Emergency Preparedness – Stay Proactive: The Critical Elements and Proactivity

In just a little more than six weeks, five hurricanes have undergone rapid intensification in the Atlantic and eastern Pacific Oceans, and research suggests this could become more common as the world warms from climate change. Not only have our senior-housing community members been impacted, displaced and suffered trauma, our employees and their families have experienced great losses. Hurricane relief is far from ending. Please consider how you can help. The aftermath of these catastrophes and the rebuilding of battered lives will take years. Thank you to Robert Young, International Goodwill Ambassador for Blue Team Restoration, for his co-authorship and insight into proactivity in disaster planning.

Notably, it has been nearly two years since the CMS Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers regulation went into effect. Health care providers and suppliers affected were to comply and implement all regulations one year after the effective date - Nov. 15, 2017. On Sept. 17, 2018, CMS issued a proposed rule impacting a wide range of Medicare providers that includes revisions to the new emergency preparedness regulations. According to a CMS press release, the proposed rule is part of the agency’s efforts to “relieve burden on health care providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for health care facilities.” The emergency preparedness requirements are targeted for rollback even though they were implemented less than a year ago.

The current emergency preparedness provisions represent years of study and review by federal agencies, nursing home providers, emergency preparedness experts, advocates and others following the horrendous impact of Hurricane Katrina on vulnerable and frail nursing home residents. In the preamble to the current regulations, CMS states that the regulations are based on lessons learned from the past and today’s proven best practices. Now, however, CMS is proposing to change the rules based solely on its intent to reduce provider burden.  Despite these rollbacks, senior housing communities cannot ease up on being fully ready when disaster strikes. 

As reported by LiveProcess, only 3 percent of long-term care facilities said they were not ready to meet the requirements of the CMS emergency preparedness rule. The vast majority, 78 percent, described their facilities as somewhat ready, while 19 percent described their facilities as completely prepared. This month, Mr. Young and I will be reviewing the core elements of emergency preparedness and unique ways to be proactive.

The CMS regulations identify Four Core Elements of Emergency Preparedness listed below. Note that the asterisk (*) reflects that there are proposed changes/rollback regulations proposed by CMS in September 2018.

Risk Assessment and Emergency Planning (Included but not limited to):

  • Hazards likely in geographic area

  • Care-related emergencies

  • Equipment and power failures

  • Interruption in communications, including cyber attacks

  • Loss of all/portion of facility

  • Loss of all/portion of supplies

  • Plan is to be reviewed and updated at least annually*

* Proposed Rollback of Emergency Plan: A facility would only be required to review and update its emergency plan every two years rather than annually. The plan is designed to address the hazards identified through a risk assessment. These risks do not remain static and can change quickly. Waiting for two years to update a plan means it is likely to not reflect important changes in both the facility and its environment. Because the plan guides and directs the facility’s response to an emergency or disaster, a flawed, inadequate plan can have catastrophic results for the safety and welfare of residents. In addition, CMS is proposing to eliminate the requirement that the emergency plan include documentation of efforts to contact local, tribal, regional, state and federal emergency preparedness officials and a facility’s participation in collaborative and cooperative planning efforts. These efforts are critical for the emergency plan to succeed, but there is no way to determine if the facility has actually contacted and collaborated with emergency preparedness officials without documentation.

  • Communication Plan

    • Complies with federal and state laws

    • System to contact staff, including patients’ physicians, other necessary persons

    • Well-coordinated within the facility; across health care providers; and with state and local public health departments and emergency management agencies*

* Proposed Rollback of Communication Plan: Nursing homes would be mandated to reexamine their communication plan and bring it up-to-date every two years and not annually as currently required. This communication plan ensures that the facility has a system to contact appropriate staff; attending physicians; other long-term care facilities; federal, state, tribal, regional or local emergency preparedness staff; and others to ensure continuation of resident care.  Because the individuals and entities included in such a plan can change frequently, failure to update the plan every year could result in faulty and inaccurate information, as well as the inability to reach the people/agencies needed to protect resident health and safety in the event of a disaster.

  • Policies and Procedures

    • Complies with federal and state laws*

* Proposed Rollback of Policies and Procedures: The review and update of policies and procedures would be mandated every two years instead of every year. The facility’s policies and procedures support the successful execution of its emergency plan. Many factors can cause policies and procedures to become outdated or ineffective, thereby jeopardizing the facility’s ability to carry out its plan.  A biennial rather than an annual review could easily fail to identify the need for revisions in a timely manner, including changes necessary based on the facility experiencing an emergency or problems during a drill or exercise.

  • Training and Testing *

    • Complies with federal and state laws

    • Maintain and at a minimum, update annually

* Proposed Rollback Training and Testing Program: Similar to the changes noted above, the training and testing program would have to be reviewed and updated every two years and not annually. To be effective, this program must be modified when gaps, problems or areas for improvement are identified. Delaying necessary changes for two years leaves the facility ill-equipped and improperly prepared for an emergency that can arise at any time. In addition, significant turnover rates among both staff and administration in nursing homes raise concerns about staff readiness if emergency preparedness training is extended to every two years.

My recommendantion is to continue annual reviews, testing and training.  Timely planning provides the foundation for effective emergency management.

Robert Young and Blue Team Restoration understand that the response to an emergency can impact an entire community and can involve numerous medical and public health entities, including health care provider systems, public health departments, emergency medical services, medical laboratories, individual health practitioners and medical support services. A coordinated response is essential. 

Mr. Young offered me many insights into comprehensive emergency management, which includes the following phases:

Hazard Identification: Health care providers should make every effort to include any potential hazards that could affect the facility directly or indirectly for the particular area where it is located. Indirect hazards could affect the community but not the provider, and as a result interrupt necessary utilities, supplies or staffing.

Hazard Mitigation: Hazard mitigation is activities taken to eliminate or reduce the probability of the event, or reduce its severity or consequences, either prior to or following a disaster or emergency.

The emergency plan should include mitigation processes for both residents and staff. Mitigation details should address care for the facility residents, and how the facility will educate staff in protecting themselves in the likelihood of an emergency. Comprehensive hazard mitigation efforts, including staff education, will aid in reducing staff vulnerability to potential hazards. These activities precede any imminent or post-impact timeframe and are considered part of the response.

Preparedness: Preparedness includes developing a plan to address how the provider will meet the needs of patients and residents if essential services break down as a result of a disaster. It will be the product of a review of the basic facility information, the hazard analysis and an analysis of the provider's ability to continue providing care and services during an emergency. It also includes training staff on their role in the emergency plan, testing the plan and revising the plan as needed.

Response: Activities immediately before (for an impending threat), during and after a hazard impact to address the immediate and short-term effects of the emergency. Mr. Young offers his insight from 24 years in the disaster recovery industry. From an emergency preparedness perspective, you can never be prepared enough for mother nature or man-made disasters. Technology and foresight for business continuity are the the key factors. Learning the idiosyncrasies of each and every property within every portfolio is critical to the mitigation and business interruption. It is all a part of a proactive risk-management approach. Blue Team Priority Response includes a Pre-Loss Assessment conducted for the community properties. The information is then loaded into a database that overlays those properties and with proprietary weather tracking systems, ownership and property facilities and management are forewarned of impending threats. Whether it be from a hurricane, flooding, wind, hail, wildfires, tornadoes or any other natural disaster, this allows time for communities to be best prepared in these type of events. For example, if  a community is performing work on the exterior of the building and a storm has developed in the Gulf of Mexico or the Atlantic or Pacific Oceans, and the storm can be tracked to find the cone of certainty and where and when it will come into contact properties. Information will automatically populate into the database and will be distributed  directly to those properties. The communities, staff and their residents and families can then prepare for the storm. Blue Team can also allocate the necessary resources to the regions of the country to ensure client coverage on every property. This type of innovative proactivity should be explored for your communities.

Recovery: Activities and programs implemented during and after response that are designed to return the facility to its usual state or a "new normal."

It is essential to be prepared for emergencies and proactively mitigate as much risk as possible. Determine the best plans for your organization and engage staff in training. There are many lessons to be learned from these recent catastrophes, so let’s make sure we respond to these lessons and be prepared. Let me know how we can assist with plan compliance.


The annual, complimentary long-term care conference I host along with Horne Rota and Kaufman Borgeest & Ryan is in its 7th year and not to be missed! Please save the dates April 3-4, 2019 for The National Long-Term Care Defense Summit (love our new conference name!) in Memphis! Education, networking, blues and BBQ! Please contact me for more information and stay tuned for details.


Rebecca Adelman is an entrepreneur, influencer, thought leader and founder of Adelman Law Firm, established in 2001. For nearly 30 years, Rebecca has concentrated her practice in insurance defense and business litigation. The firm’s practice extends through the tri-States of Arkansas, Mississippi and Tennessee. Rebecca’s insurance defense practice includes representation of insurance companies and long‐term care providers and their insurers, both regionally and nationally. She also provides consulting services and educational programming to health care professionals and business associates. She has active practices in the areas of general liability, professional liability and premises and employment law. She is a listed mediator serving all areas of business and health care litigation. Contact Rebecca at rebecca@adelmanfirm.com and visit www.adelmanfirm.com and www.rebeccaadelman.com.


Robert Young is the National Account Executive and International Ambassador for Blue Team Restoration. Blue Team provides progressive solutions on a national basis for remediation, restoration and reconstruction of commercial properties. The core business is providing emergency response, resulting from day-to-day natural events. Blue Team also provides construction services to return the facility back to pre-loss condition. Blue Team takes on capital improvement projects as expansion plans often accompany the rebuilding effort. It also has established a specialized roofing division. Blue Team creates distinct advantages by offering a complete turn-key service with the infrastructure to handle multiple emergencies at catastrophic scale nationwide.  Blue Team serves property owners and operators in the hospitality, senior and health care, commercial office, municipal, and institutional markets. www.blueteamrestoration.com

Rebecca Adelman