emergency preparedness for homecare and geriatric professionals

Disasters & Emergency Preparedness

Wen Dombrowski, MD, MBAChief Medical Information Officer & Vice President for Connected Health

VNA Health Group

@HealthcareWen @VNAHealthGroup #AGS14

Elderly & Disabled are Disproportionately Affected


Vulnerable even more so after disaster (physical & cognitive limit + chaotic environ)

Difficult to locate & track vulnerable Limited shelter options & difficult to

access Limited geriatric specialists to provide

care Foster cooperation beforehand among

clinicians + community orgs + city agencies

Address post-disaster, long-term needs: food, housing, healthcare, entitlements

Challenges & Lessons Learned from Recent Disasters


Key issues Basic needs: shelter, fuel, clothing,

bedding Mobility: disability, transport, assistive

devices Health: access to services, food, water,

sanitation, psychosocial needs Family & social: separation, dependants,

security, changes in social structures Economic & legal: income, land,

information, documentation, skills training

Older People in Disasters: HelpAge International Guidelines


What can I do to prepare my

patients for an emergency?


Hazard Vulnerability Analysis

Failure of Networks: Electric, Communications, I.T. , Transportation, Water


Network with city/state EM officials & community orgs Stockpile supplies; review vendor contracts Plan for water & electric failures Back up records Identify funds if normal payment interrupted Have alternate communication devices Establish phone tree & staff contact list Plan alternate transportation routes See “Business Continuity Planning” resources

1st Prepare Your Own Practice:Are You Ready?


Family plan for communication & evacuation

Staff plan for communication & who works Cell phone + landline phone + contact lists Supplies in car:

◦ cash; gas; maps; crank charger◦ bottled water & food; medical supplies◦ booster cables, tire patch kit, flares, flashlight,

shovel, blankets, gloves, clothes

Prepare Your Family & Your Staff


GeriGoBag: fanny pack or attachable to wheelchair ◦ Medication list & 7-day supply◦ Medical history in 1 page & description of baseline mental/physical

status◦ Personal info (name, address, phone, insurance #, adv directives)◦ Contact info for family, neighbors, police/fire, PCP, pharmacy

Devices & Equipment◦ **Power generators, car adapters, & backup batteries ◦ Glasses, hearing aids & batteries, dentures◦ Canes, walkers, wheelchairs, prostheses◦ Respirators, oxygen, other equipment◦ Simple instruction labels◦ Signs stating deaf or don’t know English

Evacuation plan◦ Where are shelters that can meet special needs & how get

there◦ Options if not able to evacuate with assistive devices

Prepare Your Patients: Special Considerations


Identify frail & disabled before & after disaster◦Your patient list: backup EMR◦Family caregivers & neighbors◦Homecare agencies, community orgs, fire dept.,

ER◦Volunteer outreach◦Opt-in registries too limited (but if your local region has one, consider joining it)◦Insurance claims & SSD databases more likely to

be comprehensive (need data sharing agreements)

Beware of exploitation & abuse

Where Are People In Need?


Mental Health: sleep, delirium, depression, PTSD

Dehydration: limited water, avoiding urination Nutrition: difficulty chewing (hard & dry

foods), appetite loss, inability to feed self, special diets

Mobility: transport, assistive devices, pressure sores, inaccessible bathrooms

Infection Control: hygiene, close quarters Comorbidities: cardiac, respiratory, etc Advanced Directives: e.g. discuss w/

terminally ill patients who wish to be Do Not Hospitalize

Emergency Response Issues


Ethical Duty to Plan: more than organizing resources, find ways to deal w/ dilemmas in advance

Information sharing & privacy Clinicians reluctant to work when personal risk Life & death decisions Allocation of scarce resources (e.g. bed or

ventilator) Age discrimination Loss of personal autonomy Decision-making capacity Advanced directives (e.g. DNH) Prognosis uncertainties Withdrawing life-support

Ethical & Legal Issues


http://www.nahc.org/assets/1/7/EP_Binder.pdf http://

www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-geriatrictoolkit-nov2009.pdf

http://www.ready.gov/individuals-access-functional-needs http://www.fda.gov/downloads/MedicalDevices/Productsand

MedicalProcedures/HomeHealthandConsumer/UCM252812.pdf

http://www.handicap-international.fr/bibliographie-handicap/5CooperationInternationale/contextes_urgence/Helpage_guidelines.pdf

Select References & Resources


http://www.nahc.org/assets/1/7/EP_Binder.pdf



http://www.nyc.gov/html/doh/downloads/pdf/bhpp/hepp-geriatrictoolkit-nov2009.pdf










