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Topic Collection: Homecare and Hospice

Having both agency and patient 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., older patients 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). Hospice services can be provided in facilities, such as those located as a part of a hospital, nursing home, or residential facility, or as a freestanding hospice inpatient facility.

Disasters, particularly pandemics, may overwhelm these 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 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.


Topic Collection (PDF - 176.7 KB)

Must Reads
Education and Training
General Resources
Guidance
Homecare and MERS/Pandemic Influenza
Legal/Regulatory
Lessons Learned
Plans, Tools, and Templates
Plans, Tools, and Templates: Hospice
Agencies and Organizations

Must Reads

Administration for Community Living. (2014). Keeping Older Americans and People with Disabilities Safe and Healthy during Emergencies. U.S. Department of Health and Human Services.

This webpage includes resources for individuals, service providers (including homecare providers), and community members on ensuring the safety of older Americans during emergency situations. Also included are links to resources, checklists, and apps for older adults and those with special needs and links to national guidance documents for higher level planning at the community, organization/system, and state levels.
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American Red Cross. (n.d.). Disaster Preparedness for Seniors by Seniors. (Accessed 1/4/2016.)

The following 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. (2010). Emergency Preparedness Packet for Home Health Agencies. National Association for Home Care and Hospice.

This document is the product of large national workgroup and includes tools and templates that can be customized and used by hospice and homecare providers while developing all hazards emergency preparedness plans.
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Centers for Medicare & Medicaid Services. (n.d.). Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.

This rule establishes consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increases patient safety during emergencies, and establishes a more coordinated response to natural and man-made disasters.
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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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Knebel, A. and Phillips, S. (Eds.). (2008). Home Health Care During an Influenza Pandemic: Issues and Resources.

This report is a summary of expert panel reviews of existing work in home healthcare pandemic planning and preparedness (the findings can be applied to other scenarios, too). It includes information on community collaboration and business continuity, workforce issues, changes in parameters of patient care, and legal and ethical issues.
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Michigan Department of Health and Human Services. (2015). Home Health Emergency Preparedness: A Handbook to Assist Home Health Care Providers in Emergency Preparedness Planning.

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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Santa Clara County Public Health Department. (2015). Home Care Guide: Providing Care at Home during Pandemic Flu.

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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U.S. Department of Health and Human Services. (2013). Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. Federal Register. Vol. 78, No. 249.

This proposed regulation lists national emergency preparedness requirements for health care providers and suppliers participating in Medicare and Medicaid, including home health agencies. (Note: ASPR TRACIE will update when final rule is published.)
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Disaster Preparedness Planning for Older Adults.

This website provides links to resources that can help assist older adults and seniors prepare for a myriad of emergencies including large scale disasters.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). HHS emPOWER Map.

The map features de-identified population data, down to the zip code level, for Medicare beneficiaries that rely upon certain life maintaining electricity-dependent medical and assistive equipment. It also features real-time National Oceanic and Atmospheric Administration severe weather tracking capabilities to help community partners identify areas that may be impacted by severe weather and thus at risk for prolonged power outages. Together, this data assists community partners, such as hospitals, EMS, emergency managers, electric companies, and civic organizations, to better anticipate, plan for, and rapidly assist electricity-dependent populations within their communities.
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Veteran’s Emergency Management Evaluation Center. (2017). Home-Based Primary Care/Home Health Agency Disaster Preparedness Toolkit.

This toolkit—comprised of six components—can help health agencies working with the homebound develop and maintain their emergency plans and procedures. It includes a hyperlinked checklist that allows providers to identify and address any gaps in planning, categorized by regulations and elements of performance.
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Education and Training

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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* 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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General Resources

Administration for Community Living. (2014). Keeping Older Americans and People with Disabilities Safe and Healthy during Emergencies. U.S. Department of Health and Human Services.

This webpage includes resources for individuals, service providers (including homecare providers), and community members on ensuring the safety of older Americans during emergency situations. Also included are links to resources, checklists, and apps for older adults and those with special needs and links to national guidance documents for higher level planning at the community, organization/system, and state levels.
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Gibson, H. (n.d.). Before Its Too Late: Planning for an Emergency. (Accessed 1/27/2016.) 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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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). Disaster Preparedness Planning for Older Adults.

This website provides links to resources that can help assist older adults and seniors prepare for a myriad of emergencies including large scale disasters.
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Guidance

Home Care Association of New York State. (2015). Primer on Home Care Emergency Preparedness in New York State.

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. 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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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 the use of 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 document includes 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 Joint Commission Accreditation. (2015). Home Care Accreditation Webinar, Emergency Preparedness: Q&A Follow-up.

The guidance in this document can help emergency planners who work for homecare and hospice facilities develop plans and guidance for their facilities.
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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

Centers for Disease Control and Prevention. (2013). Implementing Home Care and Isolation or Quarantine of People Not Requiring Hospitalization for MERS-CoV.

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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Knebel, A. and Phillips, S. (Eds.). (2008). Home Health Care During an Influenza Pandemic: Issues and Resources.

This report is a summary of expert panel reviews of existing work in home healthcare pandemic planning and preparedness (the findings can be applied to other scenarios, too). It includes information on community collaboration and business continuity, workforce issues, changes in parameters of patient care, and legal and ethical issues.
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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 in 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. (2015). Home Care Guide: Providing Care at Home during Pandemic Flu.

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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Centers for Medicare & Medicaid Services. (n.d.). Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.

This rule establishes consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increases patient safety during emergencies, and establishes a more coordinated response to natural and man-made disasters.
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U.S. Department of Health and Human Services. (2013). Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers. Federal Register. Vol. 78, No. 249.

This proposed regulation lists national emergency preparedness requirements for health care providers and suppliers participating in Medicare and Medicaid, including home health agencies. (Note: ASPR TRACIE will update when final rule is published.)
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Lessons Learned

Hobaica, K. and Moody, V. (2015). Expanding Healthcare Coalitions Beyond Hospitals: Engaging Home Health Agencies in Emergency Preparedness and Response Planning.

This presentation highlights challenges associated with home healthcare in Colorado during emergency events and strategies for overcoming them. It also shares steps that public health and emergency management agencies can take to work collaboratively.
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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 in after the 2009 H1N1 pandemic. Gaps listed included surge capacity, availability of personal protective equipment, and lack of drill participation.
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Plans, Tools, and Templates

American Red Cross. (n.d.). Disaster Preparedness for Seniors by Seniors. (Accessed 1/4/2016.)

The following 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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Carey, P., Link, D. (n.d.). The Critical Role of Home Care Providers in Emergency Preparedness & Response. (Accessed 3/23/2017.)

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. (2010). Emergency Preparedness Packet for Home Health Agencies. National Association for Home Care and Hospice.

This document is the product of large national workgroup and includes tools and templates that can be customized and used by hospice and homecare providers while 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.

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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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.
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Home Care Association of New York State. (n.d.). Planning Tools Homepage: Evacuation. (Accessed 4/4/2017.)

This website contains several planning tools for home health care agencies. Specifically there is an Evacuation section, which includes the following materials: Evacuation Tracking Tool, Emergency Evacuation Plan, Employers Guide for Evacuation, Evacuation Guide, and Emergency Checklist.
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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 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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Michigan Department of Health and Human Services. (2015). Home Health Emergency Preparedness: A Handbook to Assist Home Health Care Providers in Emergency Preparedness Planning.

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 Emergency Operations Plan Template. (Accessed 3/23/2017.)

This website provides comprehensive downloadable emergency operations templates that can be customized and used by home health providers.
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Montgomery County Advanced Practice Centerfor Public Health Emergency Preparednessand 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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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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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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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2015). HHS emPOWER Map.

The map features de-identified population data, down to the zip code level, for Medicare beneficiaries that rely upon certain life maintaining electricity-dependent medical and assistive equipment. It also features real-time National Oceanic and Atmospheric Administration severe weather tracking capabilities to help community partners identify areas that may be impacted by severe weather and thus at risk for prolonged power outages. Together, this data assists community partners, such as hospitals, EMS, emergency managers, electric companies, and civic organizations, to better anticipate, plan for, and rapidly assist electricity-dependent populations within their communities.
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* Veteran’s Emergency Management Evaluation Center. (2017). Home-Based Primary Care/Home Health Agency Disaster Preparedness Toolkit.

This toolkit—comprised of six components—can help health agencies working with the homebound develop and maintain their emergency plans and procedures. It includes a hyperlinked checklist that allows providers to identify and address any gaps in planning, categorized by regulations and elements of performance.
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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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Zane, R., and Biddinger, P. (2011). Home Health Patient Assessment Tools: Preparing for Emergency Triage.

The purpose of this guide was to develop a patient risk assessment tool that will allow home care agencies, hospitals, and emergency planners to anticipate the needs of all home care patients in a community, should a mass casualty incident (MCI) occur. It focuses on those whose needs are most complex—those patients who could not be safely evacuated to a public shelter or even a special needs shelter during a MCI. It includes a Community-Living Patient Assessment Tool for Disaster Planning, which is a screening tool that creates a record for identifying patient needs, and plans for meeting those needs.
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Plans, Tools, and Templates: Hospice

Note: 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.

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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Chatham Emergency Management Agency. (n.d.). Hospice Evacuation Plan Format. (Accessed 9/2/2016.)

Components of this evacuation plan can be used by hospice facility emergency planners when developing their own procedures.
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City of Baton Rouge. (2015). Louisiana Model Home Health/Hospice Emergency Plan.

This template can be used by home health/hospice facilities in Louisiana (or modified by planners in other states) interested in developing emergency plans.
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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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* Veteran’s Emergency Management Evaluation Center. (2017). Home-Based Primary Care/Home Health Agency Disaster Preparedness Toolkit.

This toolkit—comprised of six components—can help health agencies working with the homebound develop and maintain their emergency plans and procedures. It includes a hyperlinked checklist that allows providers to identify and address any gaps in planning, categorized by regulations and elements of performance.
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Agencies and Organizations

Note: The agencies and organizations listed in this section have a page, program, or specific research dedicated to this topic area.







U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. HHS emPOWER Map.

This ASPR TRACIE Topic Collection was comprehensively reviewed in January 2016 by: Barbara Citarella, MS, RN CHCE, President, RBC Limited Healthcare & Management Consultants; James Cowher, MS, Centers for Medicare & Medicaid Services, Center of Clinical Standards & Quality, Survey & Certification Group; John Hick, MD, HHS ASPR and Hennepin County Medical Center; and Mary Russell, EdD MSN, Emergency Services, Boca Raton Regional Hospital.