Edited Version May 10, 2000 Transcript
EIIP Virtual Online Library Presentation

"Emergency Planning for Special Needs Facilities"

Mitch Cooper
Program Director
Texas Department of Health

Moderator: Amy Sebring
EIIP Technical Projects Coordinator

The original unedited transcript of the May 10, 2000 online Virtual Library presentation is available in the EIIP Virtual Forum Archives (http://www.emforum.org). The following version of the transcript has been edited for easier reading and comprehension. Typos were corrected, date/time/names attributed by the software to each input were deleted but the content of questions and responses are as stated by each participant. Answers to participants’ questions are grouped beneath the appropriate question to facilitate meaning.


Amy Sebring: Welcome to the EIIP Virtual Library!

For the benefit of any first-timers, if you see a blue web address, you can click on it and the referenced Web page should appear in a browser window. After the first one, the browser window may not automatically come to the top, so you may need to bring it forward by clicking on a button at the status bar at the bottom of your screen. Then you will need to bring your chat window back to the top in the same way.

We will start with a presentation, and then follow with a Q&A session for your questions and comments. Right before we begin the Q&A portion we will review the procedure.

Please do NOT send direct messages to the speaker or moderator as it makes it difficult for us to follow the discussion.

Background information for today's session may be found at http://www.emforum.org/vlibrary/000510.htm . Please note there is a link to download a zip file containing a sample plan outline, instructions, and course description.


As a fellow Texan, I am very pleased to welcome Mitch Cooper today. Mitch previously worked for the Texas Division of Emergency Management, where he had an opportunity to work with many local emergency managers, particularly when it came to our annual state hurricane exercise. Mitch has since moved over to the Texas Department of Health, where he serves in the Emergency Preparedness Division and Program Director for Community Emergency Planning. It is there he has had an opportunity to focus on "Emergency Planning for Special Needs Facilities," the topic of his presentation.

Welcome Mitch, and thank you for taking time to be with us today.


Mitch Cooper: Thanks.

In early 1999, the Texas Dept of Health's Division of Emergency Preparedness implemented a community emergency-planning program. Emphasis was on health & medical response to weather-related disasters. Two major projects were conducted in Texas. The first involved the cities of Harlingen and San Benito in the Rio Grand Valley (Cameron County), and the second was conducted in Wharton County.

We developed coalitions representing the health and medical provider community. This included hospitals, EMS, local, county and state health departments, nursing homes, assisted living centers, MHMR facilities and emergency management. Several meetings were held over a six month period during which representatives from each participating agency discussed a number of response functions and developed an integrated health and medical response plan for the community. The document consists of a concise basic plan, an annex for each participating agency that covers eight core functions (will cover later), a hazard analysis for the community, etc.

As we conducted these projects, it became painfully obvious that there was a tremendous weakness in special needs facility planning and concurrent disconnects between facility management and local emergency management. I conducted a study and determined that little had been done in the state to enhance special needs planning, despite several attempts over the past 10 years. The Texas Department of Human Services (DHS) regulates special needs facilities and writes emergency management legislation for them. Yet, they have no one with emergency management planning expertise.

Backing up for a minute, the participants in the Harlingen/San Benito project signed off on the plan just two days before Hurricane Brett hit the Texas coast. Every special needs facility in those cities, as well as those in the county, who formed their own coalition based on our plan, did what they were supposed to do and either safely evacuated or sheltered-in-place.

This success received a lot of attention from the press and county government and I was asked to speak to the DHS legislative advisory sub-committee on special needs facility regulation. They provided me with a copy of current legislation, which I rewrote. I also told them I would develop a basic plan, planning guidance and a training course for facility administrators/risk managers.

From December 1999 to March 2000, I worked with planners from DEM, DHS and Texas MHMR and we developed what we feel is an excellent planning document for special needs facilities. DHS accepted what we developed as we wrote it. Recently, I was informed that effective immediately, the regulations that govern special needs facility planning had been changed to reflect suggested changes, almost verbatim.

Old regulation stated the facility must have a plan, must address evacuation transportation, shelter, supplies, staffing, equipment, emergency power and must coordinate with local emergency management when dealing with natural hazards.

New regulation requires facilities to have a written plan, attach procedures to the plan, address direction and control, warning, communications, shelter, evacuation, transportation, health and medical needs and resource management. It also requires they address all applicable hazards and coordinate with emergency management (includes signature on the plan that indicates receipt of a copy).

In order to assist facilities in making the transition, we developed the aforementioned standardized basic plan to reflect all the changes. It follows emergency management concepts, aligns with current formats, addresses critical core areas, ensures coordination.

It requires the signature of the facility administrator, the DHS long-term care regulatory regional program manager and the emergency management coordinator. It also requires a short hazard analysis be completed in conjunction with emergency management. This ensures the two entities coordinate.

I have nearly completed an 8-hour course for facility administrators guaranteeing they leave the classroom with a nearly completed plan that meets regulatory requirements.

I am meeting next week with emergency management in Amarillo, Texas to discuss a pilot project in that community that would involve training up to fifty facilities. I have discussed a similar project with Beaumont/Jefferson County.

Plans can also be developed from the sample plan and planning guidance document we developed. It is our hope that we can effectively do more in the next couple of years than has been done in the past. We've already accomplished a great deal in this endeavor.

I could go on but I think I can best fill in the gaps by answering your questions, both now and after you've seen the documents. I'll take your questions now.

[Audience Questions /Comments]

Amy Sebring: Thank you, Mitch for that introduction. Audience, please enter a question mark (?) to indicate you wish to be recognized, compose your comment or question, but wait for recognition before hitting the Enter key or clicking on Send. We now invite your questions/comments.


Dave Boyer: Have you or will you post the sample plan and guidance on the web?

Amy Sebring: For those that joined us in progress, copies are available from our Library. There is a link on today's background page at <http://www.emforum.org/vlibrary/000510.htm>.

Mitch Cooper: They are posted on this Forum at the address Amy gave. We also plan to put them on our Web site when they are finalized.


Jane Kushma: What do you believe is motivating the communities to participate?

Mitch Cooper: That's a tough one to answer. I'd like to think they are doing their civic duty with a big push from us. Also, most don't fully comply with regulations and this ensures they do.


Marilyn Barker: Do we wait for you to approach us to set this program up or can we proceed on our own? Also, do we invite all nursing care facilities in our area (which number in the 50's)?

Mitch Cooper: You can do it either way. I have sent the draft plans to a couple of jurisdictions and asked them to run with it. I am only 1 person and have a limited budget. If you can get all the administrators together for one 8-hour day, I can do a course.

Marilyn Barker: Okay, thanks. I downloaded the docs and they look pretty good.


Dave Boyer: Is there a legal interpretation of what is a special facility in Texas and what requirements are placed on them by law?

Mitch Cooper: Yes. There is a health and safety code for nursing homes, assisted living centers and MHMR facilities (one code each).


Avagene Moore: I commend the State of Texas for this approach. Florida has done an excellent job as well. Where are other states in this? Will it take similar regulations to push this type of planning across the country?

Mitch Cooper: I am only familiar with Florida as I looked at what they have done --- not familiar with other state approaches. Probably most states are regulated. It's getting the homes to interpret the regulations and correctly use emergency management planning.


Amy Sebring: Mitch, on her second part, have you had any interest yet from other states?

Mitch Cooper: I really haven't had time to share with other states yet. Am just now finishing the draft plans and course.


Roger Kershaw: Is there any sign-off by the local emergency agencies? I ask because in Connecticut where I'm from certain facilities require fire departments, etc., review of the plans. Other facilities do not. It just seems a good idea when we're all familiar with the plans, from the service end too.

Mitch Cooper: Yes. The new regulation requires coordination with the EMC and has a signature block on the plan that signifies coordination and receipt of a copy.


Diane Middleton: Is the thought with this that it would come from a state level or local? We (local) also have minimal staff time but many special-needs facilities. How much time have you seen is required to work with these facilities? Which agency is mainly responsible for assisting them develop their plans?

Mitch Cooper: At present, there is no agency "required" to assist them with their plan... They are regulated by DHS, but they have no emergency planners. Our goal is to provide an easy format for them to use. If they attend the course, they will come out with a plan that is 90% done. Then, they have to work with the EMC to finish it before they get a completion certificate. They can also use the draft plan to do their own plan. FYI, they are not required to use the format I developed, only to have the things in it required by the regulations.


Ed Pearce: An "in the trenches" question for fellow participants as well. Where can I get actual strategies? For Example: Fire Evacuation when limited staff is on duty, command and control of multi-story evacuation is difficult. Local Fire Department was little help.

Mitch Cooper: I suggest the EMC or fire department. Every facility is different. That's why we don't recommend procedures.


Joshua Lichterman: Will you post the model legislation? A group of us in California are approaching legislators.

Mitch Cooper: I can email the draft provisions to you or anyone else. Just make a request after the presentation.

Amy Sebring: We will ask you to put up your contact information at the end.


Peter Picanso: In Los Angeles it is estimated that there are over 85 languages spoken including ASL, is this addressed under the category of "special needs"?

Mitch Cooper: Special needs for emergency planning purposes only refers to the types of homes.

Amy Sebring: I think we have lost Mitch again. While waiting, I would like to mention the guidance includes identifying potential shortfalls in capability. I think this is a unique consideration and valuable info for the emergency manager. Has anyone here reviewed JCAHO's "Emergency Preparedness in Health Care Organizations" and if so, did you find it helpful? See <http://jcaho.upgrade.com/jcaho/product.asp?dept%5Fid=21&catalog%5Fitem=106> . Mitch is back.

Mitch Cooper: Yes. While that definitely fits the category of special needs, we are only addressing special needs facilities.


Amy Sebring: Mitch, do you have any comment on the JCAHO guidance?

Mitch Cooper: I haven't reviewed it, but I will.


Tanna McKeon: Have you done a full-scale exercise with a facility and did you encounter any problems? We had a nursing home here in Monroe WI that did an exercise with the patients and one had a heart attack. Do you know of anyone here in Wisconsin that would be a good contact for helping us with plans?

Mitch Cooper: We have conducted many exercises (in my former life at DEM) that included nursing facilities. They generally never did too well which led me to my present efforts. I can put you in contact with Wisconsin EM, but I don't know who regulates homes there.

Amy Sebring: I expect Hurricane Brett was the full-scale!

Mitch Cooper: That's a fact. While the homes in Cameron County did great, a home in another county evacuated just fine but then called the state DEM to ask where to go.


Ray Pena: Tanna, I'd be willing to help you out! Two Questions for Mitch: Once the plans are done, what happens (exercises, regular meetings, etc.)? And, do you work with other agencies that serve people with special needs (agencies that serve people for whom English is a second language, community-based residential facilities, the poor, etc.?

Mitch Cooper: The biggest plus for these programs is not the paperwork. It's getting the coordinators and administrators together. DEM, DHS, MHMR and TDH all worked together to help develop the plans. It is my hope that we will continue to bond this coalition in the future. Once the test class is done, the coordinators should be able to conduct classes on their own and hopefully the project will snowball.


Bob Tabler: Though Florida may have a good plan, not all facilities are up to par. For example, during our last evacuation in Hillsborough County the Special Needs Shelter did not have enough bathrooms, beds designed for disabled, and a big problem was lack electrical outlets. Does your plan address these problems with facilities being used for the Special Needs population?

Mitch Cooper: Our plan is a basic plan that tells folks what to address. Each facility has to develop their own procedures based on their needs. We can't do that for them. We encourage them to have contracts with sister facilities that already care for persons with special needs, rather than going to a shelter.


Amy Sebring: This is for resident facilities, Bob. There is a continuing need in the home care area, wouldn't you agree Mitch? Any future plans there?

Bob Tabler: Thanks for clearing that up.

Mitch Cooper: We tried to address home care, but that situation is so fluid, it's almost impossible to keep up with. It changes daily and the only thing we can recommend is for the coordinator to work with the home health care agencies and ask them to keep them advised as to their situation.


Darla Chafin: Maine now requires small facilities to have own evacuation destinations for licensing. EMA at all levels of government helps and again tries to coordinate with other agencies, but we offer and wait for request. Of course very small special needs facilities that may have very high need clients are not required to license (less than 3). I know you have small, high needs homes with people that used to be in your institutions. Have you had any requests from them?

Mitch Cooper: Do you mean assisted living or MHMR homes that have only a few people?

Darla Chafin: MHMR homes, specifically.

Mitch Cooper: They are governed under this regulation and must have a plan as well. Several were included in our pilot projects.

Darla Chafin: Thanks, if you have anything on that, I'll contact you later


Diane Middleton: Do you see this training you talk about being done by the state or locals? If at the state level, do you have recommendations for getting that process started? We are in Washington State.

Mitch Cooper: Not at the state, if you mean state EM. I plan to conduct some courses, but would like to turn it over to the local emergency managers, eventually. Will keep everyone posted if they will send me their email addresses later.


Joshua Lichterman: Have you addressed the issue of identifying people with mobility related disabilities living independently in the community when mass evacuations need to occur? The other issue is protecting them from people who would do them harm.

Mitch Cooper: That's either a home health care issue or a local issue. Most emergency managers I talk to try to keep up with that information and address it in their local EM plans. Protecting the individual evacuee probably does not fall under our jurisdiction; that would be a local issue.

Bob Tabler: Joshua, if you are interested, Hillsbourgh EOC has developed a good comprehensive plan for transporting the homebound to Special Needs Shelters. I have a contact.


Amy Sebring: Mitch, it looks like you plan to take a train-the-trainer approach with your course, is that correct?

Mitch Cooper: That is correct. If Amarillo works out, I might let Robert Smith teach (surprise Robert) in Beaumont with me watching to see how it goes.

Russell Coile: Pacific Grove Police Dept has a contract with AT&T Translation in Monterey, CA, a national resource 24/7 as long as telephones work. Also FEMA/EMI has a course "Disaster Related Needs of Seniors and Persons with Disabilities" SM 250.3

Robert Smith: In Beaumont, Jefferson County and Orange we have a project for identifying the special needs population. We are currently addressing those through home health. The program is based on Florida's idea. We have a law passes to protect ID of special needs person (HB 1353) and are working on a computer program to keep up with them and educational program to train home health personnel. We have formed a group with Lamar University Nursing , local EM and home health and vendors. We formed in 1997.

Amy Sebring: Great Robert. Mitch, further comments on this issue? By the way, we have a document of Robert's SNAP program in our Library that was featured in a FEMA Compendium of Exemplary Practice.

Robert Smith: Just a note that the SNAP program in the library and our new program are two different programs.

Mitch Cooper: Just that in order to bridge the gap between emergency managers and special needs administrators, you have to get them together and discuss pertinent issues. Then you can move on to plan development, etc.


Avagene Moore: Mitch, the Florida legislation has a fee connected with it to ensure that the emergency management office has the help needed to oversee the planning effort and review involved within their respective communities. Will Texas consider something like this to help with the planning process and enforcement? Any thoughts?

Mitch Cooper: It was tried about 2 years ago, but the Governor shot it down because it was attached to a utility fee. Don't see it happening here. On enforcement, DHS has surveyors that inspect homes. I will be training them also in the recognition of a good plan that covers all the fundamentals.

Final Question:

Amy Sebring: Thank you very much for being with us today, Mitch, and we wish you continued success in your efforts. Can you put up your contact info now, please?

Mitch Cooper: You can contact me via email as follows: [email protected]. Phone: 512-834-6700 x2471.


Amy Sebring: Thanks, please stand by while we take care of a couple of announcements.

For any first-timers, we will have a text transcript posted most likely LATE this afternoon that you will be able to access from the Transcripts link on our homepage. Then next Monday, we will have a reformatted transcript in both html and in Word for download. Again, the planning documents are available from the background page.

For those threatened by hurricane hazard, NOAA and FEMA had a news conference regarding the outlook for hurricane season this morning. We expect the Webcast will be archived at <http://www.broadcast.noaa.gov/> if you missed it.

There is also a Webcast scheduled for this afternoon, 1:00 - 3:00 PM Eastern time, on the Dept. of Justice Domestic Preparedness Program health portion of state assessments. See <http://www.bt.cdc.gov/DOJBroadcast.asp>.

We have a new pledge from Lynn Orstad in British Columbia. <//bell http://www.emforum.org/pledge.wav> Thanks Lynn!

Avagene, can you tell us what's coming up in the Virtual Forum, please?

Avagene Moore: I will be happy to share that information, Amy. Mitch, thank you for being with us today. Good information!

Mitch Cooper: You are very welcome.

Upcoming Event:

Next week, Wednesday May 17, 12 Noon EDT, we are pleased to present Janet Benini, CEM, Deputy Director of the Office of Emergency Transportation (OET) at the US Department of Transportation. Janet will address "Federal Transportation Resources in Disasters: The Role of the RSPA Office of Emergency Transportation."

The Office of Emergency Transportation manages the Departmental emergency preparedness and response programs including national security and domestic crises. The Office is also responsible for the integration of interagency programs both within and outside the DOT and management of Emergency Support Function (ESF) #1: Transportation, for the Federal Response Plan. Janet will do a superb job for us in the Virtual Forum -- make your plans to be with us next week. That's all for now, Amy.

Amy Sebring: Thank you, Ava. Thanks to all our participants today and the good questions. We will adjourn the session for now, but you are welcome to remain for informal discussion. You no longer need to use question marks.

[Please note: after the session, Mitch provided further information regarding the applicable regulations, which has been posted to the background page.

Russell Coile also provided the following additional information regarding the multiple language issue. "AT&T Language Line Services, Monterey, California was sold and the new company is now "Language Line Services" at 1 800 752-6096. LLS has translator/interpreter services for 140 languages. Listen to a demonstration (for free) on 1 800 821-0301. The cost for intermittent use such as for emergency managers is a one-time application fee of $75 for "Membership Interpretation", plus annual retainer fee of $35. Then the cost is $4 per minute daytime and $4.50 per minute at night, weekends and holidays."]