Hospices can do a great deal upfront to prepare for the next 'big one'

Disaster preparedness experts offer these tips

Whether a hospice is situated in a hurricane, earthquake, fire, flood, or tornado zone there's a lot managers can do to prepare for a disaster.

For one, every hospice should have a disaster plan that takes into consideration as many difference scenarios as can be imagined, experts say.

"We've had a disaster planning process in place since 1993, and we continually update that," says Dale O. Knee, MHSA, president and chief executive officer of Covenant Hospice in Pensacola, FL. Knee spoke about delivering hospice care after a catastrophic disaster at the National Hospice and Palliative Care Organization's (NHPCO's) 20th management and leadership conference and exposition, held Sept. 22-24, 2005, in Hollywood, FL.

"Not only do we update it based on lessons learned, we test it and have periodic drills of differing types with different scenarios," Knee adds. "Our plan is office and count specific, and each office has its own individual plan, which in turn ties into the master plan for the organization."

The plan is available on an in-house computer link, and hard copies are available in every hospice office, he says.

VITAS Healthcare Corp., based in Miami, has hospices located in some of the most disaster-prone regions, including Florida, the Gulf Coast, and California, says Robin Kruth, BSN, vice president of hospice operations for VITAS in San Diego.

"We're very proactive when it comes to disaster planning and preparations," Kruth says.

Knee and Kruth offer these suggestions for how to improve a hospice's disaster plan:

1. Plan for everything, but know which disasters are most likely.

Covenant Hospice, which has 13 satellite offices and corporate headquarters in Pensacola, also divides potential catastrophes into three categories, including these:

- Natural disaster, including hurricanes and floods;

- Man-made disasters, including chemical spills from train derailments;

- Violence and terrorist incidents, including bombings and riots.

"We have a matrix called the continuity of operations planning that addresses all of these three categories, and with that we generate what we call a hazard vulnerability analysis," Knee says.

The hazardous vulnerability analysis is in a matrix format, and it shows the probability of something happening from one to five, Knee explains.

"So if, for example, we have an office close by a railroad track where there are a lot of chemical transports being made, then that might be a three from a hazard standpoint," Knee says.

Also, the hospice has a three-step process for hurricane planning, divided by 72 hours, 48 hours, and 24 hours before the hurricane is expected, Knee says.

VITAS hospices review their disaster plans at least annually, and many review the plans on a quarterly basis, Kruth says.

When a disaster strikes, a hospice needs to know who the key staff and managers are so they can be called to coordinate the plan, Kruth says.

"There are a lot of staff members who don't have families, and they'll step up and say, 'I'll give 100 percent during this disaster,' while others say, 'I have four young kids, and if I don't have schools to provide care, then I need to stay home with my kids,'" Kruth notes. "The key thing is to be proactive and really look within your organization to see who the key leaders in the program are."

It's a hospice's responsibility to ensure the safety of patients, their families, and staff, Kruth says.

2. Have contingency arrangements for telephone service, medications, and equipment.

"Because we are a national organization and have programs in various parts of the country, if we have to transfer phones or assist sister programs we can do that," Kruth says.

The hospice organization has arrangements with medication, durable medical equipment, and other vendors to have extra supplies on hand during the days or hours before a hurricane strikes, Kruth says.

"So we can be sure all hospices have enough medicine and supplies to protect them for a two-week period of time," she adds.

During hurricane season, Covenant Hospice stacks up on supplies, Knee says.

Covenant Hospice will have all calls forwarded to a call center out-of-state in the 12 to 24 hours before a storm is expected to hit, Knee says.

"It's a seamless process, and patients and referral services don't even realize that the calls are forwarded," Knee says.

3. Share decision-making and have communications plans.

Covenant Hospice has a safety manager who is in charge of disaster planning, as well as risk management, and adverse events, Knee says.

"She chairs a committee made up of representatives of the organization, and they periodically look at the disaster plan," Knee says. "The plan, although it's centralized and is a corporate disaster plan, the only way it can work is by decentralizing decision-making."

So each branch manager and other key people are authorized to make decisions on a case-by-case basis, Knee says.

One key aspect of disaster planning is the recall plan.

"The most important thing that happens as part of the plan is there's an overall request that as soon as possible after an incident or storm or hurricane that by 9 o'clock the morning after the storm all staff will return to their office if they're able to safely," Knee says.

VITAS hospices also include in their disaster scenarios a plan to have staff meet at a particular place at a scheduled time after the disaster strikes, Kruth says.

"That's the meeting point, and you put together what we call a disaster tree, where you have an outline of what's going to occur prior to the disaster, Kruth says.

"In Houston, we have patient care teams and inpatient care units, and each team has a team manager," Kruth says. "One person was delegated to be the key person in charge of that particular group of patients, and it's that person's responsibility to see that they're all contacted either by phone or by care provider going directly to the home."

Communication planning during disasters should include alternative ways to reach staff and patients, Knee says.

Covenant Hospice, for example, has a call list that can be used as staff wait for a storm or hurricane.

Knee will call several people at the top of a calling list to give them detailed instructions. Then each of those people call 10 or more people on their list, and this process continues until everyone is reached, Knee says.

"Last time we used this was during the approach of Rita, just to disseminate information," Knee recalls. "From the time I put out two or three sentences of information later in the evening until the information reached over 800 people, it was just about 70 minutes."

Then the last people who receive the information have to call Knee or a safety manager or another designated manager to let the person in charge know that they've been contacted, he adds.

After the disaster strikes, the staff will communicate by cell phone if possible, and if there is no telephone reception, then everyone reverts to the planned recall list to meet in person, Knee notes.

4. Know everyone's evacuation plan.

Each patient at Covenant Hospice has to have an evacuation plan as part of the admission process, Knee says.

"While it's nice to have several days notice with a hurricane, there are too many other incidents in which you'd have virtually no notice at all," Knee says. "So each patient has an individualized evacuation plan which we work with them on."

"Seventy-two hours before the storm we double-check our evacuation plans, and we ensure hospitals and nursing homes have evacuation plans for our patients," Knee says. "We put a hospice nurse in any special needs shelter where our patients might be going."

At 48 hours before the storm, the hospice makes certain patients have all the medications and supplies they need for two weeks, and staff advisories are issued, Knee says.

And then 24 hours before the storm, the hospice reinforces its storm plan and makes certain all medical and electronic records are in a secure place.

As a final part of evacuation planning, it's important to note that no hospice has to handle everything on its own because there are many hospice providers who are willing to help during a tragedy and disaster, Kruth says.

"We're all out to provide quality end of life care and the support that people can depend on," Kruth says.