Long-term Care

Skilled Nursing Facility: An institution (or a distinct part of an institution) which: is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, or rehabilitation services for injured, disabled, or sick persons, and is not primarily for the care and treatment of mental diseases; has in effect a transfer agreement with one or more hospitals having agreements in effect.

Nursing Facility: An institution (or a distinct part of an institution) which is primarily engaged in providing skilled nursing care and related services for residents who require medical or nursing care, rehabilitation services for injured, disabled, or sick persons, or on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; has in effect a transfer agreement with one or more hospitals having agreements in effect.

Many facilities in the State of New Hampshire fall under this category. Licensed facilities are also required to meet the Administrative Rules according to their license type. Applicable healthcare facilities licenses include:

• He-P 803 Nursing Homes
• He-P 805 Assisted Living Residence - Supported Residential Health Care Facilities
• He-P 807 Residential Treatment and Rehabilitation Facilities
• He-P 814 Community Residences at the Residential Care and Supported Residential Care Level

Emergency Planning

The Long Term Care/Assisted Living/Nursing Home must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually.

The plan must do all of the following:

• Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents.
• Include strategies for addressing emergency events identified by the risk assessment.
• Address resident population, including, but not limited to, persons at-risk; the type of services the LTC center has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.
• Include a process for cooperation and collaboration with local, regional, state, and federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the LTC center's efforts to contact such officials and, when applicable, its participation in collaborative and cooperative planning efforts.

Policies and Procedures

The LTC center must develop and implement emergency preparedness policies and procedures, based on the emergency plan, risk assessment , and the communication plan. The policies and procedures must be reviewed and updated at least annually.

At a minimum, the policies and procedures must address the following:

• The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:
  • Food, water, medical, and pharmaceutical supplies.
  • Alternate sources of energy to maintain:
    • Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;
    • Emergency lighting;
    • Fire detection, extinguishing, and alarm systems; and
    • Sewage and waste disposal.
• A system to track the location of on-duty staff and sheltered residents in the LTC center's care during and after an emergency. If on-duty staff and sheltered residents are relocated during the emergency, the LTC center must document the specific name and location of the receiving facility or other location.
• Safe evacuation from the LTC center, which includes consideration of care and treatment needs of evacuees; staff responsibilities; transportation; identification of evacuation location(s); and primary and alternate means of communication with external sources of assistance.
• A means to shelter in place for residents, staff, and volunteers who remain in the LTC center.
• A system of medical documentation that preserves resident information, protects confidentiality of resident information, and secures and maintains the availability of records.
• The use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency.
• The development of arrangements with other LTC centers and other providers to receive residents in the event of limitations or cessation of operations to maintain the continuity of services to LTC residents.
• The role of the LTC center under a waiver declared by the Secretary, in accordance with section 1135 of the Act, in the provision of care and treatment at an alternate care site identified by emergency management officials.

Communications Plan

The LTC center must develop and maintain an emergency preparedness communication plan that complies with federal, state, and local laws and must be reviewed and updated at least annually.

The communication plan must include all of the following:

• Names and contact information for staff, entities providing services under arrangement, residents' physicians, other LTC centers, and volunteers.
• Contact information for the following:
  • Federal, state, regional, and local emergency preparedness staff.
  • The State Licensing and Certification Agency.
  • The Office of the State Long-Term Care Ombudsman.
  • Other sources of assistance.
• Primary and alternate means of communicating with LTC center's staff and federal, state, tribal, regional, and local emergency management agencies.
• A method for sharing information and medical documentation for residents under the LTC center's care, as necessary, with other health care providers to maintain the continuity of care.
• A means, in the event of an evacuation, to release resident information as permitted under 45 CFR 164.510(b)(1)(ii).
• A means of providing information about the general condition and location of residents under the facility’s care as permitted under 45 CFR 164.510(b)(4).
• A means of providing information about the LTC center's occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee.
• A method of sharing information from the emergency plan that the facility has determined is appropriate with residents and their families or representatives

Training and Testing

Training

The LTC center must do all of the following:

• Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role.
• Provide emergency preparedness training at least annually.
• Maintain documentation of the training.
• Demonstrate staff knowledge of emergency procedures.

Testing

The LTC center must conduct exercises to test the emergency plan at least annually, including unannounced staff drills using the emergency procedures. The LTC center must do all of the following:

• Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based. If the LTC center experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC center is exempt from engaging in a community-based or individual, facility-based full-scale exercise for 1 year following the onset of the actual event.
• Conduct an additional exercise that may include, but is not limited to the following:
  • A second full-scale exercise that is community-based or individual, facility-based.
  • A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan.
• Analyze the LTC center's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the LTC center's emergency plan, as needed.

Additional Considerations

In addition to the above required components, every LTC must have an emergency operations plan that details how the facility accounts for missing residents.

All long term care facilities and nursing homes are required to have their emergency operations plan reviewed annually by the town or city's Emergency Management Director. Contact your regional Public Health Emergency Preparedness Coordinator if you need help connecting with your town's Emergency Management Director.