2013 Biennial Survey of Long-Term Care Facilities - RESIDENTIAL CARE FACILITIES 1/1/ /31/2013

Transcription

1 2013 Biennial Survey of Long-Term Care Facilities - RESIDENTIAL CARE FACILITIES 1/1/ /31/2013

2 April 2014 Dear Administrator, The Ohio Department of Aging has once again contracted with the Scripps Gerontology Center at Miami University to conduct the Ohio Biennial Survey of Long-Term Care Facilities. Participation in this survey is mandated for all nursing homes and residential care facilities by Section of the Ohio Revised Code. Beyond the statutory mandate for the survey, we wanted you to know how important and useful the survey results are. Data that you provide by completing the survey questionnaire are used for, among other purposes, continuing the longitudinal study of long-term care utilization in Ohio. We have found that data from the survey are used by the General Assembly, state agencies, and long-term care facilities themselves. We need your assistance to continue this important effort. If you are interested in findings from previous surveys, you may view the most recent report on the Scripps Gerontology Center website at: Thank you for taking the time to complete the Biennial Survey. This survey provides the only source of information for every facility in Ohio - your participation is extremely important. Sincerely, Bonnie Kantor-Burman Director, Ohio Department of Aging

3 Dear Colleagues, The Biennial Survey of Long-Term Care Facilities is again being conducted by the Scripps Gerontology Center at Miami University. Again, this year s survey has been streamlined in an effort to make it easier for you to complete and is done online. Scripps has collected and used these data to track the changes underway in the field of long-term care. Results from the study are communicated to long term care facilities by Scripps researchers through written reports and through presentations at our association meetings. We believe that good information places providers, industry representatives, and policy makers in a better position to make good decisions about skilled nursing facilities and residential care facilities. We strongly support these data-gathering and analysis activities and feel they are highly beneficial to a better understanding of our profession, by policy makers, and the general public. We urge you to complete this important and mandated survey within the next two weeks. Sincerely, Steve R. Wermuth LeadingAge Ohio Peter Van Runkle Ohio Health Care Association Jean Thompson Ohio Assisted Living Association Chris Murray The Academy of Senior Health Sciences, Inc.

4 Instructions ****Please complete your survey by May 27, 2014**** -Use information from the calendar year 2013 to complete this survey. -If your organization has both a licensed nursing home and a residential care facility, your organization will receive one survey for the nursing home and another for the RCF. Complete this survey based on information from the RCF only. -You may save your partially completed survey and return to it another time by choosing Save Responses at the bottom of the page where you end your work. Return to your survey from the link in your invitation and log in with your password, which can be found in your invitation. -If you are using a HIPAA compliant connection or your web browser has a time-out feature, you may be logged off after a period of inactivity. Save your work often so you do not lose it. -Use the Back and Next buttons at the bottom of the page to move through the survey, not the buttons on your browser. If you use the back or forward buttons in your browser, you may be disconnected from the survey and will lose your work. -You may print your responses at any time by choosing the Print responses button on the bottom of the screen. When you choose "Print responses" a new page will appear with the entire survey displayed. You will need to allow pop-ups in your browser in order to see the screen to print your survey responses. Do not choose Submit until you have completed all work on your survey, printed a copy (if desired) and are ready to leave the survey. If you submit the survey before you are finished we will have to reset your survey and your work will be lost. -If you choose to complete a paper version of the survey or want a paper copy to use as a worksheet, please print the PDF version of the survey found here: You may mail your survey to: Biennial Survey of LTC Facilities Scripps Gerontology Center Miami University Oxford, OH If you have any questions about this survey, please call or Scripps Gerontology Center biennialltcsurvey@miamioh.edu ****Please complete your survey by May 27, 2014****

5 If any of the following information is not correct, please overwrite it with the correct information. Q1 Name of Facility as it appeared on your license December 31, 2013 Q2 Did this name change during 2013? Yes No Q3 Mailing Address Q4 City Q5 State Q6 Zip Q7 County Q8 Facility address (General facility or administrator if no general ) Q9 Phone number

6 Q10 Does the facility have a physical address that is different from your mailing address? Yes No

7 Q11 Physical Address (if different from mailing address) Q12 City Q13 State Q14 Zip If we have questions about your survey responses, whom should we contact? Q15 Contact Name Q16 Contact Title Q17 Contact Phone Number Q18 Contact Q19 Did your facility change ownership or operator during 2013? Ownership Operator No change

8 Q20 You indicated that your facility's name changed during Please enter the previous name. You checked a facility ownership or operator change during If you have resident census records about your facility for only part of 2013, please provide the dates for which you have information. Q21 From: mm-dd-yy Q22 To: mm-dd-yy Q23 Ownership (check appropriate category): Not-for-profit For-profit Government

9 Q24 Q25 Is your facility's parent organization traded on a stock exchange? Yes No Is your residential care facility owned or leased by a multi-facility organization? (Two or more RCFs in different locations.) Yes No

10 Q26 How many RCFs (including yours) are there in your company in Ohio? Q27 How many RCFs (including yours) are there nationally? Q28 Is your facility part of a Continuing Care Retirement Community? (For our purposes, a CCRC has independent living and assisted living/residential care facility along with the nursing home on the same campus.) Yes No

11 Residential Care in a CCRC Q29 Currently, how many independent living units are there in your CCRC? Q30 How many independent living units are currently occupied in your CCRC? Q31 How many independent living units were in your CCRC at the end of 2013? Q32 How many independent living units were occupied at the end of 2013? Q33 Is your facility a free-standing (i.e. only RCF beds at your location) residential care facility? Yes No

12 Q34 Does your organization have both nursing home beds and residential care at this location? Yes No Residential Care Facility Occupancy Because the number of licensed beds in residential care facilities is often many more than the actual number of residents the facility intends to house, occupancy trends in residential care facilities have been difficult to track. The following questions will be used to calculate the occupancy rate for your facility. Q35 How many residents are you licensed to care for as of 12/31/2013? Q36 How many RCF units/apts. were in your facility as of 12/31/2013? Q37 How many RCF units/apts. were occupied as of 12/31/2013? Q38 Did your facility have any units/apts. out of service in 2013? (By out of service we mean closed for renovation or otherwise unavailable to residents.) Yes No

13 Please describe the extent of out-of-service units and days in Q39 During 2013, how many units were out of service at any time? Q40 During 2013, how many total days were units out of service (i.e. if one unit was out of service for 10 days and another for 30 days, then the total days out of service is 40) Please complete the following chart regarding your average monthly RCF number of residents. Do not include residents in other levels of care. If a resident is out of the facility (vacation, hospital) but their unit is being paid for, include them in your monthly census. Average Monthly Census Q41 January 2013 Q42 February 2013 Q43 March 2013 Q44 April 2013 Q45 May 2013 Q46 June 2013 Q47 July 2013 Q48 August 2013 Q49 September 2013 Q50 October 2013 Q51 November 2013 Q52 December 2013

14 Resident Payment Source What payment sources were accepted by your facility during 2013? Please enter a percentage of total residents during the year (no percent sign, only enter whole numbers) for each payment source. Enter 0 if no residents had this as a payment source during Questions 53 through 59 should add up to 100%. Q53 What percentage of your residents had private pay as their primary payment source? Q54 What percentage of your residents had the Medicaid Assisted Living Waiver as their primary payment source? Q55 What percentage of your residents had County DD Authority as their primary payment source? Q56 What percentage of your residents had County Behavioral Health Authority as their primary payment source? Q57 What percentage of your residents had Veteran's Administration as their primary payment source? Q58 What percentage of your residents had long-term care insurance as their primary payment source? Q59 What percentage of your residents used other funds as their primary payment source?

15 Q60 You indicated other payment source(s). Please describe: Your total percentage of residents by payment sources is {V2}%. This is not 100%. Please click the "Back" button to re-enter your payment source percentages.

16 Q61 What percentage of your residents had long-term care insurance as any (both primary and secondary) part of their payment?

17 Resident Admissions and Discharges Q62 How many new residents were admitted to your facility during 2013? (Do not count as a new admission those residents who returned to your facility while still having their room held or were paying monthly fees/rent.)

18 Of these {Q62} 2013 move-ins, how many residents came from each of the places below? If no residents came from a place listed below, mark zero "0". Q63 The community (include independent living in this or another retirement community/ccrc) Q64 Another assisted living/rcf facility Q65 A nursing home independent of this RCF Q66 A nursing home associated with this RCF Q67 A hospital Q68 Other

19 Q69 You indicated admissions from other places. Please describe:

20 You indicated {Q62} residents were admitted, and {V3} came from different places. These numbers are different. Please go back and correct them on the previous page.

21 Q70 How many residents permanently left your facility during 2013? (Include deaths) Of the {Q70} discharges in 2013, how many residents moved out of your RCF to go to each of the places below? If no residents went to a place below, mark zero "0".: Q71 Q72 The community (include independent living in this or another retirement community/ccrc) Another assisted living/rcf facility Q73 A nursing home outside this facility Q74 A nursing home associated with this facility Q75 A hospital Q76 Q77 Discharge due to death (Include deaths at the hospital if residents were still having their units/apts. held) Other discharge places You indicated {Q70} residents left your facility, and {V4} went to different places. These numbers do not match. Please go back and correct them on the previous page.

22 Q78 You indicated other discharge places. Please describe: Q79 Of the {V1} discharges to nursing homes in 2013, how many were due to residents' skilled nursing care needs? Q80 Of the {V1} discharges to nursing homes in 2013, how many were due to residents' high memory care/dementia needs?

23 Facility Rates Of the {Q36} units/apts. in your facility, provide the number of units of each type as of December 31, Q81 Number of: One room, private bath units in facility Q82 Number of: One bedroom units (has separate rooms for sleeping, cooking/sitting, and bathing) in facility Q83 Number of: Two bedroom units (has 2 separate rooms for sleeping, 1 cooking/sitting, and bathing) in facility Q84 Number of: Private units/rooms with shared bath in facility Q85 Number of: Semi-private units/rooms with shared or private bath in facility Q86 Number of: Rooms with 3 or more beds, with shared or private bath in facility Q87 Number of other units in facility Q88 Other type of units. Please describe:

24 Your total number of units, according to type, is {V5}. This is not the same as your total number of units, {Q36}, stated previously. Please go back and correct your number of units by type of unit.

25 Q89 Do you have a memory support/dementia unit? Yes No Q90 How many apts./rooms are in your memory support/dementia unit? Q91 What is the average monthly total charge for residents in the memory unit? Please enter numbers only (no dollar signs, commas, or decimal points) rounded to the nearest whole number. Q92 Excluding memory care, what is the average monthly private pay total charge for residents in private units? (Include average cost of services plus the average base rates among different types of private units). Please enter numbers only (no dollar signs, commas, or decimal points) rounded to the nearest whole number. Q93 Excluding memory care, what is the average monthly private pay total charge for residents in semiprivate units? (Include average cost of services plus the average base rates among different types of private units). Please enter numbers only (no dollar signs, commas, or decimal points) rounded to the nearest whole number.

26 Assisted Living Q94 Do at least some of your units/apts. have the following features? (Check all that apply) Single occupancy Lockable by resident In-unit bathroom with toilet, sink, and shower or tub In-unit bathroom with toilet and sink (no shower or tub) Identifiable in-unit space for socialization (e.g. space for a visitor) Stove or cooktop (at least in some units) Refrigerator (at least in some units)

27 Q95 Q96 In your marketing and promotional materials, do you refer to your facility as assisted living? Yes No Are you participating in the Assisted Living Waiver Program? Yes No

28 Q97 Do you enroll an individual in the AL waiver based on presumptive eligibility for Medicaid? Yes No Q98 To what extent do you perceive the following are barriers to your RCF's participation in the Assisted Living Waiver Program? Client assessment process Client enrollment process Length of client Medicaid eligibility determination process Facility Medicaid waiver certification process Nurse staffing requirement Adequacy of reimbursement rate Adequacy of Room and Board rate Current occupancy levels Compatibility of frail Medicaid residents with the type of residents already served Not a barrier at all A little bit of a barrier Somewhat of a barrier A major barrier A large enough barrier to hinder participation Not familiar with this aspect of the waiver

29 Q99 To what extent do you perceive the following are barriers to your facility's participation in the Assisted Living Waiver Program? (cont'd) Not a barrier at all Additional agency oversight by Ohio Department of Aging Additional agency oversight by local Area Agency on Aging Lack of evidence/history of program success Completion of application process Length of time to become certified as a provider Your facility's capacity to provide nursing services Your facility's capacity to provide medication administration Your facility's capacity to provide things such as special diets Your facility's ability to collect room and board from residents Your facility's need to "subsidize" Medicaid residents with fees from other residents Lack of Medicaid payment for temporary absence days (no bedholds) Transition of AL Waiver to MyCare Ohio A little bit of a barrier Somewhat of a barrier A major barrier A large enough barrier to hinder participation Not familiar with this aspect of the waiver Q100 Other (Please describe)

30 Q101 What changes would improve the AL waiver program? Q102 What changes would encourage your facility, or assisted living facilities in general, to become certified to participate in the assisted living waiver, if your facility has not already done so? Q103 How many total residents were in your facility s Assisted Living Waiver on December 31, 2013?

31 Q104 How many of these {Q103} Assisted Living waiver residents were previously private-pay residents in your facility? Q105 Please rate your local Area Agency on Aging on the following aspects of the Assisted Living Waiver process: Assistance with the waiver provider certification process Case manager's assistance with resident enrollment Ongoing case management monitoring and assistance Very Good Good Poor Very Poor Q106 Anything else we should know about your experience with the Area Agency on Aging?

32 Employee Safety This section provides aggregate information regarding the extent to which employee injuries are an issue for Residential Care Facilities in Ohio. Please report the following summary values from the OSHA Form 300A that you file in the first quarter of 2014 if it includes information only for your RCF. Letters and numbers in ( ) refer to the item on OSHA Form 300A. If you file another similar form, please provide comparable information here. Include only information for staff in your RCF. Aggregate Employment Information for 2013 Q107 Total number of RCF employees paid in all pay periods. (Include part-time, contract, and any other paid staff. Round to the highest whole number). Q108 Total hours worked by all RCF employees last year - sum of hours paid in all pay periods. Number of cases Q109 Total number of RCF employee injuries with days away from work (H). Q110 Total number of RCF employee injuries with job transfer or restriction (I). Q111 Total number of other recordable cases (J). (Recordable cases as defined by OSHA on Form 300A include work-related injuries and illnesses that result in death, loss of consciousness, days away from work, restricted work activity or job transfer, or medical treatment beyond first aid.) Number of cases Q112 Total number of days away from work (K). Q113 Total number of days of job transfer or restriction (L).

33 Injuries and Illness Types Q114 Total number of injuries (1). Q115 Total number of other illnesses (2-6). (Recordable cases as defined by OSHA on Form 300A include work-related injuries and illnesses that result in death, loss of consciousness, days away from work, restricted work activity or job transfer, or medical treatment beyond first aid.) Q116 Does your facility have a written policy about lifting residents? Yes No

34 Facility Staffing Q117 What pay schedule is used for the majority of your employees? a. Monthly b. Semi-monthly (e.g. 15th and 31st) c. Bi-weekly (e.g. every other Friday) d. Weekly (e.g. every Friday) Q118 What is the minimum number of hours worked per pay period to be considered full-time? Report the total number of hours worked by employees in your facility in each category for the first payroll period in RNs in the RCF Q119 Total RN hours (Include all hours during the pay period worked by full-time, part-time, and other RNs employed by your facility - not contract hours) Q120 Total RN contract hours (Include contract, agency, contingent or other "as needed" RNs) LPNs in the RCF Q121 Total LPN hours (Include all hours during the pay period worked by full-time, part-time, and other LPNs employed by your facility - not contract hours) Q122 Total LPN contract hours (Include contract, agency, contingent or other "as needed" LPNs) Other direct care frontline staff (e.g. Personal Care Aides, Resident Assistants, Medication Aides, STNAs) Q123 Total direct care staff hours (Include all hours during the pay period worked by full-time, part-time, and other direct care staff employed by your facility - not contract hours Q124 Total contract aide hours (Include contract, agency, contingent or other "as needed" aides)

35 Social Service Staff Q125 Do you have a licensed social worker on your staff? Yes No Q126 Total hours worked by all full-time, part-time and other social service staff employed AND contracted by your facility. Facility Leadership Q127 Do you have a Director of Nursing in your RCF? Yes No Q128 Is the administrator a licensed nursing home administrator? Yes No

36 Resident Functioning Previous questions asked you to report on Use information about your current residents to complete the following questions. Q129 How many residents currently reside in your RCF? How many current residents received assistance in the previous week with the following? Q130 Bathing Q131 Dressing Q132 Walking Q133 Transferring (e.g. bed to chair) Q134 Toileting Q135 Eating Q136 Medication assisting by an aide (e.g. opening bottles, reminders, but NOT administering) Q137 Medication administration by a licensed nurse Q138 How many need assistance with 2 or more of the activities above or require extensive monitoring or supervision due to cognitive impairments?

37 Q139 How many current residents use a mobility device (e.g. walker, wheelchair, or scooter)? Q140 How many current residents usually exhibit moderate to severe cognitive impairment (make poor decisions, require extensive supervision, or never/rarely make decisions about their daily lives)? Q141 How many current residents receive part-time exempted skilled care in your RCF? (i.e. dressing changes, medication administration, and supervision of special diets) Q142 How many current residents receive skilled nursing care through a home health agency? Q143 How many current residents receive hospice services? Q144 How many current residents have behavior issues (e.g. socially inappropriate behavior, verbally or physically abusive)

38 Q145 How many current residents have behavioral issues as a result of diagnosed mental illness? Q146 How many current residents have behavioral issues as a result of dementia? Q147 How many current residents have behavioral issues as a result of other medical issues? How many residents reside in a designated behavioral health unit of the following types? Q148 Secured Q149 Unsecured Q150 How many current residents receive short-term respite care?

39 Younger Residents in RCF Q151 Do you accept residents under age 50? Yes No Q152 How many residents are under age 50? Q153 Younger residents often pose service challenges since most facility-based settings predominantly serve older adults. To what extent are each of the areas below a challenge in serving your younger residents? Not a challenge at all A little bit of a challenge Somewhat challenging A major challenge Meeting dietary preferences Needs for privacy Use of cell phones and Internet access Type of preferred activities Number of activities desired Adapting activities for conditions such as TBI, quadriplegia or mental health diagnoses Meeting psychosocial/emotional needs Addressing behavioral health needs Training staff to care for conditions common among younger residents Maintaining appropriate relationships among sameage staff and residents Other Q154 You indicated other areas. Please describe:

40 Q155 What other issues are important when serving younger residents in facility-based settings?

41 Care Integration Q156 Are you working on any programs to reduce hospital readmissions or admissions? Yes No Q157 To what extent are each of the following entities your partners in integrating care in your community. For example, working on care transitions or reducing hospitalizations? Check all partnership agreements/arrangements that apply. Individual physician(s) or physician practice(s) Do not work with this group Formal partnership such as memo of understanding, contract, business partnership Informal Partnership Individual hospitals Hospital or health care system Local or regional hospital council/consortium Health information exchange/electronic health record consortium Accountable Care Organization(s) Private-market network/consortium of providers Local community care coordination coalition Medicaid managed care organization Medicare advantage organization Area Agency on Aging Other nursing home(s) Assisted living facility(s) Home care agencies Veteran s Administration (home care services contracts, VA medical centers) Other partner Q158 You indicated other partner. Please describe:

42 Q159 For each activity described below, please indicate the extent to which you and/or your network of partners has it in place to assist with reducing hospital readmissions and avoidable admissions? Developed a clear understanding of new healthcare regulations and initiatives Chose or developed an evidence-based practice model Determined which post-acute services would be offered in our facility Hired new personnel or retrained current staff to implement new program(s) Developed strategies for effective communication of patient information among providers Developed common assessment tools, data elements, or tools for patient information Developed/purchased technology or record systems for access across multiple providers Determined payment approach-e.g. risk -based payments, bundled payments Established new billing strategy or system Developed tools for monitoring patient outcomes Developed marketing and advertising plan for new networks/partnership Developed a plan for measuring/ensuring quality Treated patients/residents under this new model of care Do not plan to work on this Plan to work on this but have not begun Have begun working on this but have not completed the activity Have completed the activity or implemented the practice Q160 Please check which specific care transitions model(s )your program is based on, if any. (Check all that apply) Care Transition Intervention (CTI) (Coleman Model) Bridging Nursing Support/Transitional Care Model (Naylor Model) Better Outcomes for Older Adults Through Safe Transitions (BOOST) Best Practices Intervention Package (BPIP): Transitional Care Coordination Interventions to Reduce Acute Care Transfers (INTERACT) Guided Care GRACE - Geriatric Resources for Assessment and Care of Elders (Steven Counsell s model) Transferring Care at the Bedside (TCAB) Re-engineered Discharge (RED) Enhanced Discharge Planning Program (EDPP-Rush Bridge Program) Our program is not based on any of these models; ours is a hybrid of these models or newly developed for us Don't know

43 Q161 To what extent are the following issues challenges or barriers to collaborative efforts with acute care and other long-term care providers in order to reduce hospital readmissions and avoidable admissions? Lack of a common language Lack of common understanding of proposed programs/services Differences in technology availability between our facility and acute care providers Resistance of hospital/health care staff to working with RCFs Additional funds to implement changes/plans( e.g. new staff, new EMR system) Lack of time to implement changes/make new plans Establishing fair and sufficient reimbursement rates Establishing new billing methods/systems Confusion with billing and bundled payments Unwillingness of our health care partners to take financial risk Competition within the healthcare community Slow, inconsistent or unreliable payment Not a barrier Little bit of a barrier Somewha t of a barrier Major barrier Enough to stop efforts Not familiar with the issue

44 Q162 To what extent are the following issues challenges or barriers to collaborative efforts with acute care and other long-term care providers in order to reduce hospital readmissions and avoidable admissions? Competition within the long-term care community Health care system expectations regarding our RCF s financial resources Unwillingness of our own facility/board or corporate office to take financial risk Our facility s lack of expertise with outreach and marketing to acute care patients Attitudes of health care professionals towards RCFs and/or our facility Attitudes of our RCF staff toward health care community Lack of clarity regarding division of labor between our facility and other partners Determining leadership within the partnership Lack of clarity regarding program accountability Legal issues/agreements that will be needed Not a barrier Little bit of a barrier Somewha t of a barrier Major barrier Enough to stop efforts Not familiar with the issue Lack of data sharing Resources required for new training of staff Lack of physical facilities to accommodate acute care needs Other challenges or barriers Q163 You indicated other challenges. Please describe:

45 Emergency Issues and Planning The next section addresses some of the physical characteristics and the location of your facility. Q164 What is your facility s primary energy source for heating? Geo-thermal Electricity Natural Gas Propane (LPG) Other Q165 You indicated other energy source. Please describe: Q166 Does your facility have a back-up generator? Yes No Q167 What is the primary fuel source for the back-up generator? If your generator runs on multiple types of fuel, check all that apply. Gasoline Diesel fuel Propane (LPG) Natural Gas Q168 How many days supply of generator fuel do you have on hand? If you are not sure, mark "DK" (don't know) in the box. Q169 Is your facility located in a floodplain? Yes No Not sure

46 Q170 Is your facility located in an emergency planning zone around a nuclear power plant or other industrial facility? Yes No Not sure Q171 Is your facility located within ½ mile of actively-used railroad tracks? Yes No Not sure

47 The next questions address issues related to emergency planning and management in your facility. For how many days does your facility store an emergency supply of each of the items below? If you aren t sure, mark DK in the box. If you do not have emergency stores, mark 0. Q172 A supply of bottled water: Q173 Extra medical supplies and equipment: Q174 Extra pharmacy stocks of common medications: Q175 Non-perishable foods: Q176 Other emergency stocks: Q177 You indicated other emergency stocks. Please describe:

48 Q178 Place a check next to each area below that is included in your facility s emergency plan. We do not have an emergency plan Plans specific to freezing temperatures/loss of heat Plans specific to extreme heat/loss of air conditioning Plans specific to impassable roads (e.g. snowbound, flood) Plans specific to facility flooding Plans specific to facility fire Plans specific to wildfire Plans specific to tornado/windstorm Plans specific to extended loss of power Requirements for sufficient staffing levels during an emergency Backup plan for staffing during an emergency Plans for assisting/accommodating staff families and pets Identification of residents during emergency or evacuation (e.g. wristband or nametag) Specification of resident information to be transferred with resident Mode for transferring resident information during evacuation Strategy for tracking relocated residents Communications plan Public agency emergency contacts Agreements or contracts with hospitals for sheltering high-acuity residents Agreements or contracts with other pre-determined evacuation locations Agreements or contracts with appropriate transportation providers during evacuation (e.g. can accommodate wheelchairs) Other

49 Q179 Did you work with local partners (e.g. public health, hospitals, area agency on aging) and/or emergency management organizations to develop your emergency plan? Yes No Not sure Q180 Who were your primary partners in developing your emergency plan? List the one or two most important partners. Q181 Has your facility participated in a community-wide emergency exercise or drill? Yes No Not sure Q182 In Ohio, there are 7 regional healthcare coalitions (one in each of the state's Homeland Security Regions), which focus on preparedness-planning activities, and primarily comprised of public health, emergency management, and healthcare organizations. Has your facility been contacted by or been engaged with any of these coalitions? Yes No Not sure Q183 Which one? (The coalitions coordinating agencies are in parentheses.) Northwest Region (Hospital Council of Northwest Ohio) Northeast Region (The Center for Health Affairs) Northeast Central Region (Akron Regional Hospital Association) Southeast Region (Ohio Hospital Association) West Central Region (Greater Dayton Area Health Information Network) Southwest Region (Greater Cincinnati Health Council) Central Region (Central Ohio Trauma System)

50 Thank you for completing this survey. If you have additional comments about the survey or RCFs in general, please type them here: If you would like to print a copy of your survey, click on "Print responses" at the bottom of the page and then click on "Submit" to submit your survey. When you choose "Print responses" a new page will appear with the entire survey displayed. You will need to allow pop-ups in your browser in order to see the screen to print your survey responses. Please note: you will NOT be able to print your survey after you click on "Submit".