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Part III Standards for Compliance

REGULATIONS GOVERNING EMERGENCY PLANNING

Federal and state regulations are found in laws, regula- tions, and executive orders. The primary regulation for emergency management is the Disaster Relief Act of 1950. Prior to this time, emergencies were handled on a case-by-case basis. The Pandemic and All-Hazards Preparedness Act of 2006 was the first law that addressed responsible care of the older adult and estab- lished mandates for those agencies and health care facilities that receive federal aid and grants for the welfare of the older adult. Following the terrorist attacks of September 11, 2001, the US Department of Homeland Security (DHS) was developed and offi- cially established in 2003. Each year, additional regula- tions are enacted by federal, state, and local agencies. Facilities that receive Medicare and Medicaid monies or are accredited by the Joint Commission or other accrediting bodies all require written, well-rehearsed, and active emergency/disaster plans. Furthermore, Hurricanes Katrina (2005), Agnes (1972), and Betsy (1965) all led to changes in the Disaster Relief Act of 1950. Table 26.1 lists specific legal authorities (see page 365).

The dietary department, as well as the registered dietitian nutritionist (RDN), should stay informed of changes in regulations by systematically reviewing current regulatory changes. Reviewing websites such as those at Ready.gov (www.ready.gov), DHS (www. dhs.gov), and others listed in Table 26.2 are important resources for finding the most current information (see page 368). As circumstances change, the facility disas- ter plan should also change. The emergency management system comprises federal, state, and local government agencies, nonprofit organizations, businesses, and other private-sector enti- ties. To coordinate efforts, offices of emergency man- agement are established at each of these levels. Remember that disaster relief begins and ends at the local level. The management of these offices may differ in each locale and will vary based on the most frequent type of disaster situations in that specific area. It is the responsibility of the facility to maintain a working relationship and current knowledge of the processes of their locale’s emergency management organization and processes. Additionally, each area of the country now has knowledgeable, trained first responders who initiate rescue, care, and manage- ment of any emergency situation. The facility’s responsibility is to initiate a well-planned emergency/disaster plan, train staff and volunteers, establish a communication system, and provide for the nutrition and care of older adults in their care.

PLANNING FOR EMERGENCIES

IN THE DIETARY DEPARTMENT Initial planning should include the establishment of an emergency committee and the development of an emergency contact list, including administration, staff, all consultants, vendors, and local agencies. Home, business, and cell numbers and e-mail addresses should be included. During power outages and active disas- ters, communicating via text message or e-mail is often quicker and more reliable. See the Appendix for sample facility planning and policy documents for emergency preparedness.

Thought should be given to employees with fami- lies and children who do not have a safe place to stay during an emergency. It is better to include these indi- viduals in the facility plan than to have employees who are not able to work during the emergency period. Employees should complete yearly continuing educa- tion on the facility emergency plan and be able to demonstrate understanding of the policies and proce- dures they will need to follow. Emergency plans should be reviewed annually, and attention should be given to changes in state and federal regulations. Preparations should include determining the federal and state regulations outlined for electrical, gas, and water requirements in emergencies. These regulations can be found on state and federal web- sites. Preparations should include developing emer- gency supply lists, menus, procedures, and departmental responsibility lists. The Appendix to this book includes sample emergency supplies and menus.

Emergency supplies should be clearly labeled as

such, with staff in-service training as to its use. Care should be taken to regularly update these supplies so that they are always within the “use by” dates.

Emergency Water Bottled water for emergency situations is required. The amount and storage method is dependent on each state’s regulations. Water storage should take into account anticipated use (eg, consumption, cooking, personal hygiene) and the appropriate quantity to have on hand for residents, residents plus staff, or any family members. Water or purified water for enteral feedings, IV irrigation, and catheter irrigation should be calcu- lated into the amount stored. The plan should also include the need to provide water for personal care and toilet flushing if the sewage system is compromised. In an emergency, hot water tanks and toilet tanks contain some water; this water is not potable and must be puri- fied by chemicals or boiling. The emergency supplies stock is based not only on census but also on the licensed number of beds plus the