The software that powers HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE

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2 Today s educational presentation is provided by The software that powers HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE sales@kinnser.com

3 About the presenter SHARON HARDER President C3 Advisors, LLC More info: c3advisors.com

4 The Agenda Gaining a basic understanding of the Emergency Preparedness Rules Performing the Risk Assessment Developing Policies and Procedures Implementing the Communication Plan Training and Testing Requirements

5 EMERGENCY PREPAREDNESS 101 The Basics Who? Includes home health agencies and hospices What? Comprehensive program with the four core elements Why? New Condition of Participation When? By November 15, 2017

6 Survey Survival Home Health Agencies and Hospices will be surveyed on compliance with the new conditions Advance Interpretive Guidance SOM Appendix Z Code of Federal Regulations! For hospice 42 CFR ! For home health 42 CFR

7 KEY DEFINITIONS Emergencies vs. Disasters EMERGENCY = A hazard impact causing adverse physical, social, psychological, economic or political effects that challenges the ability to respond rapidly... requiring stepped-up capacity and capability to meet the expected outcome... requiring a change from routine management to incident command. DISASTER = An emergency with greater magnitude, longer duration and generally lower outcomes.

8 KEY DEFINITIONS The EP Program & Plan The EP Program is a comprehensive approach to meeting the health, safety and security needs of the agency s staff, patients and community prior to, during and after an emergency. Every EP Program must contain the four core elements. The Plan is the written framework for the EP Program that is developed based on the risk assessment.

9 KEY DEFINITIONS Risk Assessment Process to assess and document hazards Those that are likely to impact the geographic region or community Those that present gaps and capacity challenges Hazard Vulnerability Analysis

10 KEY DEFINITIONS The All-Hazards Approach The all-hazards methodology requires an integrated approach to EP program planning and development.! Natural and man-made emergencies! Care related! Equipment or power failures! Communication interruptions/cyber-attacks! Loss of facility! Supplies loss of essentials such as food, water

11 KEY DEFINITIONS Training & Testing Full-scale exercises! Multiple agencies or groups involved! Often a mock disaster Table-top exercises TTX! Key staff and other constituents -- simulated scenarios! Utilizes informal assessment of plans, policies and procedures -- identifies gaps that should be addressed

12 Elements of the EP Plan Establishing responsibility for evaluation, ongoing surveillance and annual updates Vulnerability assessments Collaboration opportunities and arrangements Contact lists government agencies, patients, staff, physicians, others Staff education Patient risk assessment and evacuation plans Staff safety and communication protocols call down lists Information and medical records Business continuity plans

13 Step 1 The Risk Assessment Hazard Vulnerability Analysis From: Home Health Emergency Preparedness, Office of Public Health Preparedness, Michigan Department of Health and Human Services,

14 Hazard Vulnerability Analysis Worksheet Identify the hazards that present the highest risk Ice and Snow Extreme Heat Hurricanes Hazards Natural & Man-Made Hazardous Material Accidents Civil Disturbances Terrorist ACacks Floods Earthquake Tornados Nuclear Accidents Mass Casualty Accidents InfecEous/Pandemic Diseases

15 HAZARD VULNERABILITY ANALYSIS Scoring the Risks Measure the probability High, Moderate or Low Risk? Measure the vulnerability and potential disruption High, Moderate or Low Risk? Measure your agency s level of preparation Poor, Fair or Good Each level for each category has a score from 1 to 3 The total score indicates the priority that should be placed on risk assessment and planning

16 HAZARD VULNERABILITY ANALYSIS Identifying the Priorities

17 Service Interruptions Do the same exercise for potential service interruptions Potential Service Interruption Risks Utilities Electricity and Natural Gas Emergency Warning Systems Information EMRs/Medical Records Transportation & Access to Patients Heating/Air Conditioning Communications Internet & Phone Water Failure/Contamination Medical Equipment Failures

18 SERVICE INTERRUPTION Assessment Template Same type of worksheet Same scoring methodology For ideneficaeon of high priority exposure or weaknesses

19 Assessing Patient Risk For home health agencies Needs to be done as a part of the comprehensive assessment For both home health and hospice! How will clinical information and patient care requirements be communicated?! Consider evacuation requirements! Limitations on patient mobility! Limitations on transport of life-saving equipment! Special needs/limitations language barriers, diet, intellectual ability

20 PATIENT RISK LEVELS High Risk Patients No available caregiver or family present patient cannot be left alone for extended periods Bedbound or chair bound patients with physical assistance needs Unable to administer meds self-injections of daily meds Wound care patients who are unable to perform dressing changes Infusion patients IV therapy or feedings

21 PATIENT RISK LEVELS Moderate Risk Patients Patients with assistive devices or stable in the use of medical equipment able to manage for a short period of time Stable with administration of meds Patients with reasonably managed chronic disease Patients for whom a visit can be postponed for up to 3 days without jeopardizing safety

22 PATIENT RISK LEVELS Low Risk Patients Patients with family and/or caregiver support systems in place who can manage for longer than three days Patients with less complicated wound care or other care needs Patients for whom the patient or a caregiver is already managing and administering medications

23 Policies and Procedures E0013 Policies and procedures based on the emergency plan, risk assessment and communication plan Policies and procedures must be updated annually Can be incorporated into the standard manual set, but the agency must be able to demonstrate that they are kept in a central place

24 Policy Statements Patient subsistence needs in case of an emergency Preservation and sharing of medical records Arrangements with other providers Staff safety, tracking and call down lists Communication with local and state agencies Comprehensive assessment of individual patient emergency planning (home health only) Patient evacuation plans and sheltering (hospice only)

25 Communications Planning Written plan for emergency communications Must address alternate measures for communication among staff, agencies and facilities that would receive patients The plan must specifically include:! Staff names and contact information with primary/alternate communication plans! Identification of organizations providing services under arrangement! Patient physician names and contact information! Facility names and contacts! Volunteer names and contact information! Contact information for assistance sources Fed, State, Local agencies

26 COMMUNICATIONS PLAN Sharing Medical Information Plan for sharing medical record information to ensure continuity of care Must include the means for sharing information about the general condition and location of patients

27 EP Training Training plans must specifically address each one of the agency s identified risks The training plan must be written and must extend to all staff members at least one training each year The training plan must have a means of demonstrating staff knowledge and retention Training must be rooted in applicable policies/procedures and how they will be implemented

28 EP Testing Requirements The agency must conduct at least one full-scale exercise annually When community-based testing is not feasible and individual full-scale test can be substituted An additional exercise must be done and can include a table-top exercise led by a facilitator with clinically relevant emergency scenarios

29 SURVEY READINESS E-Tags to Know E-Tag HHA Hospice Tag Requirement E-0001 Y Y Establishment of the Emergency Program (EP) E-0004 Y Y Develop and Maintain the EP Program E-0006 Y Y Maintain Annual EP Updates Risk Assmnt w/all hazards + strategies for addressing emergency events E-0007 Y Y EP Program Patient Population Types of emergency services, continuity of operations, delegation of authority and succession planning E-0009 Y Y Process for Collaboration Coordination and collaboration with local, tribal, regional, State and Federal emergency officials/offices E-0013 Y Y Development of EP Policies and Procedures Based on the overall plan, risk assessment and communications plans with at least annual review E-0015 N Y Subsistence Needs for Staff and Patients Food, water, medical supplies, meds, alternate energy sources for maintaining temperature, lighting, fire detection systems, sewage and waste disposal

30 SURVEY READINESS E-Tags to Know E-Tag HHA Hospice Tag Requirement E-0016 N Y Hospice Procedures for Follow Up Procedures for following up with onduty staff to determine services needed with plans for notifying officials regarding staff who are unable to be located E-0017 Y N Comprehensive Assessment During a Disaster Individualized plans for patients during a disaster must be conducted as a part of the comprehensive assessment according to including a plan to be kept with the patient E-0018 N Y Procedure for Tracking Staff and Patients System to track location of onduty staff and patients who may be relocated with documentation of the name and location of receiving facilities or other locations to which patients are transported E-0019 Y Y Policies and Procedures for Risk Assessment Procedures for informing emergency officials about homebound patients who may be in need of evacuation due to medical or psychiatric conditions or their home environment

31 SURVEY READINESS E-Tags to Know E-Tag HHA Hospice Tag Requirement E-0020 N Y Policies and Procedures for Evacuation Procedures to address consideration of care and treatment needs of patients, staff responsibilities, transportation, evacuation locations, communications and external sources of assistance E-0021 Y N Procedures for Follow Up Procedure for following up with on-duty staff and patients to determine needed services including protocols for informing State and local officials of any on-duty staff or patients who could not be contacted E-0022 N Y Policies and Procedures for Sheltering Policy to address the means through which patients, staff and volunteers can shelter in place E-0023 Y Y Policies and Procedures for Medical Documents A system of medical documentation that will preserve patient information, protect patient confidentiality and ensures availability of records

32 SURVEY READINESS E-Tags to Know E-Tag HHA Hospice Tag Requirement E-0024 Y N Policies and Procedures for Volunteers Policies for use of volunteers in an emergency or for emergency staffing needs including the process and role for integration of State and Federal health professionals for surge needs E-0025 N Y Policies and Procedures for Arrangements with Others Development of arrangements with other facilities for receiving patients due to limitation or cessation of operations to maintain continuity of care E-0026 N Y Roles under Waiver Role under a waiver declared by the Secy of HHS for provision of care and treatment at an alternate site E-0029 Y Y Development of Communication Plan E-0030 Y Y Names and Contact Information Names and contact information for staff, entities providing services under arrangement, patient physicians, other organizations, volunteers

33 SURVEY READINESS E-Tags to Know E-Tag HHA Hospice Tag Requirement E-0031 Y Y Emergency Officials Contact Information Contact information or all Federal, State, Tribal, regional and local emergency preparedness offices E-0032 Y Y Primary/Alternate Means of Communication Primary and alternate means for communication with staff and Federal, State, Tribal, local and regional emergency management agencies E-0033 Y Y Methods for Sharing Information Sharing medical documentation for patients with other health providers to maintain continuity of care E-0034 Y Y Sharing Information on Occupancy Needs Procedure for providing information about occupancy needs and ability to provide assistance to jurisdictional authorities or their designee(s) E-0036 Y Y Emergency Prep Training and Testing Development of a training and testing program based on the emergency plan, agency policies/ procedures and the communication plan

34 SURVEY READINESS E-Tags to Know E-Tag HHA Hospice Tag Requirement E-0037 Y Y Training Program Development of a training program to familiarize existing and new staff with the emergency plan and policies with demonstration of staff knowledge retention E-0039 Y Y Emergency Prep Testing Requirements Annual testing plans including full-scale and table top testing exercises E-0042 Y Y Integrated Health Systems Coordination of emergency planning for integrated health systems (does not apply to free-standing agencies)

35 In Closing... Remember that your agency must be ready by November 15 th. Perform the risk assessment using an easy to use template. Develop your plan based on the risk assessment results. Make sure that your policies and procedures address the E-Tag requirements that are applicable to your agency. Develop and document the communication plan. Make sure that the elements of the emergency plan are tested and that the testing process is documented. Train the staff.

36 Kinnser is software for better post-acute care. HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE 4,500 + Agency Customers 49% Faster Documentation 27% More Productive 52% Faster Billing 33% Less Expense sales@kinnser.com

37 Request a demo of the Kinnser solutions that will help your agency succeed kinnser.com/requestademo OR use the Chat window during the webinar! sales@kinnser.com