Knowledge · Communications · Health Services · Security · Person Centered Care
Emergency Planning for Long Term Care / Seniors Nursing Home Residential-Care-Facilities
Assume that 20 minutes from now, a fire breaks out in a building down the street from your facility. Flames burst from the windows, while black smoke shrouds the neighbourhood. A firefighter appears at your reception desk and says that he might ask you to evacuate your staff and residents shortly, "depending on the toxic fume hazard."
Are you prepared for such an event? Many long term care facilities aren't, despite occasional fire drills and binders crammed with directions from emergency response agencies.
A good emergency plan starts with a summary of the risks that prevail at your facility. Every region has its natural risks, from high winds and winter storms in the Maritimes and Central Canada, to flooding on the Prairies , to earthquakes in British Columbia. Heat waves and freak storms are increasingly common across North America. Any of these risks can lead to property damage, power outages and supply problems for care facilities.
Technological risks include computer failures and data loss, toxic spills, electrical fires and explosions. Contrary to popular opinion, these risks prevail just as often in less populated rural regions as in cities and towns. Technological problems often result from human error. Somebody pushes the wrong button or forgets to push the right one, and the lights go out all over town. Somebody else trips over a cable in the server room, disables an entire network and you lose access to your electronic files, including those pertaining to essential resident care.
While human error is unintentional, some harmful actions are purposeful. These are security risks: theft, sabotage, vandalism and fraud. A thief could steal cash, drugs and residents' valuables. A prankster might leave a bomb threat on your voice mail or hack into your Web site and tamper with its contents. Crooks have been known to get vulnerable care facility residents involved in different kinds of bogus financial schemes. While some neighbourhoods are more secure than others, security risks prevail wherever there are people.
Make a list. What risks threaten your facility? Remember that risks at nearby sites can threaten you directly. For example, an accident on an adjacent roadway could isolate your facility for hours. A fuel spill at the local gas station could lead to an explosion that cuts your power. And then there's the fire in the building down the street that's making your eyes water. Some of your residents are starting to cough. Nearby threats are called proximity risks, and every property manager should be aware of them.
Once you've determined the risks to your facility, consider the best ways to mitigate them. There are always means of dealing with a risk so that it's less likely to disrupt your operations. For example, high winds and severe winter weather may be unavoidable, but if your building has a good preventative maintenance program in place, you'll experience fewer problems from roof leaks and heating problems. If you're concerned about power failures, investigate the feasibility of a backup generator. Ask your staff and residents to report any facility problems promptly. You should be able to mitigate most of your risks to the point where they no longer pose serious threats to your facility.
But occasionally risks turn into emergencies. You need an emergency response plan to deal with the real thing. You don't need a huge binder to tell you how to evacuate your building or restore your power. Often a small brochure containing the standard procedures is more useful than a binder that only a few of your staff members have studied carefully. Besides, you don't want to start leafing through a binder when a fire threatens your facility and the smoke gets in your eyes. As for reviewing emergency response procedures during a power outage, forget it. You'll have other uses for those flashlights -- if you can find them.
You can create a small brochure on your office workstation and reproduce your fire department's advice to meet the specific needs of your facility. You can print separate brochures for staff and residents. You can include handy reminders and space for notes and personal information, including room numbers, addresses, family contacts and the locations of refuge areas and safe gathering sites. Brochures can be designed to fit in a wallet, coin purse or pocket. When they're attractively laid out and contain concise, practical response measures, brochures are ideal tools for emergency orientation and procedural training. They're also much less expensive than those binders.
After an emergency, how can you resume adequate levels of service and restore your administrative operations? Many organizations rely on business resumption (or continuity) plans, which contain solutions to problems that arise after the storm has died down or the fire has been extinguished. Often a resumption plan begins with a damage assessment checklist, which guides you through your facility and points out those areas where different kinds of damage can occur. Has a storm damaged your roof? Here's what to look for: cracks, pools of water, debris from trees and neighbouring structures, broken wires, leaky skylights. Even if you're not a trained property manager, your damage assessment checklist will help you to make a record of any damage to a roof or any other part of your facility's structure.
A key component for any care facility's resumption plan is a strategic alliance program. After an emergency, you might have difficulty in obtaining supplies that in normal circumstances you'd take for granted. What if severe weather puts your usual delivery service out of action for a few days? Fortunately, you've organized an alliance with a local taxi firm, which will pick up medications, groceries and office equipment from suppliers and deliver them to you as soon as possible. Taxis can also serve as couriers and help staff members get to and from your facility if the roads are closed. Taxi companies use radio communications to receive information regarding road closures and other lifeline problems, and are often better prepared to travel in disaster areas than local police and firefighters.
Your residents might be frightened or disoriented by an emergency. To restore their good morale, you should include normalization guidelines in your resumption plan. Getting residents to talk about their experience during an emergency is one way to ease their anxiety. Another is to hold a "closure party," during which staff and residents are served refreshments and given a chance to celebrate the conclusion of events relating to the emergency. Sometimes facilities need trauma counsellors to address an individual's concerns or ongoing fears. But residents are not always disturbed by emergencies. After a fire near a Vancouver care facility that resulted in an evacuation, some residents told their caregivers that they enjoyed the excitement. "It was a nice break from the usual TV game show," said one resident.
Your resumption plan can contain advice concerning alternative sites for residents, a list of post-emergency service priorities, a summary of emergency team activities, and advice regarding the auditing and testing of the plan. Since each care facility is unique, each should have an emergency plan customized to meet its specific needs. A template (or &nbps;cookie-cutter ) plan will not necessarily give you the most effective guidance. It's up to you to ensure that your facility has a plan that takes into account those institutional characteristics that makes it different from a facility in a different part of the country, city or neighbourhood.
You have only three minutes until that fire breaks out down the street and you hear the wail of the sirens. Fortunately this is only an imaginary scenario. But next time it might be the real thing. Isn't it time that you developed a real emergency plan for your facility?
[Article by Guy Robertson - Originally published in July/August 2004 issue of LTC, Long Term Care Assoc. of Ontario magazine]
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