Emergency preparedness

More federal funding should be provided to the Administration for Community Living to develop and implement its emergency management responsibilities on behalf of older people. 

The Federal Emergency Management Agency (FEMA) should have specific and detailed protocols that address the needs of older adults and vulnerable populations in disasters. FEMA should study the breakdowns in assistance that occurred in previous disasters and use these lessons to guide the development of new emergency response protocols. 

Federal and state licensing standards should require that nursing facilities and assisted living/residential care settings have well-developed, feasible, and practiced emergency plans for residents. They should also have adequate numbers of well-trained staff to carry out such plans. 

The standards should require that emergency plans be on file with the state. 

Emergency plans should be prepared and reviewed annually by the local emergency management agency as well as the state regulatory agency. 

Emergency plans must include procedures for safely evacuating residents and continuing needed care. There should also be plans for safely transporting medical records, emergency medicines, and other supplies. 

Emergency plans should be given to family members when a consumer is admitted to the facility and annually thereafter, following state approval. 

Facility administrators should be criminally liable for not properly following emergency plans and any emergency orders issued by federal, state, or local authorities. 

Federal and state licensing standards should require nursing facilities and residential care settings to have effective emergency procedures for residents. They should also be required to have adequate numbers of well-trained staff to carry out such procedures. Providers should conduct test drills of the procedures. 

Federal and state licensing standards should require that LTSS providers who offer services in private homes include emergency plans in the consumer’s service plan. Plans should outline how consumer needs will be addressed if staff are unable to work. They should also detail appropriate evacuation procedures. 

States should ensure that local public health departments and emergency preparedness departments include nursing home representatives in all planning meetings. Nursing homes should partner with these local departments to coordinate responses to infectious disease outbreaks. There should also be appropriate consumer participation. 

States should prioritize identifying, registering, and tracking older people in local communities who cannot evacuate on their own. Efforts must be made to protect registry data from data mining or ransomware efforts. 

States should educate emergency management personnel about the needs of older people and train aging-network personnel in emergency management procedures. 

Older adults and people with disabilities should be included in emergency drills and training exercises. 

States should include protections for vulnerable older people in state and local emergency preparedness activities, such as planning, communications, evacuations, transportation, and housing. 

Federal and state licensing standards should require that nursing facilities and assisted living/residential care facilities have well-developed, feasible, and practiced emergency plans for residents, as well as an adequate number of well-trained staff to carry out such plans. Plans should include an adequate number of personal protective equipment (PPE) for all staff. Supply should be stocked to prevent PPE shortages in high demand incidents. 

These emergency plans should be publicly available and reviewed by public agency emergency managers to determine whether conflicts exist between the agency and LTSS plans. 

Federal and state governments should require all facilities to prepare a consumer-friendly summary of their emergency plan and provide it to current and prospective nursing home residents and their families and caregivers. It should be posted on the premises and also available to members of the public upon request. 

Facilities’ plans should include readiness for shelter-in-place plans, as well as off-site evacuation and sheltering. Plans should identify specific modes of evacuation and locations for sheltering and contracts with transportation providers to guarantee the safe transport of residents. Emergency power generator plans should include emergency cooling or heating plans. 

Emergency plans should also be reviewed annually by state/local fire marshals in addition to the current agencies listed. 

Facilities should have an adequate emergency supply of essential items such as food, water, fuel, medical supplies, and medications for both residents and staff. 

State and federal public health agencies should have actionable emergency contact-tracing plans that include rapid recruitment and redeployment of public health staff and ongoing training in order to reduce transmission of infectious diseases. 

In addition to registries, individuals receiving home- and community-based services should have an individualized emergency plan that includes friends, neighbors, and family members who are able to assist them. 

Congress must provide oversight to ensure that federal funds already allocated to nursing homes and other long-term care facilities to deal with emergencies are used to enable such facilities to provide care to residents. It must ensure the health and safety of residents and staff during the emergency. Congress should also establish guardrails to ensure that future funds are used for such intended purposes. 

Long-term care providers should not receive grants of blanket immunity during a federal- or state-declared public health emergency. If steps to provide immunity to LTSS providers during a declared state of emergency are taken, they should be narrowly drawn, limited to civil immunity, and only for the duration of the public health (or other) declared state of emergency. Immunity should only be granted to LTSS providers and facilities for the care they provided: 

• pursuant to the declared emergency, 
• in good faith, 
• during the period of the state of emergency, and 
• absent willful misconduct or gross negligence.