Emergency Preparedness

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


What You Need to Know​​​ ​

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.​ ​
Active Shooter Preparedness​
HealthCap® offers a free webinar that focuses on key aspects of active shooter events and what to do if your long term care community experiences a threat or real-life active shooter.




AHCA/NCAL Requests Extension Of Public Health Emergencyhttps://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/AHCANCAL-Requests-Extension-Of-Public-Health-Emergency-.aspxAHCA/NCAL Requests Extension Of Public Health Emergency8/9/2022 4:00:00 AM<p></p><div><span style="font-size:14.6667px;"><strong>WASHINGTON, D.C. – </strong>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes and assisted living communities across the country that provide care to approximately five million people each year, sent a letter today to U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra, requesting an extension of the Public Health Emergency (PHE). With new COVID-19 variants emerging and flu season approaching, extending the PHE will ensure that long term care facilities have the necessary resources to continue providing quality care to our nation’s seniors. In addition, as the pandemic continues to evolve, AHCA/NCAL asked that HHS update its COVID-19 guidance for health care settings. </span></div><div><span style="font-size:14.6667px;"> </span></div><div><span style="font-size:14.6667px;">Read the full letter <a href="/News-and-Communications/Fact-Sheets/Letters/AHCA-NCAL-Letter-HHS-Aug2022.pdf" data-feathr-click-track="true" target="_blank">HERE</a>.</span></div><div><br></div>AHCA/NCAL sent a letter today to U.S. Department of Health and Human Services Secretary Xavier Becerra, requesting an extension of the Public Health Emergency.
CMS Issues Final Rule and Brings Solution to FSES Problemhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/CMS-Issues-Final-Rule-and-Brings-Solution-to-FSES-Problem.aspxCMS Issues Final Rule and Brings Solution to FSES Problem8/2/2022 4:00:00 AM<p></p><div>Most organizations have never heard of a Fire Safety Evaluation System (FSES), much less had to complete and submit one as part of their annual life safety survey. However, for a small group of providers across the country, the FSES has been a critical tool in documenting Life Safety Code® compliance through an equivalent means. When an unforeseen amendment to the mandatory safety values in the 2013 edition of NFPA 101A (FSES) left many providers without an effective equivalency tool, some facilities faced significant construction projects, resulting in massive costs and operational disruption to maintain strict Life Safety Code® compliance. This was the only option even though organizations that passed the previously adopted 2001 edition of 101A, but failed the 2013 edition, were no less safe.    </div><div><br></div><div>After many years of advocacy, reviews by CMS, and multiple limited waiver extensions, CMS issued a <a href="https://public-inspection.federalregister.gov/2022-16457.pdf" data-feathr-click-track="true" target="_blank">final rule</a> in July 2022 that addresses the problem. It also allows the FSES to be a realistic tool once again for long term care facilities that had utilized it in the past.  </div><div><br></div><div>The CMS final rule essentially permits nursing homes that were Medicare or Medicaid certified before July 5, 2016, and previously utilized an FSES as a mechanism to determine equivalency, to utilize the mandatory values found in the 2001 edition of NFPA 101A. <strong>The more restrictive mandatory values found in the 2013 edition of NFPA 101A will not apply.</strong> This is important since the 2013 edition of the NFPA 101A is the edition currently adopted by CMS.     </div><div><br></div><div>While this issue only directly affects a minority of nursing homes and AHCA members, it has been an extremely consequential issue for those providers that were impacted. AHCA has long advocated on behalf of its members affected by the problem and is pleased that CMS has finalized a solution.</div><div><br></div><div>The full text can be found starting on page 298 of the <a href="https://public-inspection.federalregister.gov/2022-16457.pdf" data-feathr-click-track="true" target="_blank">final rule</a>.<br></div>Most organizations have never heard of a Fire Safety Evaluation System, much less had to complete and submit one as part of their annual life safety survey.
View HealthCap’s® New Free Active Shooter Preparedness Webinarhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/View-HealthCap’s-New-Free-Active-Shooter-Preparedness-Webinar.aspxView HealthCap’s® New Free Active Shooter Preparedness Webinar7/26/2022 4:00:00 AM<p><br></p><div>HealthCap® offers a new free webinar titled <em><a href="https://riskmanagement.healthcapusa.com/products/active-shooter-preparedness" data-feathr-click-track="true" target="_blank">Active Shooter Preparedness​</a></em>. This program focuses on key aspects of active shooter events and what to do if your long term care community experiences a threat or real-life active shooter.​ </div><div> </div><div>Most of us think we work in a home that would never have an active shooter event. Unfortunately, it happens, and active shooter training is a mandatory part of disaster preparation. Even if your home has a “lock down” protocol, it may not be effective.  </div><div> </div><div>Many communities want to keep active shooter training private and not share information about active shooter event planning. However, it is critical that this discussion and the planning for active shooter disaster be clear and open to prepare your staff and decrease the risk of a negative outcome in the event of an active shooter.   </div><div> </div><div>This training focuses​ on key aspects of active shooter preparation and what to do if your community experiences a threat or real-life active shooter event. The training will help you answer these questions:   </div><div><br></div><div><ul><li>​Who will you call?  </li><li>Who will you notify?  </li><li>How will you deploy your staff and use additional resources?  </li><li>What are the keys to protecting your residents and staff?  </li><li>How do work, in advance, with local law enforcement? <br></li></ul></div><div><br><a href="https://riskmanagement.healthcapusa.com/products/active-shooter-preparedness" data-feathr-click-track="true" target="_blank">Registration</a> for all participants is free. The webinar is approved for 1.0 ANCC contact hours  and 1.25 NAB CEs upon completion. The course learning objectives include:   </div><div><br></div><div><ul><li>​Define an active shooter event </li><li>Identify strategies to protect your residents and staff </li><li>Discuss the importance of open lines of communication with first responders  </li><li>Discuss media interaction/communication  </li><li>Identify methods to establish response and recovery post-event. </li></ul></div><div><br></div><div>AHCA/NCAL has embraced <a href="https://healthcapusa.com/" data-feathr-click-track="true" target="_blank">HealthCap®</a> for more than a decade as a premier provider of liability insurance that is solely dedicated to serving senior care communities. HealthCap® clients have the fewest liability claims in the industry, and HealthCap settles claims below the industry average.<br></div>HealthCap® offers a new free webinar titled Active Shooter Preparedness.
CDC Updates Guidance on Enhanced Barrier Precautions for Nursing Homeshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/CDC-Updates-Guidance-on-Enhanced-Barrier-Precautions-for-Nursing-Homes.aspxCDC Updates Guidance on Enhanced Barrier Precautions for Nursing Homes7/12/2022 4:00:00 AM<p><span style="font-size:11pt;"><span style="color:#808080;font-family:arial, helvetica, sans-serif;font-size:16px;background-color:#ffffff;"></span></span><span style="font-size:11pt;">Coinciding with a new <a href="https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf" data-feathr-click-track="true" target="_blank">report</a> on antimicrobial resistance, the CDC has updated its guidance on <a href="https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html" data-feathr-click-track="true" target="_blank">enhanced barrier precautions​</a> (EBP) for all health care settings, including nursing homes. The guidance expands to residents that trigger the use of EBP and indicates it should be followed for any resident in the facility with:​​</span></p><div><ol><li>​An open wound requiring a dressing change</li><li>Has an indwelling catheter for the duration of their stay</li><li>Is colonized with <span style="color:#555555;font-size:14.6667px;background-color:#ffffff;">multi-drug resistant organisms</span> (MDROs)​ <strong>and</strong> contact precautions do not apply </li></ol></div><div><br></div><div>The EBP requires the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of  MDROs to staff hands and clothing. Use of eye protection may be necessary when splash or spray may occur but is not necessary in other situations.</div><div><br></div><div>Examples of high-contact resident care activities requiring gown and glove use ​among residents that trigger EBP use include:<br><br></div><div><ul><li>​Dressing</li><li>Bathing/showering</li><li>Transferring</li><li>Providing hygiene</li><li>Changing linens</li><li>Changing briefs or assisting with toileting</li><li>Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator</li><li>Wound care: any skin opening requiring a dressing<br></li></ul></div><div>Gown and gloves are <strong>not​</strong> required for resident care activities other than those listed above, unless otherwise necessary for adherence to standard precautions. <strong>Residents on EBP are not restricted to their rooms or limited from participation in group activities.</strong></div><div><br></div><div>The CDC provides the following considerations for use of EBP in nursing facilities:<br><br></div><div><ul><li>MDRO transmission is common in skilled nursing facilities, contributing to significant morbidity and mortality for residents and increased costs for health care systems.<br></li></ul></div><div><ul><li>EBP is an approach of targeted gown and glove use during high-contact resident care activities, designed to reduce transmission of S. aureus and MDROs.<br></li></ul></div><div><ul><li>Effective implementation of EBP requires staff training on the proper use of PPE and the availability of PPE with hand hygiene products at the point of care.</li></ul></div><div>It also clarified that, in most situations, EBP is​ to be continued for the duration of a resident’s admission.  </div><div><br></div><div>Facilities should consider that EBP is one of a continuum of infection prevention interventions. EBP implementation requires increased use of gown and gloves, ongoing competency with PPE use and hand hygiene, and the current nursing home and pandemic environment.  </div><div><br></div><div>Additional information and supplemental resources to support implementation of EBP are available at the below links. </div><div><br></div><div><strong>Guidance:</strong> </div><div><ul><li><a href="https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html" data-feathr-click-track="true" target="_blank">Implementation of Personal Protective Equipment (PPE) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) </a></li></ul></div><div><br></div><div><strong>FAQs: </strong></div><div><ul><li><a href="https://www.cdc.gov/hai/containment/faqs.html" data-feathr-click-track="true" target="_blank">Frequently Asked Questions (FAQs) about Enhanced Barrier Precautions in Nursing Homes</a> </li></ul></div><div><br></div><div><strong>Resources: </strong></div><div><ul><li><a href="https://www.cdc.gov/hai/pdfs/containment/EBP-Presentation-July2022.pptx" data-feathr-click-track="true" target="_blank">Implementation of Enhanced Barrier Precautions in Nursing Homes Presentation </a></li><li><a href="https://www.cdc.gov/hai/pdfs/containment/Letter-Nursing-Home-Residents-Families-Friends-508.pdf" data-feathr-click-track="true" target="_blank">Enhanced Barrier Precautions Letter to Nursing Home Residents, Families, Friends, and Volunteers </a></li><li><a href="https://www.cdc.gov/hai/pdfs/containment/Letter-Nursing-Home-Staff-508.pdf" data-feathr-click-track="true" target="_blank">Enhanced Barrier Precautions Letter to Nursing Home Staff </a></li></ul></div>The CDC updated its guidance on enhanced barrier precautions (EBP) for nursing homes to expand the residents that trigger the use of EBP.

 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:
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. ​​



 ‭(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. 

AHCA/NCAL's Active Shooter Resources
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


 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.