Emergency Planning for Home Health (Review)

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You will find in this section, the information needed to prepare for the Home Health Aide In-Service exam. You can view, download and print for better preparation.

EMERGENCY PLANNING FOR HOME HEALTH

Overview

All home health agencies must be prepared in the case of natural, man-made, and public-health emergencies when caring for all patients. The Centers for Medicaid and Medicare Services (CMS) has developed standards for comprehensive agency emergency preparedness. These include policy and procedure requirements for staff training and readiness, as well as individual patient care planning. As a part of the agency staff and patient care team, you will play an important role in emergency planning and preparedness.

Each home health agency must develop emergency planning policies and procedures and review these annually, including a practice implementation (drill) of their agency's plan for what to do in the case of an emergency or disaster. The agency may perform this drill as a "tabletop" discussion for a second required annual exercise.

The agency must also include policies for addressing risks assessed for each individual patient within that patient's plan of care. The patient's plan of care must also include a stated emergency plan for evacuation and shelter, notification of local services/assistance, and how follow up care needs will be met in the case of an emergency, disaster, or evacuation.

Emergency Planning & Preparedness Requirements

The requirements for emergency planning and preparedness are set forth by CMS and are a Condition of Participation (COP) for home health agencies that wish to provide Medicare and Medicaid reimbursed services. The minimum requirements include:

Policy Requirements

1. During patient comprehensive assessment, a patient's risks must be identified, and the plan of care must address strategies for addressing these risks.

2. The home health agency must develop procedures to follow up with on-duty staff and patients to determine services that are needed if there is an interruption in services during or due to an emergency. The agency must inform State and local officials of any on-duty staff or patients that they are unable to contact.

3. The home health agency must develop a backup system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains the availability of records.

4. The home health agency must have a plan for the use of volunteers in an emergency or other emergency staffing strategy, to address increased needs during an emergency.

5. The home health agency must develop procedures to inform State and local emergency preparedness officials about HHA patients in need of evacuation from their residences at any time due to an emergency situation based on the patient's medical and psychiatric condition and home environment. Many agencies will identify patients by a "triage" or "risk" score to help identify those most at risk.

Communication Requirements

1. CMS requires that the agency develop a communication plan as a part of the overall emergency plan that includes the names and contact information of all staff, contractors, physicians caring for the agency's patients, and volunteers.

2. The communication plan must also contain contact information for the following:

Federal, State, tribal, regional, or local emergency preparedness agencies and staff (including an alternate means of communication for these agencies)

Other local agencies that aid patients (for example: mobile meals)

3. The communication plan must include a HIPAA compliant method for sharing information and medical documentation from the patient's medical record as well as information about the general condition and location of patients under the agency's care to maintain continuity of care during an emergency or disaster.

4. The communication plan must include a means of providing information about any needs of the agency and the agency's ability to assist in providing care to the designated authority in any given emergency or disaster.

Training & Testing the Emergency Plan

1. At least once a year, home health agency staff must participate in emergency planning and preparedness training. This helps all staff maintain a current knowledge of the agency's policy and plan, should an actual emergency or disaster occur. This training includes:

Initial training at hire for new staff members and every year thereafter

Initial training for new contract staff members, which must be repeated annually

Initial training for new volunteers, which must be repeated annually (if consistent with the volunteer role)

Demonstration of understanding

Documentation of training

2. Home health agencies must also test their emergency planning and preparedness at least once a year. Testing of the emergency planning and preparedness is a team effort and involves all staff because the agency must practice as if an actual emergency or disaster were to occur. This is called performing a "full-scale exercise" and involves all the agency staff.

3. Additional annual testing must be done, and this includes:

A second full-scale exercise OR

A group discussion-based practice based on a set of problem scenario statements and/or ques-tions related to a narrated emergency scenario that the group of staff must discuss together, applying the principles of the agency's emergency planning policy and procedure. This is called a "table-top exercise."

Actual activation of the emergency planning and preparedness response plan due to a true emergency, disaster (natural or man-made), or public health crisis

When the agency experiences an actual natural or man-made emergency that requires activation of the emergency plan, no table-top or full-scale exercise is required until the following year.

4. At the completion of all required testing exercises for each year, the types of drills performed should be documented, along with the emergency event scenarios used, home health agency's response, and an analysis of the team's efficiency and outcomes.

Emergency Planning and Patient Care Planning

When an emergency strikes, the agency must prioritize patient care. Policies require agencies to identify patients at risk so that, should an emergency or disaster occur, the agency can easily identify and contact patients in the order of greatest need. Familiarize yourself with your agency's method of identifying patient risk (often referred to as "acuity") and where to identify this on the patient's plan of care.

All patients must also have an emergency plan in the home that provides the patient with easy access to emergency assistance numbers. Always be sure that this emergency plan and contact list is in a highly visible place for your patient to see, such as posted on the wall by the bed or on the refrigerator in the kitchen.

The agency must also maintain an up-to-date evacuation plan for the patient's plan of care and updated contacts related to the care of the patient. This includes the patient's emergency contacts, physician, pharmacy, and other important patient contact information. Always remember to notify your home health agency clinical supervisor or Director of Nursing right away if contact information related to a patient you are caring for requires an update. This is part of your important role in emergency planning and preparedness and can be vital to ensuring that your patient receives care if an emergency or disaster were to occur.

Source: Essential In-Services for Home Health, 2023