Emergency Preparedness

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​AHCA/NCAL provides information and resources to help members respond to an emergency in a timely, organized, and effective manner. ​​​


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What You Need to Know​​​ ​

Monkeypox
In August 2022, the United States declared the ongoing monkeypox outbreak a public health emergency. Learn more about the disease and the warning​ signs you need to watch out for in LTC.​  

COVID-19 Updates​
​​Find the latest information on COVID-19 for long term care providers. This includes infection control practices, regulatory requirements and resources on COVID-19 vaccinations for long term care staff and residents. 

To meet Emergency Preparedness requirements, providers must be able to demonstrate their experience activating their emergency plans through written documentation. This is most commonly accomplished through ​an After-Action Report (AAR) and Improvement Plan. AHCA has developed a COVID-19 AAR Template that members can utilize to document their response and recovery efforts during the pandemic. 
Long term care facilities should prepare to manage potential flu outbreaks and double efforts to encourage residents and staff to take the influenza vaccine. Individuals 65 years or older are one of the high risk groups who can experience serious complications, even death, from influenza infection. Learn more on how to minimize the flu for residents.​ ​

 

 

 

New AHCA Tool Helps Simplify Emergency Preparedness Compliancehttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/New-AHCA-Tool-Helps-Simplify-Emergency-Preparedness-Compliance.aspxNew AHCA Tool Helps Simplify Emergency Preparedness Compliance3/21/2025 4:00:00 AM<p></p><div>Disaster preparedness has long been an important function in the operation of a long term care (LTC) facility. To better assist LTC providers with developing and maintaining emergency preparedness programs while managing compliance with the Centers for Medicare and Medicaid Services (CMS), AHCA has developed an emergency preparedness program self-assessment and resource tool called the <a href="/Survey-Regulatory-Legal/Emergency-Preparedness/MemberOnlyDocs/EP%20regulation%20crosswalk%20Feb%202025.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><em>CMS Emergency Preparedness Regulations Crosswalk Tool</em></a>. Please note that this resource is available for AHCA members and requires a log in to access.     </div><div><br></div><div><span style="font-size:11pt;">This tool identifies each requirement applicable to long term care, provides key guidance from Appendix Z, and describes surveyor validation methods. It also includes a variety of useful web links that provide access to information and tools on everything from incident command to after-action reports. </span></div><div><br></div><div><span style="font-size:11pt;">This resource aims to be helpful in a time when the focus on disaster preparedness has increased. In 2016, CMS established national emergency preparedness requirements for participating providers. The final rule addressed various components of emergency preparedness, including plan development, content, preparation, training, and testing. </span></div><div><br></div><div><span style="font-size:11pt;"><a href="https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_z_emergprep.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">State Operations Manual - Appendix Z</a> outlines the emergency preparedness requirements for 17 different provider types, including LTC facilities. It does not apply to most assisted living and independent living providers since they are generally state regulated and don’t participate in Medicare or Medicaid programs. </span></div><div><br></div><div><span style="font-size:11pt;">There are 44 individual requirements outlined in Appendix Z, with 24 of them specifically applicable to long term care. Each requirement is provided with an “E-tag” designation (e.g. E-001). Appendix Z outlines the requirements, applicability, guidance information, and surveyor procedures for assessing compliance. Needless to say, digesting and applying the 108-page document can be a daunting task for any provider, and that is why AHCA has developed this resource to assist providers </span></div><div><br></div><div><span style="font-size:11pt;">AHCA is always available to support members with emergency preparedness questions by emailing <a href="mailto:emergencyprep@ahca.org" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">emergencyprep@ahca.org​</a>.   </span></div><p>​</p>Disaster preparedness has long been an important function in the operation of a long term care facility.
Updates on Vaccine Effectivenesshttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/Updates-on-Vaccine-Effectiveness-.aspxUpdates on Vaccine Effectiveness3/10/2025 4:00:00 AM<p></p><div><span style="font-size:14.6667px;">Recently released <a href="https://www.cdc.gov/mmwr/volumes/74/wr/pdfs/mm7406-H.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">data</a> show that this year’s COVID-19 and Influenza vaccines both reduce the risk of acute respiratory illness and hospitalizations in older adults. Vaccine effectiveness of 2024–2025 COVID-19 vaccine was 45%–46% against hospitalizations among adults aged 65 years and older, compared with not receiving a 2024–2025 vaccine dose. This was based on data from two networks evaluating vaccine effectiveness, VISION and IVY networks, that collect information from hospitalized individuals on their vaccination status and the type of infections.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">Interim 2024–2025 seasonal influenza vaccine effectiveness estimates were calculated from four American vaccine effectiveness networks. Among adults aged 65 years and older, vaccine effectiveness against any influenza-associated acute respiratory infections was 51% in outpatient settings. And it was 38% (IVY) and 57% (VISION) against hospitalization. As of February 3, 2025, testing for the strains of virus causing human infections found that they match with those strains covered in this year's vaccine.  </span></div><div><span style="font-size:14.6667px;"><br></span></div><div><span style="font-size:14.6667px;">Details of these studies, along with additional information on VE for children and adults can be found at <a href="https://www.cdc.gov/mmwr/volumes/74/wr/pdfs/mm7406-H.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">MMWR Feb 27, 2025​</a>.  </span></div><p>​</p>Recently released data show that this year’s COVID-19 and Influenza vaccines both reduce the risk of acute respiratory illness and hospitalizations in older adults.
Listeria Outbreak Linked to Supplement Shakeshttps://publish.ahcancal.org/News-and-Communications/Blog/Pages/Listeria Outbreak-Linked-to-Supplement-Shakes-.aspxListeria Outbreak Linked to Supplement Shakes2/26/2025 5:00:00 AM​<span data-contrast="none" lang="EN-US" style="font-size:11pt;">The </span><a href="https://www.cdc.gov/listeria/outbreaks/shakes-022025/index.html" target="_blank" rel="noreferrer noopener" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" style="font-size:11pt;"><span data-contrast="none" lang="EN-US">Centers for Disease Control and Prevention (CDC)</span></a><span data-contrast="none" lang="EN-US" style="font-size:11pt;">, the Food and Drug Administration (FDA), and public health officials in several states are investigating a multistate outbreak of Listeria infections linked to supplement shakes. Many people in this outbreak lived in long term care facilities or were hospitalized before becoming sick. Currently, there have been 38 cases, 37 hospitalizations, and 12 deaths across 21 states</span><div><span data-contrast="none" lang="EN-US" style="font-size:11pt;">.</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":300,"335559739":300}" style="font-size:11pt;"> </span><div><span data-contrast="none" lang="EN-US"><em>Listeria</em> </span><span data-contrast="none" lang="EN-US">is especially harmful to pregnant women, people 65 or older, and those with weakened immune systems. This is because Listeria is more likely to spread beyond their gut to other parts of their body, resulting in a severe condition known as invasive listeriosis.</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":300,"335559739":300}"> </span></div><div><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":300,"335559739":300}"><br></span></div><div><span data-contrast="none" lang="EN-US"><strong>Timeline</strong></span><span data-ccp-props="{"134233117":false,"134233118":false,"134245418":true,"134245529":true,"335559738":280,"335559739":80}"> </span></div><div><span data-contrast="none" lang="EN-US">On February 22, 2025, Lyons Magnus LLC (“Lyons Magnus”) announced a voluntary recall of 4 oz. Lyons ReadyCare and Sysco Imperial Frozen Supplemental Shakes due to the potential for contamination with Listeria monocytogenes. These products were distributed throughout the United States. The top of the carton has a printed label identifying the Lot Code and Best By Date for these products. A chart of all recalled products is available on the </span><a href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/lyons-magnus-recalls-lyons-readycare-and-sysco-imperial-frozen-supplemental-shakes-manufactured#recall-announcement" target="_blank" rel="noreferrer noopener" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"><span data-contrast="none" lang="EN-US"><span data-ccp-charstyle="Hyperlink">FDA website</span></span></a><span data-contrast="auto" lang="EN-US">.</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":300,"335559739":300}"> </span></div><div><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":300,"335559739":300}"><br></span></div><div><span data-contrast="none" lang="EN-US"><strong>What You Should Do</strong></span><span data-ccp-props="{"134233117":false,"134233118":false,"134245418":true,"134245529":true,"335559738":280,"335559739":80}"> </span></div><div><ul role="list"><li data-leveltext="" data-font="Symbol" data-listid="3" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1" role="listitem"><span data-contrast="none" lang="EN-US">Do not serve any recalled products to residents. Throw them away or return them to where you bought them.</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":220,"335559739":220}"> </span></li></ul></div><div><ul role="list"><li data-leveltext="" data-font="Symbol" data-listid="3" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1" role="listitem"><span data-contrast="auto" lang="EN-US"></span><a href="https://www.cdc.gov/food-safety/communication-resources/clean-refrigerator-steps.html" target="_blank" rel="noreferrer noopener" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"><span data-contrast="none" lang="EN-US"><span data-ccp-charstyle="Hyperlink">Clean</span></span></a><span data-contrast="none" lang="EN-US"> the refrigerator, containers, and surfaces that may have touched the recalled products. Listeria can survive in the refrigerator and can easily spread to other foods and surfaces.</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":220,"335559739":220}"> </span></li></ul></div><div><ul role="list"><li data-leveltext="" data-font="Symbol" data-listid="3" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1" role="listitem"><span data-contrast="none" lang="EN-US">Call a healthcare provider right away if a resident presents with the following symptoms after consuming recalled products:</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":220,"335559739":220}"> </span></li></ul></div><div><ul role="list"><li data-leveltext="o" data-font="Courier New" data-listid="3" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"hybridMultilevel"}" aria-setsize="-1" data-aria-posinset="1" data-aria-level="2" role="listitem"><span data-contrast="none" lang="EN-US">Headache, stiff neck, confusion, loss of balance, and convulsions, in addition to fever, muscle aches, and tiredness.</span><span data-ccp-props="{"134233117":false,"134233118":false,"335559738":220,"335559739":220}"> </span></li></ul></div><div><span data-contrast="none" lang="EN-US">Visit</span><span data-contrast="auto" lang="EN-US"> the Lyons Magnus </span><a href="https://www.lyonsmagnus.com/" target="_blank" rel="noreferrer noopener" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"><span data-contrast="none" lang="EN-US"><span data-ccp-charstyle="Hyperlink">website</span></span></a><span data-contrast="auto" lang="EN-US"> for more information or contact them at </span><a href="mailto:%E2%80%AFfrozenshakerecall@lyonsmagnus.com" target="_blank" rel="noreferrer noopener" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083"><span data-contrast="none" lang="EN-US"><span data-ccp-charstyle="Hyperlink"> </span><span data-ccp-charstyle="Hyperlink">frozenshakerecall@lyonsmagnus.com</span></span></a><span data-contrast="auto" lang="EN-US">.</span><span data-ccp-props="{}"> ​</span></div></div>The CDC, FDA, and public health officials in several states are investigating a multistate outbreak of Listeria infections linked to supplement shakes.
Do You Maintain a Compliant Fire Safety Plan?https://publish.ahcancal.org/News-and-Communications/Blog/Pages/Do-You-Maintain-a-Compliant-Fire-Safety-Plan.aspxDo You Maintain a Compliant Fire Safety Plan?1/22/2025 5:00:00 AM<p><span style="font-size:11pt;">F</span><span style="font-size:11pt;">ire safety is a critical component of any healthcare organization’s overall safety program. As such, healthcare providers are required to develop facility-specific fire and evacuation procedures, provide fire safety training, and conduct regularly scheduled fire drills.   </span></p><div><span style="font-size:11pt;">Most facility fire procedures correctly focus on the critical actions to take upon discovery of a fire. These actions are often simplified into an acronym such as RACE (rescue, alarm, contain, evacuate) or something similar. However, the Life Safety Code® requires some very specific information to be included in a healthcare occupancy’s fire safety plan. Review your fire safety plan and fire procedures against these nine (9) required components to ensure they are comprehensive and compliant with Section 19.7.2.2 of the Life Safety Code® (2012 edition) and CMS tag K-711.  </span></div><div><br></div><div><ol><li><span style="font-size:11pt;"><strong>Use of Alarms:</strong> Upon discovery of a fire, procedures should direct staff to quickly activate the fire alarm system via the closest manual pull station. In addition to building-wide notification, activation of the fire alarm will likely initiate a variety of automatic actions such as door release, HVAC shutdown, and fire department notification.   <br><br></span></li><li><strong>Transmission of Alarms to the Fire Department:</strong> Your fire alarm system most likely maintains some direct connection to ensure the fire department is automatically notified when the alarm is activated. This is commonly accomplished via the use of a central monitoring service. However, there are a handful of other arrangements that lead to the same outcome. Ensure your procedures specifically spell out how alarms are transmitted to the fire department.   <br><br></li><li><strong>Emergency Phone Call to Fire Department:</strong> Although the fire alarm system is required to automatically contact the fire department, a direct phone call to the fire department (usually via 911), is an extremely important step. Not only does it serve as a back-up communication, but it allows the facility to provide details regarding the situation directly to emergency personnel. Specific information can be extremely valuable to dispatchers and firefighters and may have a direct impact on the emergency response. Make sure your procedures include a back-up phone call and clarify who is to make the back-up call on all shifts.   <br><br></li><li><strong>Response to Alarms:</strong> It is important that procedures clarify who should respond to the fire area when. For example, during normal business hours, there are often additional staff in the building available to respond to alarms. However, in the evening and overnight, it may be necessary for additional clinical staff to report to the fire area to ensure there are enough hands to implement the procedures. Procedures should detail roles for all staff upon activation of the alarm.    <br><br></li><li><strong>Isolation of the Fire:</strong> Health care occupancies are specifically designed to contain smoke, thereby limiting its ability to travel throughout the building. Closing doors, and keeping them closed, is a critical step in limiting smoke travel. Staff procedures should clarify their role in closing the door to the fire room along with the remaining doors in the building.  <br><br></li><li><strong>Evacuation of Immediate Area:</strong> Quick removal of the occupants of the fire room is essential. Procedures should place emphasis on evacuation of the fire room followed by closure of the fire room door to keep smoke from spreading.  <br><br></li><li><strong>Evacuation of the Smoke Compartment:</strong> Extended evacuation beyond the fire room is an important decision to be made and depends on a few factors. Procedures should clarify when it is appropriate to evacuate the remainder of the smoke compartment, order of evacuation, and the evacuation destination. Evacuation floorplans are often a helpful visual reference that clarify smoke barrier boundaries, evacuation direction, and fire department entry.    <br><br></li><li><strong>Preparation of Floors and Building for Evacuation:</strong> While the initial point of focus is the immediate fire area, staff should simultaneously be taking action throughout the remainder of the building as well. This includes preparing for possible extended evacuation of the fire floor, floors above or below, or possibly the entire building. Procedures should outline who will determine the need for further evacuation, how it will be communicated, and what the extended evacuation process will entail. This may include vertical evacuation techniques for multi-story buildings.  <br><br></li><li><strong>Extinguishment of Fire:</strong> It may be appropriate for staff to extinguish a fire. Procedures should clarify the situations, methods, and supporting equipment available for fire suppression.  </li></ol></div><div><br></div><div><span style="font-size:11pt;">Fire drills serve as an opportunity to evaluate staff knowledge and test staff implementation of the fire safety plan.  Fire drills are required to be conducted quarterly on each shift with the drill times and conditions varied. Drills conducted between 6:00am and 9:00pm should include the activation of the building fire alarm system. Otherwise, overnight fire drills are permitted to use a coded announcement instead of audible alarms. It is not the intent of fire drills to excite or disturb residents. Detailed fire drill requirements are found in Section 19.7.1 of the Life Safety Code® (2012 edition) and referenced in CMS tag K-712. </span></div><div><br></div><div><span style="font-size:11pt;">Knowledge of applicable codes and standards is your best tool for ensuring life safety compliance. You can purchase a copy of the Life Safety Code® (NFPA 101) online at <a href="http://www.nfpa.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.nfpa.org</a>. The AHCA/NCAL <a href="/Survey-Regulatory-Legal/Pages/Fire-Life-Safety.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083">website​</a> is also a good source for on-going fire safety education, tools, and resources. </span><span style="font-size:11pt;">​</span></div><p>​</p>Fire safety is a critical component of any healthcare organization’s overall safety program.

 Featured Video

 Top Resources

 Planning Ahead

​In order to effectively handle disasters and emergencies, it is important for centers to plan ahead and prepare in advance. Long term and post-acute care centers can use a targeted approach to addressing vulnerabilities and hazards to help them best respond to and recover from events. This site seeks to assist centers in creating a plan to address its greatest risks:
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Hazard Vulnerability Assessment
The Hazard Vulnerability Assessment (HVA) is a tool designed to assist centers in evaluating vulnerability to specific hazards. The tool uses various categories, such as probability of experiencing a hazard, human impact, property and business impact and response, to create a numeric value based on various hazards.

 Incident Command System

The Incident Command System is part of the emergency management system in many levels (federal, state, and local). Every significant incident or event, whether large or small, and whether it is even defined as an emergency, requires certain management functions to be performed.

The Nursing Home Incident Command System (NHICS) and Assisted Living Incident Command System (ALICS) outline a management framework that empowers long-term care staff to improve the effectiveness and efficiency of their incident response -- no matter what shift, or what day of the week the event occurs. ​​

Resources


 

 ‭(Hidden)‬ CMS Emergency Preparedness Rule

The Emergency Preparedness Final Rule was released on Friday, September 16, 2016. AHCA, along with guest speakers, will hold a webinar series event​ this year on the new emergency preparedness final rule impacting Skilled Nursing Facilities (SNF), Nursing Facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This final rule is not applicable to Assisted Living Providers. 

Providers will need to be in compliance by November 15th 2017. The webinar series will include, special guest speakers, an overview of the key new requirements, a list of tools to assess if you are prepared for the rule, steps to take now to prepare.

On Friday, September 1st, CMS released a memorand​um to State Survey Agency Directors announcing that the Emergency Preparedness Training is now available. All surveyors are required to take the training prior to surveying the Emergency Preparedness requirements. Surveying for requirements begins November 15th, 2017. 

The online course is now available on the Surveyor Training Website On-Demand. Once in the course catalog for provider training, search “emergency” and the course information will appear. Providers will have continued (ongoing) access to the course, so they can review it anytime.

Members are strongly encouraged to review and complete the training as it includes quizzes and exercises to check understanding. The training states to surveyors that the requirements do not prescribe or mandate specific technology or tools nor detailed requirements for how facilities should write emergency plans. The training includes the questions surveyors will ask and how documentation will be reviewed and checked. Links to resources and glossary terms are also included.​

​Emergency Resources

In addition to planning for natural disasters, staff and facilities must be prepared for other emergencies, such as pandemics, influenza, active shooters and more. All emergency situations must be handled swiftly, diligently and with the utmost care for staff and patients.

 Active Shooter

​While many emergencies are caused by natural disasters and are, staff and facilities should also be prepared for other types of emergencies. One emergency for which facilities should have plans in place is an active shooter.
Please note: The policies below are models only and should be modified and tailored to meet the needs of individual communities. 

External Resources

 Assisted Living Resources

The Emergency Preparedness Guide for Assisted Living is a comprehensive resource that will assist members with developing emergency operations plan and includes the planning process. The guide includes templates and numerous resources for members to utilize.

 

Assisted Living Incident Command System (ALICS)

The Incident Command System (ICS) is one component of the National Incident Management System or (NIMS). The Assisted Living Incident Command System or “ALICS” is a simplified ICS and through its use, long-term care providers can become part of this standardized system of efficient response. ICS was modified by two consultants for assisted living and reviewed by AALNA board members and then reviewed by the NCAL Workgroup of the AHCA/NCAL Emergency Preparedness Committee.

ALICS offers long-term care providers a flexible framework for command and control that is based on the standardized system of ICS. It does this through a system that is designed to:
  • Manage all emergency, routine, or planned events, of any size or type, by establishing a clear chain of command and a process for communication, decision‐making and delegation.
  • Allow personnel from different agencies or departments to be integrated into a common structure that can effectively address issues and delegate responsibilities.
  • Provide needed logistical and administrative support to operational personnel.​

 Shelter In Place

Shelter In Place: Planning Resource Guide for Nursing Homes

For the purposes of this resource guide, shelter in place (SIP) is defined as: A protective action strategy taken to maintain resident care in the facility and to limit the movement of residents, staff and visitors in order to protect people and property from a hazard.

Shelter In Place Guidebook (PDF)

 State Resources

Wisconsin

 Winter Weather

The Centers for Disease Control and Prevention published a comprehensive winter weather health and safety site. Owners and administrators can take tips to prepare for extreme cold conditions and winter storms.​

 In Case of An Emergency

AHCA/NCAL regularly publishes and distributes informative documents for members regarding emergency preparedness, response, and recovery.

During public health emergencies, CMS will post updates on waivers on their Emergency Response and Recovery page. Members should check this page for updates during an event.