Hello, my name is Morgan Katz. I'm an assistant professor of infectious disease at Johns Hopkins University. I'm going to talk with you today about forming your emergency preparedness plans in your community. First, we will discuss how to identify and delegate roles to your incident command team for an emergency response to Covid. We then will talk about identifying and preparing physical space for positive or exposed residents, the importance of updating advanced directives and finally, I'll share some materials to help you draft your emergency preparedness plan for Covid-19 in your community. Emergency preparedness is incredibly important to adequately address this pandemic and forming a clear response team allows you to delegate and address the many challenges that may arise. The most complete plans are prepared by a diverse planning team, including internal stakeholders, such as residents and family members, as well as administrative and executive level employees. External stakeholders may include personnel from local emergency management offices, law enforcement, or service providers such as hospice and home health partners. First, we recommend identifying a core incident command team that will meet regularly to discuss changes that may arise throughout your response to Covid-19. Listed here on the slide are some examples of individuals you may want to include in your team. We recommend including members of the administration such as the CEO or president, as well as staff who are working at the point of care, such as the Director of Nursing or Wellness Care Coordinator. So that they Incident Command team has a clear understanding of the issues that are arising throughout various levels. Some communities, of course are quite small and your incident command team may only include the CEO and the Director of Nursing. This is okay too, as long as you make sure that you delegate all the responsibilities necessary to a specific individual. Delegating tasks is of paramount importance here. One person is not capable of managing the Covid response for your community and ensuring that roles are clear before an outbreak is an absolute must. There should be no uncertainty regarding who is responsible for major tasks. One individual should be designated to be responsible for staying up to date on all of the potential regulations on a local, state, and federal level. This person should be given time to look up any new guidance at the beginning of each day, and also to attend any Webinar's offered by the health department or CMS. This is a big job. They should have a contact with the local health department to ask questions and clarify any issues with changes in regulations. Changes in regulations may include; how to report positive cases or who to test and how often to test in the facility. All of these can change on a daily basis. It is important to have someone looking at this regularly. One individual should also be responsible for monitoring and maintaining your supply of personal protective equipment. Plan to have a minimum three months supply and identify several different suppliers in the case of shortage or delays in deliveries. This person should be aware of contacts to the local and state health department to request emergency supplies. Do not wait until you are in crisis capacity before notifying the health department, as it can take up to a week or more to receive these supplies. Next, you should designate one individual to be responsible for obtaining access to Covid-19 testing and creating policies and procedures to perform any testing necessary. As you know, the policies on testing have changed throughout the course of this pandemic and this individual should be responsible for staying up-to-date on regulations or recommendations in regard to testing. They need to think about access to test kits, who will obtain the test specimen and how they will be obtained. We also recommend designating one person responsible for making sure you have adequate staffing throughout the course of the pandemic. We're learning more and more through research. How important adequate staffing is in nursing homes and assisted living communities to reduce the size of outbreaks of Covid-19. This is an incredibly important job. This individual should be responsible for updating and reviewing staff return-to-work forms based on symptoms and positive tests and ensuring that you have access to backup staff and a clear contingency plan. Next, someone should be responsible for communication, in larger communities this may be the marketing director. Communication is important, both of the residents and family, as well as external stakeholders, including the media. Finally, you need to have a designated individual to address infection prevention. This means training staff and the importance of hand hygiene, how to don and doff PPE, how to maintain physical distancing in the community and regular and adequate environmental cleaning. Displayed on this slide is an example of a spreadsheet you might want to use to identify the information needed and delegate who is responsible for obtaining that information. Delegating these roles earlier rather than later can help to prevent confusion down the road. Let's take a minute to talk a little bit more about staff contingency plans. As I mentioned, having adequate, reliable, trained staff who are complying with safe practices is probably one of the most important actions to preventing large outbreaks in your community. Because of this, delegating someone to be responsible for ensuring you have adequate staff with contingency plans in case staff gets sick is incredibly important. This individual should conduct a daily assessment of staffing status and needs in both a non outbreak and outbreak setting. While it is best to avoid agency staffing if possible because they can work at several facilities and potentially introduce the virus in your community, there should be a contingency plan in place to use alternate staff should you reach a situation that you do not have enough staff in-house to provide care for the residents. You can also consider reaching out to local hospitals and clinics for additional staffing. Many of these settings have had openings with decreased ambulatory flow. There should be a clear understanding of the minimum staff required in a crisis and a trigger to initiate the contingency plan and use agency or hospital staff as needed should you get close to reaching this point. Additionally, we recommend reaching out to your state to explore emergency waivers to hire staff in dire circumstances. Preparation is key here. Next, think about walking through and preparing your physical environment for positive cases, those that need to be isolated, as well as individuals that may need to undergo observation because they are new admits or have had a potential exposure. Those that need to be quarantined. First, determine a desired location to place COVID-positive residents and those under observation. These observation areas ideally should be areas where residents can have their own private room and bathroom, and the area can be accessed through a separate entry so the individual or staff entering this region will not have to walk through the rest of the community. It is acceptable but not ideal to have to have two COVID-positive residents housed in the same room if private rooms are not available. We do not recommend doing this for observation residents, however. Areas where staff have space to don and doff their PPE should be identified even before there are cases in the community, as well as a separate staff quarters, which includes the break room, charting room, and the restaurant for staff working with infected residents. Specific equipment should be identified to areas which are designated for positive residents. This equipment should not leave that part of the community. Now let's move on to updating advanced directives. All residents should have the opportunity to review and update their advanced directives on a regular basis. This is even more important in the setting of a pandemic with the potential for the need for prolonged ventilator support if infected. If possible, reaching out to palliative care teams to discuss the risks associated with a pandemic and ensure that each resident understands and conveys their wishes regarding hospital transfer, whether they could consent to intubation, or whether they would prefer to remain in the community is an incredibly important step to address resident's wishes appropriately. Having this information in a spreadsheet form, accessible and available, should a crisis or outbreak develop, should be part of your emergency preparedness plan. Finally, we cannot emphasize enough the importance of over communication. So much confusion can be avoided by providing a clear, truthful picture of the communities plans prior to an outbreak and should a case be identified, family members and resonance should be given information regarding plans for cohorting positive residents, how testing is being performed in the community, plans for safe visitation, and procedures for hospital transfer. Without adequately communicating information, even best-laid plans will be scrutinized. Over-communicating will give your staff and residents comfort and will help to avoid complaints and potentially lawsuits. We recommend preparing communication both for internal sources such as staff, as well as external communication for family members or their press prior to any identified case in the community. This allows you to communicate this information in real time so that you do not have to waste time that may be needed to address the outbreak should this situation arise. Communication is a key feature of ensuring that the community is satisfied and your staff are responding appropriately. As we discussed, delegating a point person for this important job is imperative.