Acknowledgements All agency, organization, and participant names were current as April 2010. The following subject matter experts provided input into the development of the Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies: Barbara Citarella RBC Limited John Dwyer Champaign-Urbana (Illinois) Public Health Department Kerry Kernen Summit County (Ohio) Health District Peter Teahen Teahen Funeral Home The following representatives participated in the April 2010 Pandemic Influenza Preparedness and Response in Long-Term Care Facilities and Their Communities Stakeholder Meeting in, which formed the foundation for this document Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies: Kay Aaby Montgomery County (Maryland) Department of Health and Human Services Billy Atkins Austin (Texas) Office of Homeland Security and Emergency Management Patty Benesh Golden Living Sherl Brand Home Care Association of NJ, Inc. Lisa Brown University of South Florida Natasha Brown-Pope Georgia Department of Community Health James Bulot Georgia State Department of Human Services Anna Buchanan Association of State and Territorial Health Officials Denise Burcombe Utah Healthcare Association Deb Burdsall Lutheran Life Communities Bev Campbell Infection Control Consultant, Ottawa, Canada Mary Carr National Association for Home Care Sherri Cassidy The Valley View Center for Nursing Care and Rehabilitation Charles Cefalu Louisiana State University School of Medicine Barbara Citarella RBC Limited James Crouch Region 6 Bio-Terrorism Coordinator Muskegon County (Michigan) Medical Control Authority Tina Danka Presbyterian SeniorCare Paul Drinka Medical College of Wisconsin, Milwaukee Andrew Duncan National Hospice and Palliative Care Organization Theresa Edelstein New Jersey Hospital Association Charles Fahey Fordham University
Adrianne Feinberg Georgia Hospital Association Rob Farmer Delaware County (Ohio) Emergency Medical Services Lowell Feldman Terrace Health Care Center Pat Giorgio Evergreen Estates Joie Glenn New Mexico Association for Home and Hospice Care Cheryl Gray Peninsula, A Division of Parkwest Medical Center Stefan Gravenstein Brown University / Quality Partners of Rhode Island Calvin Groeneweg American Assisted Living Nurses Association Daniel Haimowitz Haimowitz & Scannapieco MDs Kim Herron Ethica Health and Retirement Communities James Hodge, Jr. Sandra Day O'Connor College of Law Aaron Jennings City of Delaware (Ohio) Fire Department Elva Johnson-Pompa Alexian Brothers Behavioral Health Hospital Lori Josefczyk Dunlap Community Hospital Sister Monica Justinger Berger Hospice Kerry Kernen Summit County (Ohio) Health District Aysha Kuhlor National Association Director of Nursing Fergus Laughridge Nevada State Health Division Gerald Lewis Gerald Lewis and Associates Doyle Love Life Care Center of East Ridge / American College of Health Care Administrators Alysia McDonald Georgia Funeral Directors Association, Inc. Connie McDonald MaineGeneral Rehabilitation and Nursing Care Janet McLay City of Tucson (Arizona) Fire Department Jocelyn Montgomery California Association of Health Facilities Tamara Moreland Hospicomm Leigh Murphy Grand Rapids (Michigan) Home for Veterans Adelita Orefice Rhode Island Department of Health Joe Perkins Midwest Health, Inc. LuMarie Polivka-West Florida Health Care Association Bill Pretzer Collaborative Healthcare Urgency Group Sharon Roth-Maguire Horizon Bay Retirement Living Allison Schletzbaum Public Health – Seattle & King County (Washington) Clayton Scott, III Chatham Emergency Management Agency Don Sheldrew Minnesota Department of Health Phillip Smith University of Nebraska Medical Center Christine Snow Lodi Community (Ohio) Hospital Peter Teahen Teahen Funeral Home, Inc. Jo Ellen Warner
National Association of County and City Health Officials Karen Waters Georgia Hospital Association Sarah Wells National Citizens' Coalition for Nursing Home Reform / The National Consumer Voice for Quality Long Term Care Brad Whitacre Superior Air-Ground Ambulance Service Astrid Wistedt Ascension Health Joan Woods Genesis Islander Genesis Health Care Richard Wulfekuhle Buchanan County (Iowa) Emergency Management Janice Zalen American Health Care Association
From whom will you get access to these nonmedical supplies? To be filled in To be filled in 3.3 Resource Management Planning Requirement Answer/Response Person Responsible Due Date Complete? How will you prioritize your facility's or agency's medical resources in terms of critical needs during a public health emergency? To be filled in To be filled in
Protect vital records identified in the plan. To be filled in To be filled in Ensure uninterrupted service of communication systems supporting essential functions. To be filled in To be filled in 3. Facility Operations Planning Requirement Answer/Response Person Responsible Due Date Complete? Ensure uninterrupted utility services and maintenance work. To be filled in To be filled in
Stockpile food and water. To be filled in To be filled in Stockpile the medications and medical supplies identified in the plan. To be filled in To be filled in Stockpile the nonmedical supplies identified in the plan. To be filled in To be filled in
Providers will need to interact on a continuous basis to monitor the mental health of families of residents/patients. To be filled in To be filled in Address cultural issues that arise from implementing crisis standards of care. To be filled in To be filled in Address social issues that arise from implementing crisis standards of care. To be filled in To be filled in
The action plan shown on the following pages follows the same format as the Preplanning section. It provides a compilation of the planning requirements discussed above. Planning requirements are posed as questions, and space is provided for you to write in your answers or responses to the questions. Additional space is provided to list who is responsible for completing each required task and when they are required to complete it. A checkbox allows you to see which tasks have been completed. Upon completion of the planning requirements for this section, you will need to incorporate them into a recovery plan for your facility. This plan in turn will need to be incorporated into your facility's or agency's public health emergency preparedness and response plan.
#6, 2 Directions: For each vital system or equipment identified above, list the location(s) of the system/equipment, maintenance frequency, and any particular methods of protection. If there are no protection methods in place or those in place do not seem sufficient, suggest additional methods in the last column. Location Maintenance Frequency Current Protection Method(s) Recommendations for Additional Protection Method(s) (if necessary) To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in #7, 1 Directions: Make copies of this worksheet before you start, as you will need to complete it for each essential function identified in Worksheet #2. Using the information gathered in the Essential Function Questionnaire Worksheet (Worksheet #1), list those records that are necessary for the continued operation of critical processes or services for fourteen days. Records can be in electronic or paper form. Do not include records that may be useful, but are not essential to performing the service. Also, indicate whether these records are time-critical—needed within 72 hours of an emergency. ESSENTIAL FUNCTION: _____________________________________________________ Vital Record Description Form of Record Time Critical To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in
#7, 2 Directions: For each vital record identified above, list where the records are kept, how often they are backed up or revised, and any particular methods of protection, including security measures. Those vital records that have no protection other than backup or duplicate copies maybe candidates for additional protection measures. Vital Record Storage Location Maintenance Frequency Current Protection Method(s) Recommendations for Additional Protection Method(s) (if necessary) To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in #8 Directions: Review information already gathered on vital systems and equipment for clues on communication systems that support critical processes and services and in turn their associated essential functions. In this chart, list the current vendor and contact information; the services the vendor is currently providing the agency; and any special emergency services the vendor has to offer. Communication Mode Current Provider Services Provided Alternate To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in To be filled in