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Topic Collection: Long-term Care Facilities

Long-term care includes a range of support services that an individual may need to meet their personal care needs. Long-term care may be provided through home healthcare services, or in facilities, such as nursing homes, assisted living facilities, and continuing care retirement communities. Individuals needing long-term care may include the elderly, those with chronic health conditions, and individuals involved in a debilitating accident.

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 - 166.4 KB)

Must Reads
Legal/Regulatory
Articles
Guidelines
Legal/Regulatory Issues
Pandemic/Epidemic Influenza Planning
Plans, Tools, and Templates: Emergency Planning
Plans, Tools, and Templates: Evacuation and Shelter-in-Place
Plans, Tools, and Templates: Hazard Vulnerability Analysis/Risk Assessment
Studies: Emergency Preparedness
Studies: Evacuation and Sheltering
Studies: Other Specialized Services
Toolkits
Trainings
Webinars/Conference Materials
Agencies and Organizations

Must Reads

California Association of Health Facilities. (n.d.). CAHF Disaster Planning Guide.

This guide was developed to assist long-term care providers to enhance their existing emergency operations plans and procedures. It includes self-assessment tools, checklists, templates, and other resources that can be found across multiple tabs. The information contained in this guide was developed in consideration of the core concepts and guiding principles of the National Incident Management System (NIMS). The Nursing Home Incident Command System (NHICS), a derivative of the Incident Command System, is promoted throughout this guide.
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California Association of Health Facilities. (2009). Evacuation Drill For Long-Term Care Facilities.

This guidebook is designed to help long-term care facilities evaluate their preparedness for an evacuation. It contains the materials necessary to conduct a simulated evacuation using a tabletop exercise. The evacuation drill is detailed in four steps, and includes multiple templates and forms.
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California Department of Public Health. (n.d.). California Department of Public Health Standards and Guidelines for Healthcare Surge during Emergencies: Long-Term Care Health Facilities Operational Tools. (Accessed 5/5/2015.)

This manual contains tools that assist long-term care facilities in healthcare surge planning for management, delivery of care, and administrative functions. Tools include, but are not limited to the following: self-assessment and hazard vulnerability tools, business continuity plan checklist and template, standard operating procedures template, sample memoranda of understanding, disaster preparedness tool, emergency evacuation decision-making tools, and patient transfer forms.
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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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Centers for Medicare and Medicaid Services. (2013). Emergency Preparedness Checklist: Recommended Tool for Effective Health Care Facility Planning.

This document is an emergency preparedness checklist intended for all healthcare facilities. It can help these facilities, including long-term care facilities, determine their level of preparedness and action steps.
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Claver, M., Dobalian, A., et al. (2013). Comprehensive Care for Vulnerable Elderly Veterans during Disasters. Archives of Gerontology and Geriatrics. 56(1): 205-13.

This study examines the experiences of evacuations and sheltering of Veterans Health Administration (VHA) nursing homes (VANHs) during Hurricanes Katrina and Rita. Interviews were conducted with nursing home staff and representatives, which revealed that physical harm, psychological distress, cognitive decline, and increased social isolation were areas that deserved special attention for this vulnerable population.
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Colorado Department of Public Health and Environment. (2014). Long Term Care Emergency Operations Toolkit: For Colorado Nursing Homes and Assisted Living Residences.

This toolkit was developed to assist Colorado nursing homes and assisted living residence providers with the resources and guidelines needed to effectively develop, maintain, and implement an emergency operations plans for all hazards. It provides a template to build a facility emergency operations plan using a hazard vulnerability analysis tool, as well as identifying standard operating guidelines for potential hazards, disasters, and emergencies.
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DeAtley, C., Potter, A., Massey, M., et al. (2011). NHICS: Nursing Home Incident Command System. American Health Care Association.

This document was developed to provide planning and response guidance to nursing homes and other long-term care facilities. It describes the nursing home incident command system, which can be used by facilities regardless of size or resident care capabilities, and is intended to assist with their emergency planning and response efforts for all hazards.
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Dosa, D., Hyer, K., et al. (2012). To Evacuate or Shelter In Place: Implications of Universal Hurricane Evacuation Policies on Nursing Home Residents. Journal of the American Medical Directors Association. 13(2): 190 e1-7.

The objective of this study was to examine the differential morbidity/mortality associated with evacuation versus sheltering in place for nursing home residents exposed to four hurricanes in the Gulf region. The authors discuss their methodology and results of the study.
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Laditka, S.B., Laditka, J.N., et al. (2008). Providing Shelter to Nursing Home Evacuees in Disasters: Lessons from Hurricane Katrina. American Journal of Public Health. 98(7): 1288-93.

The authors examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. Interviews were conducted with nursing home administrators that sheltered evacuees in four states.
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Santa Clara Valley Health and Hospital System, Public Health Department; and Santa Clara County Emergency Medical Services Agency, Allied Healthcare Facilities Work Group. (2007). Emergency Preparedness and Planning Toolkit for Long-Term Care Providers.

This toolkit provides checklists on various long-term care related topics such as, personal preparedness, emergency planning for healthcare facilities, emergency supplies, food supplies, transportation, and pandemic influenza planning and supplies checklists. It also provides tools for hazard and vulnerability analysis, guidance for home healthcare providers, plan templates, guidance for writing memorandum of understanding, evacuation planning considerations, and a list of emergency preparedness courses and training.
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Virginia Department of Health. (2013). Don't Sweat It: Preparing for Disasters in Nursing Homes and Assisted Living Facilities. (Accessed 5/7/2015.)

This video was developed to be an educational tool for staff training on emergency preparedness specific to long-term care facilities. The scenario follows staff as they deal with a major storm that causes a week-long power outage. The video covers topics including preparedness, sheltering in place, and evacuation.
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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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Articles

Deal, B.J., Fountain, R.A., et al. (2006). Challenges and Opportunities of Nursing Care in Special-Needs Shelters. (Abstract only.) Disaster Management and Response. 4(4): 100-5.

This article discusses lessons learned and challenges that were encountered by nurses volunteering in special-needs shelters during Hurricanes Katrina and Rita. It also addresses issues related to human and physical resources, patient care, and confidentiality. Evacuee patients included residents with special needs, and residents of nursing homes and group homes caring for mentally and physically disabled persons.
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Goldstraw, P., Strivens, E., et al. (2012). The Care of Older People during and after Disasters: A Review of The Recent Experiences in Queensland, Australia and Christchurch, New Zealand. Australasian Journal on Ageing. 31(2): 69-71.

The authors of this article discuss the impacts that the cyclone and earthquake that struck Queensland, Australia and Christchurch, New Zealand, respectively, had on the elderly population. They note the importance of geriatrician’s involvement in disaster management. Lessons learned from these disasters and suggestions for mitigation are also provided in this article.
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Hyer, K., Brown, L.M., et al. (2006). Establishing and Refining Hurricane Response Systems for Long-Term Care Facilities. Health Affairs (Millwood). 25(5): w407-11.

In February 2006, the John A. Hartford Foundation funded a long-term care “Hurricane Summit,” sponsored by the Florida Health Care Association. Summit participants included representatives from five Gulf Coast states that sustained hurricane damage during 2005, along with representatives from Georgia, which was a receiving state for hurricane evacuees. Participants evaluated disaster preparedness, response, and recovery for long-term care provider networks and identified gaps that impeded safe resident evacuation and disaster response. Specific areas warranting further attention are presented as lessons learned.
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Hyer, K., Brown, L.M., et al. (2010). Helping Nursing Homes Prepare for Disasters. Health Affairs (Millwood). 29(10): 1961-5.

The John A. Hartford Foundation funded an initiative called Hurricane and Disaster Preparedness for Long-Term Care Facilities as a result of deaths and suffering of older adults in long-term care facilities following Hurricanes Katrina, Rita, and Wilma. The authors of this paper describe the planning, research, and dissemination efforts of the Hartford grantees. This paper also provides insights into successful disaster grant making, noting foundations’ unique flexibility, strategic and long-term view, and ability to be a neutral convener of stakeholders that can help grantees work toward achieving major policy change.
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Guidelines

American Health Care Association. (2013). Ethical Guidelines for the Development of Emergency Plans.

This report is designed to help long-term care facilities develop planning processes that include careful consideration of ethical principles during disasters and emergencies. It provides a guideline for long-term care facilities to use as they review their disaster plans to ensure ethical values and considerations are addressed.
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American Health Care Association. (2014). Emergency Preparedness Requires a Communications Plan.

This document provides guidance to long-term care facilities on developing or modifying emergency preparedness communications procedures.
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American Health Care Association/National Center for Assisted Living. (2015). Emergency Preparedness Guide for Assisted Living. (Member only resource; requires login.)

This is a comprehensive resource that assists American Health Care Association/National Center for Assisted Living members with developing an emergency operations plan, and includes the planning process. It includes templates and numerous other resources. Note: this is resource is for members only.
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Brown, L.M., and Hyer, K. (2008). Psychological First Aid: Field Operations Guide for Nursing Homes. American Health Care Association.

This guidance document provides supportive interventions designed to reduce the initial distress caused by traumatic events and help in the immediate aftermath of a disaster. It addresses the specific emotional needs and concerns of nursing home patients. The guide is intended for nurses, certified nurses' aides, social workers, and other direct-care staff.
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* Centers for Disease Control and Prevention. (2011). Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities. (Accessed 5/7/2015.)

The Centers for Disease Control and Prevention developed this resource to provide guidance for influenza outbreak management in long-term care facilities. It addresses preventing transmission of influenza viruses and other infectious agents within long-term care facilities, with a multi-faceted approach that includes vaccination, testing, infection control, antiviral treatment, and antiviral chemoprophylaxis.
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DeAtley, C., Potter, A., Massey, M., et al. (2011). NHICS: Nursing Home Incident Command System. American Health Care Association.

This document was developed to provide planning and response guidance to nursing homes and other long-term care facilities. It describes the nursing home incident command system, which can be used by facilities regardless of size or resident care capabilities, and is intended to assist with their emergency planning and response efforts for all hazards.
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Brown, L.M., Hyer, K., et al. (2007). A Comparative Study of Laws, Rules, Codes and Other Influences on Nursing Homes’ Disaster Preparedness in the Gulf Coast States. Behavioral Sciences and the Law. 25(5): 655-75.

This article discusses Federal and state laws and regulations that govern disaster preparedness with a particular focus on nursing homes. It highlights gaps in these laws and provides suggestions regarding future disaster planning.
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Pandemic/Epidemic Influenza Planning

American Health Care Association. (2013). Caring for Persons with Dementia during an Influenza Pandemic.

This guide is for non-clinical staff who become involved in direct patient care during an influenza pandemic or other emergency. The document addresses areas of concern for long-term care residents with dementia that may require special attention during an influenza pandemic, along with potential response strategies.
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Amirov, C., Howard, P., and Kohm, C. (2007). Influenza Pandemic Planning: One Organization’s Experience. (Abstract only.) Healthcare Management Forum. 20(1): 16-9.

The authors of this article describe the influenza pandemic planning process that was conducted by a geriatric facility in Toronto, Canada. The facility developed a pandemic plan in order to ensure preparedness for staff, clients, and families.
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Anderson, E., Montgomery, J., et al. (2010). Pandemic Influenza Workbook for Long Term Care Providers. California Association of Health Facilities.

This report provides guidance to long-term providers on what actions to take to protect the health and safety of the staff and residents in their facilities in the event of a pandemic influenza outbreak. The document explains why long-term care providers need to prepare for a pandemic, what they need to do to be prepared, and how they can go about making preparations.
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* Centers for Disease Control and Prevention. (2011). Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities. (Accessed 5/7/2015.)

The Centers for Disease Control and Prevention developed this resource to provide guidance for influenza outbreak management in long-term care facilities. It addresses preventing transmission of influenza viruses and other infectious agents within long-term care facilities, with a multi-faceted approach that includes vaccination, testing, infection control, antiviral treatment, and antiviral chemoprophylaxis.
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Mody, L., and Cinti, S. (2007). Pandemic Influenza Planning in Nursing Homes: Are We Prepared? Journal of the American Geriatrics Society. 55(9): 1431-7.

This authors of this article provide an overview of current recommendations for pandemic preparedness and the potential effect of a pandemic on the nursing home industry. The article highlights the need for collaborative planning and dialogue between nursing homes and various stakeholders already heavily invested in pandemic preparedness.
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Mody, L., Langa, K.M., et al. (2006). Impact of the 2004-2005 Influenza Vaccine Shortage on Immunization Practices in Long-Term Care Facilities. Infection Control and Hospital Epidemiology. 27(4): 383-7.

The objective of this study was to assess the response of long-term care facilities to the 2004-2005 influenza vaccine shortage and the impact on resident and healthcare worker immunization rates.
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* New Jersey Hospital Association. (2010). Planning Today for a Pandemic Tomorrow: A Tool for Nursing Facilities.

This tool is intended to assist nursing healthcare facilities in developing their pandemic preparedness and response plans. It consists of several modules, which are to be used as a guide to facilitate discussion and to ensure that key points related to a specific topic, such as human resources, are identified and addressed in the planning process. It also includes sample policies and procedures.
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Nuno, M., Reichert, T.A., et al. (2008). Protecting Residential Care Facilities from Pandemic Influenza. Proceedings of the National Academies of Science of the United States of America. 105(30): 10625-30.

The authors of this study modeled a residential care facility to determine if conditions exist under which non-pharmaceutical interventions alone might prevent the introduction of a pandemic virus.
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U.S. Department of Health and Human Services, and Centers for Disease Control and Prevention. (n.d.). Long-Term Care and Other Residential Facilities: Pandemic Influenza Planning Checklist. (Accessed 3/22/2017.)

The Centers for Disease Control and Prevention developed this checklist to help long-term care and other residential facilities assess and improve their preparedness for responding to pandemic influenza. It identifies key areas for pandemic influenza planning. Long-term care and other residential facilities can use this checklist to self-assess the strengths and weaknesses of current planning efforts. This tool also provides links to websites with helpful information.
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Plans, Tools, and Templates: Emergency Planning

Centers for Medicare and Medicaid Services. (2007). Emergency Planning Checklist: Recommended Tool for Persons in Long-Term Care Facilities and Their Family Members, Friends, Personal Caregivers, Guardians and Long-Term Care Ombudsmen.

This document is an emergency preparedness checklist for healthcare facility planning.It includes sections for long-term care ombudsmen, and long-term care residents, their family members, friends, personal caregivers, and guardians. Topics include emergency planning, and relocation.
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Centers for Medicare and Medicaid Services. (2013). Emergency Preparedness Checklist: Recommended Tool for Effective Health Care Facility Planning.

This document is an emergency preparedness checklist intended for all healthcare facilities. It can help these facilities, including long-term care facilities, determine their level of preparedness and action steps.
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Centers for Medicare and Medicaid Services, Survey and Certification Group. (2009). Health Care Provider After Action Report/Improvement Plan (AAR/IP).

This resource provides an AAR/IP template and instructions for completion. It is intended to be a user-friendly tool for healthcare providers to document their performance during emergency planning exercises and real emergency events. It is also used to make recommendations for improvements for future performance. The AAR/IP template is modeled after the U.S. Department of Homeland Security’s Homeland and Security Exercise and Evaluation Program (HSEEP) Vol. III AAR/IP, which was issued in February 2007.
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Mackechnie, R. (2012). Community Residential Care Facility: Emergency Operation Plan Checklists for Plan Components. South Carolina Department of Health and Environmental Control.

This document is intended for use by residential care facilities and includes checklists related to evacuation and sheltering, staffing, mass care, and transportation information.
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Washington State. (n.d.). Disaster Preparedness Plan: Template for use in Long Term Care Facilities. (Accessed 5/6/2015.)

This is a template plan intended to be used and completed by long-term care facilities. It provides situations, assumptions, legal authorities, concept of operations, a list of roles and responsibilities, and checklists for various hazards.
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* Wisconsin Department of Health Services. (2017). Long Term Care: Nursing and Skilled Nursing Facilities Toolkit.

This toolkit was prepared to help long term care and skilled nursing facilities in Wisconsin comply with the CMS Emergency Preparedness Rule. It includes tools and templates and links to helpful resources.
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Plans, Tools, and Templates: Evacuation and Shelter-in-Place

Blake, S.C., Howard, D.H., et al. (2012). San Diego's Area Coordinator System: A Disaster Preparedness Model for US Nursing Homes. (Abstract only.) Disaster Medicine and Public Health Preparedness. 6(4): 424-7.

In October 2007, a series of wildfires burned over 500,000 acres in Southern California causing 14 nursing homes to evacuate more than 1,200 residents. In response to this event, nursing home administrators and officials from various healthcare and emergency management agencies in San Diego County collaborated to form a model for nursing home emergency preparedness. The authors of this report describe the model, known as the area coordinator system, and discuss its strengths, limitations, and how it could be replicated in other areas of the country.
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California Association of Health Facilities. (2009). Evacuation Drill For Long-Term Care Facilities.

This guidebook is designed to help long-term care facilities evaluate their preparedness for an evacuation. It contains the materials necessary to conduct a simulated evacuation using a tabletop exercise. The evacuation drill is detailed in four steps, and includes multiple templates and forms.
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California Association of Health Facilities. (2011). Long-Term Care Facility Evacuation: Planning Considerations.

This resource provides suggested emergency operations plan components for the evacuation of long-term care facilities. It includes general and evacuation provisions, and physical plant, re-entry, and other considerations for widespread evacuation.
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California Association of Health Facilities. (2012). Long-Term Care Facility Evacuation Resident Assessment Form for Transport and Destination.

This document is an assessment form for residents of long-term facilities who need to be evacuated and transported in an emergency. It provides information about three levels of care, facility type, transport type, and number of residents.
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Florida Health Care Education and Development Foundation. (2008). National Criteria for Evacuation Decision-Making in Nursing Homes.

This resource provides criteria for evacuation decision-making in nursing homes and is intended to assist administrators and health care professionals determine whether to evacuate or shelter-in-place during disasters. It also includes guidance on the evacuation process.
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Minnesota Department of Health. (2009). Long Term Care Facilities Evacuation Tips.

This webpage provides tips to use when evacuating a long-term care facility, including points on how to keep the evacuation organized, while caring for the patients.
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Minnesota Department of Health. (2011). Long-Term Care Evacuation Job Aid: Threat Assessment and Decision Tool.

This resource includes a decision tool for long-term care facilities to use when assessing the incident to determine whether to evacuate or shelter-in-place. Job Aids are provided for Incident Command and other positions for actions to take during the situational assessment period through recovery. A priority list in which patients should be evacuated is also provided.
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Plans, Tools, and Templates: Hazard Vulnerability Analysis/Risk Assessment

Wisconsin Department of Health Services. (2013). Nursing Home and Assisted Living Residence Hazard and Vulnerability Analysis.

The Wisconsin Department of Health Services tailored the Kaiser Permanente Hazard Vulnerability Analysis Tool for use by nursing homes and assisted living residences. This resource provides a copy of the tailored template for review.
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* Wisconsin Department of Health Services. (2017). Long Term Care: Nursing and Skilled Nursing Facilities Toolkit.

This toolkit was prepared to help long term care and skilled nursing facilities in Wisconsin comply with the CMS Emergency Preparedness Rule. It includes tools and templates and links to helpful resources.
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Studies: Emergency Preparedness

Agency for Healthcare Research and Quality. (2007). Nursing Homes in Public Health Emergencies: Special Needs and Potential Roles.

This document provides the findings of focus groups from five states, in which the emphasis of discussions was disaster preparedness in nursing homes.
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Levinson, D.R. (2012). Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010. U.S. Department of Health and Human Services Office of Inspector General.

In a 2006 report, results indicated that nursing homes that experienced hurricanes lacked many provisions recommended by experts in their emergency plans. In response, the Centers for Medicare & Medicaid Services (CMS) issued guidance checklists for emergency planning of healthcare facilities, long-term care ombudsman programs, and state survey agencies. This study was conducted to assess emergency preparedness and response of nursing homes that experienced disasters from 2007-2010.
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Seale, G. S. (2010). Emergency Preparedness as a Continuous Improvement Cycle: Perspectives from a Postacute Rehabilitation Facility. (Abstract only.) Rehabilitation Psychology. 55(3): 247-54.

The objectives of this study were to describe the iterative process of emergency planning and preparedness as it relates to post-acute rehabilitation facilities. The study focused on facility staff involved in the evacuation and ongoing care post evacuation, and adults with moderate to severe acquired brain injury receiving residential post-acute rehabilitation and long-term care services.
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Studies: Evacuation and Sheltering

Blanchard, G., and Dosa, D. (2009). A Comparison of the Nursing Home Evacuation Experience between Hurricanes Katrina (2005) and Gustav (2008). Journal of American Medical Directors Association. 10(9): 639-43.

The authors of this report discuss their findings from a study in which they conducted telephone surveys with multiple nursing home administrative directors in Louisiana after Hurricanes Katrina and Gustav. The objective was to ascertain whether nursing home facilities were more prepared to evacuate their nursing home facilities for Hurricane Gustav then they were for Hurricane Katrina.
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Brown, L.M., Dosa, D.M., et al. (2012). The Effects of Evacuation on Nursing Home Residents with Dementia. (Abstract only.) American Journal of Alzheimer’s Disease and Other Dementias. 27(6): 406-12.

The authors of this report discuss their findings from research conducted on the effects of evacuation from Hurricane Gustav on residents with severe dementia.
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Castle, N.G. (2008). Nursing Home Evacuation Plans. American Journal of Public Health. 98(7): 1235-40.

The author of this study examined evacuation plans from 2,134 nursing homes and analyzed national data to determine the types of deficiencies cited in their evacuation plans. Data was collected from 1997 to 2005, and the following four citations were specifically examined: written emergency plans, staff training, written evacuation plans, and fire drills.
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Christensen, J.J., Brown, L.M., et al. (2012). A Haven of Last Resort: The Consequences of Evacuating Florida Nursing Home Residents to Nonclinical Buildings. Geriatric Nursing. 33(5): 375-83.

The authors of this study conducted a series of six focus groups with nursing home administrators and directors of nursing who worked in nursing homes during the 2004-2005 Florida hurricane season. The purpose of the focus groups was to explore issues faced by nursing home administrators, nurses, and residents during hurricane evacuations to nonclinical buildings.
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Claver, M., Dobalian, A., et al. (2013). Comprehensive Care for Vulnerable Elderly Veterans during Disasters. Archives of Gerontology and Geriatrics. 56(1): 205-13.

This study examines the experiences of evacuations and sheltering of Veterans Health Administration (VHA) nursing homes (VANHs) during Hurricanes Katrina and Rita. Interviews were conducted with nursing home staff and representatives, which revealed that physical harm, psychological distress, cognitive decline, and increased social isolation were areas that deserved special attention for this vulnerable population.
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Dosa, D., Hyer, K., et al. (2012). To Evacuate or Shelter In Place: Implications of Universal Hurricane Evacuation Policies on Nursing Home Residents. Journal of the American Medical Directors Association. 13(2): 190 e1-7.

The objective of this study was to examine the differential morbidity/mortality associated with evacuation versus sheltering in place for nursing home residents exposed to four hurricanes in the Gulf region. The authors discuss their methodology and results of the study.
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Laditka, S.B., Laditka, J.N., et al. (2008). Providing Shelter to Nursing Home Evacuees in Disasters: Lessons from Hurricane Katrina. American Journal of Public Health. 98(7): 1288-93.

The authors examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. Interviews were conducted with nursing home administrators that sheltered evacuees in four states.
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McGrady, E., Blanke, S.J., et al. (2014). Hospice Patient Evacuation: A Case for Using a Checklist for Safe Disaster Response. (Abstract only.) 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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Nomura, S., Gilmour, S., et al. (2013). Mortality Risk Amongst Nursing Home Residents Evacuated after the Fukushima Nuclear Accident: A Retrospective Cohort Study. PLoS One. 8(3): e60192.

The authors of this study conducted a retrospective cohort survival survey of elderly evacuees after the Fukushima Daiichi Nuclear Plant accident. Results from the study indicate that no meaningful influence of evacuation distance on mortality was observed. However, the first evacuation from the original facility caused significantly higher mortality than subsequent evacuations.
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U.S. Government Accountability Office. (2006). Disaster Preparedness: Limitations in Federal Evacuation Assistance for Health Facilities Should be Addressed.

This report discusses the factors that limit Federal help in evacuating hospitals and nursing homes in emergencies. It also provides recommendations for executive action.
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Studies: Other Specialized Services

Brown, L. M., K. Hyer, et al. (2010). Use of Mental Health Services by Nursing Home Residents After Hurricanes. Psychiatric Services. 61(1): 74-7.

The authors of this report discuss the findings of their study on the evaluation of pre- and post-hurricane mental health service use in Florida nursing homes. Results indicated that although most nursing homes provided some type of mental health service during normal operations, disaster-related mental health services were not routinely provided to residents. The authors also found that receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents.
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Feret, B., and Bratberg, J. (2008). Pharmacist-based Intervention to Prepare Residents of Assisted-Living Facilities for Emergencies. (Abstract only.) Journal of American Pharmacists Association. (2003) 48(6): 780-3.

The objective of this study was to assess views of disaster preparation and readiness of assisted-living residents after a comprehensive program developed and presented by pharmacists on the importance of preparing for an emergency, specifically regarding organizing of medical information.
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Toolkits

California Association of Health Facilities. (n.d.). CAHF Disaster Planning Guide.

This guide was developed to assist long-term care providers to enhance their existing emergency operations plans and procedures. It includes self-assessment tools, checklists, templates, and other resources that can be found across multiple tabs. The information contained in this guide was developed in consideration of the core concepts and guiding principles of the National Incident Management System (NIMS). The Nursing Home Incident Command System (NHICS), a derivative of the Incident Command System, is promoted throughout this guide.
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California Department of Public Health. (n.d.). California Department of Public Health Standards and Guidelines for Healthcare Surge during Emergencies: Long-Term Care Health Facilities Operational Tools. (Accessed 5/5/2015.)

This manual contains tools that assist long-term care facilities in healthcare surge planning for management, delivery of care, and administrative functions. Tools include, but are not limited to the following: self-assessment and hazard vulnerability tools, business continuity plan checklist and template, standard operating procedures template, sample memoranda of understanding, disaster preparedness tool, emergency evacuation decision-making tools, and patient transfer forms.
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Colorado Department of Public Health and Environment. (2014). Long Term Care Emergency Operations Toolkit: For Colorado Nursing Homes and Assisted Living Residences.

This toolkit was developed to assist Colorado nursing homes and assisted living residence providers with the resources and guidelines needed to effectively develop, maintain, and implement an emergency operations plans for all hazards. It provides a template to build a facility emergency operations plan using a hazard vulnerability analysis tool, as well as identifying standard operating guidelines for potential hazards, disasters, and emergencies.
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Minnesota Department of Health. (2012). Minnesota Long-Term Care Preparedness Toolkit.

This toolkit was developed to assist with emergency preparedness planning for individuals requiring long-term care. It can be used by long-term care facility owners, administrators, and staff. This toolkit includes sample templates, forms, and suggested resources to develop and/or enhance facility emergency preparedness plans.
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* New Jersey Hospital Association. (2010). Planning Today for a Pandemic Tomorrow: A Tool for Nursing Facilities.

This tool is intended to assist nursing healthcare facilities in developing their pandemic preparedness and response plans. It consists of several modules, which are to be used as a guide to facilitate discussion and to ensure that key points related to a specific topic, such as human resources, are identified and addressed in the planning process. It also includes sample policies and procedures.
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Santa Clara Valley Health and Hospital System, Public Health Department; and Santa Clara County Emergency Medical Services Agency, Allied Healthcare Facilities Work Group. (2007). Emergency Preparedness and Planning Toolkit for Long-Term Care Providers.

This toolkit provides checklists on various long-term care related topics such as, personal preparedness, emergency planning for healthcare facilities, emergency supplies, food supplies, transportation, and pandemic influenza planning and supplies checklists. It also provides tools for hazard and vulnerability analysis, guidance for home healthcare providers, plan templates, guidance for writing memorandum of understanding, evacuation planning considerations, and a list of emergency preparedness courses and training.
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Trainings

University at Albany, State University of New York, School of Public Health and Health Professions, Center for Public Health Preparedness. (2008). Long-Term Care Facilities: Emergency Preparedness Plans. (Requires free registration.)

This 2 hour course reviews the reasons for planning in long-term care facilities and who should be involved. The course explains the all-hazards model of emergency management planning, and the critical issues involved in preparedness planning.
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Virginia Department of Health. (2013). Don't Sweat It: Preparing for Disasters in Nursing Homes and Assisted Living Facilities. (Accessed 5/7/2015.)

This video was developed to be an educational tool for staff training on emergency preparedness specific to long-term care facilities. The scenario follows staff as they deal with a major storm that causes a week-long power outage. The video covers topics including preparedness, sheltering in place, and evacuation.
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Webinars/Conference Materials

Dolan, J. (2011). The Joplin Tornado: A Long Term Care Perspective. Missouri Health Care Association.

These slides were presented at the 2011 Public Health & Medical Disaster Response in Action: The Joplin Story conference, held November 15-16, 2011 in Omaha, NE. The presentation discusses the impact of the May 22, 2011 tornado on long-term care facilities in Joplin, MO and offers recommendations for disaster preparedness in these facilities going forward.
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Florida Health Care Association. (2007). Caring for Vulnerable Elders during a Disaster: National Findings of the 2007 Nursing Home Hurricane Summit.

The second Southeastern Nursing Home Hurricane Summit was held in St. Petersburg Beach, Florida on May 21-22, 2007. This summary document includes lessons learned, promising practices, experiences, research findings, and guidance on disaster preparedness for elders.
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Howard, D.H., Blake, S.C. (2012). Improving Disaster Planning in Nursing Homes and Home Health Agencies. Centers for Disease Control and Prevention.

This webinar discusses the results of a study conducted by the Emory University Preparedness and Emergency Response Research Center (PERRC). The study examined disaster preparedness in nursing homes and home health agencies, which have typically not been included in disaster planning efforts.
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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.

American Health Care Association/National Center for Assisted Living. Emergency Preparedness.

California Association of Health Facilities. CAHF Disaster Preparedness Program.


Michigan Department of Health and Human Services. Long Term Care Disaster Planning Resources.

The National Long-Term Care Ombudsman Resource Center. Emergency Preparedness.

Virginia Department of Health. Nursing Facility Emergency Preparedness.


This ASPR TRACIE Topic Collection was comprehensively reviewed in May 2015 by the following subject matter experts (listed in alphabetical order): Peggy Connorton, MS, LNFA, Director, Quality and LTC Trend Tracker, American Health Care Association; Kristen Finne, Senior Policy Analyst, HHS/ASPR/OPP/Division of Health System Policy (DHSP); John Hick, MD, HHS ASPR and Hennepin County Medical Center; and Jocelyn Montgomery, RN, PHN, Director of Clinical Affairs, California Association of Health Facilities.

Additional assistance provided by Alicia Livinski, Biomedical Librarian, HHS National Institutes of Health; and James Paturas, Director, Center for Emergency Preparedness and Disaster Response, Yale New Haven Heath System.