.
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The Association for Home and Hospice Care of North Carolina. (2007). Emergency Preparedness Handbook.
This handbook was designed to help home and hospice care agencies, staff, and patients develop their disaster plans. It provides an introduction to a variety of hazards for providers, discussion scenarios, forms, and templates.
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Virginia Department of Health, Office of Licensure and Certification. (2006). Emergency Preparedness Planning for Hospice and Home Care Providers.
This document provides clear, concise emergency plan guidance for hospice and homecare providers in Virginia (but it can be used by those in other states responsible for developing a plan).
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West Central Minnesota Healthcare Preparedness Coalition. (n.d.). Home Care Business Continuity Plan. (Accessed 5/23/2019.)
This business continuity template may be referenced and adapted by other home care agencies developing their own plans.
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* Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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Plans, Tools, and Templates: Hospice


* Centers for Disease Control and Prevention. (2016). Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies. U.S. Department of Health and Human Services.
This planning guide is geared towards long-term care, homecare, and hospice providers and is comprised of six sections: situational awareness, continuity of operations, facility or agency operations, crisis standards of care, staffing, and fatality management.
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Florida Hospice and Palliative Care Association. (n.d.). Hurricane Preparedness: A Guide for Hospice Patients & Caregivers. (Accessed 1/11/2019.)
This resource includes information on preparing for a hurricane, as well as a blank “Hurricane Plan” that individuals may fill in with their specific preparedness plan.
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This checklist can help home care and hospice staff analyze workplace hazards and carry out safety protocols (e.g., standard and COVID-19 infection prevention, respiratory protection, cleaning and disinfection).
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South Carolina Department of Health and Environmental Control. (2013). Patient/Client Evacuation Planning: A Tool for Emergency Preparedness.
This tool can help home health, hospice and other agencies assist their patients/clients in developing an appropriate emergency evacuation plan by enabling staff to maintain an information record of summary medical information and specific patient needs during an emergency.
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* The Association for Home and Hospice Care of North Carolina. (2007). Emergency Preparedness Handbook.
This handbook was designed to help home and hospice care agencies, staff, and patients develop their disaster plans. It provides an introduction to a variety of hazards for providers, discussion scenarios, forms, and templates.
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* Wisconsin Department of Health Services. (2018). CMS Emergency Preparedness Rule Toolkits.
This webpage includes links to toolkits and other resources designed to help certain types of healthcare facilities better understand the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness Rule. There is both a PDF (toolkit) and Word version (workbook) for each facility type, and the relevant CMS rules for each facility type are included. Each toolkit includes sample templates and planning worksheets that can help facilities develop compliant plans, policies, and procedures.
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HHS emPOWER Program. HHS emPOWER Map.
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