[MUSIC] I'm JJuliana Bilowich with LeadingAge and now I'll be talking with you about emergency preparedness plans for senior housing providers navigating COVID-19. Starting with our learning objectives, we'll review considerations for emergency planning and response. And we'll identify CDC that Center for Disease Control recommendations and resources. And we'll discuss tools for emergency preparedness during the planning, response, and recovery phases. And finally we'll expand our awareness of emergency scenarios. First, let's set the stage here. What are things that senior housing providers have to consider when preparing for, responding to, and eventually recovering from an emergency like COVID-19? Of course for independent housing providers, there is just little direct guidance. Leaving broad leeway for the property staff and the owners to set policies and procedures that best fit their community's needs. And through these decisions housing providers need to balance federal and state and even local requirements or restrictions. Like mask ordinances or reporting requirements or Privacy Act restrictions. All of these decisions are made with an eye toward addressing not only the housing needs of residents served, but also the health needs. Because housing is a determinant of health. Managing workflow is another important consideration because the plans and policies you make will need to be implemented by the staff at your communities. Even if they themselves have been impacted by the crisis. So that includes number of staff, for example, design of your building, availability of project funds and other factors. And lastly, housing provider preparedness plans should consider equitable recovery from a crisis, meaning that everyone in the community should be able to recover together. An example of an inequitable preparedness plan would be to distribute information about COVID-19 in only one language, when many residents in the community might not have English language proficiency. Or to move all communication activities to a virtual platform when some residents are hard of hearing or have visual impairments and may not be able to participate without modifications. Let's start with an overview of the guidance that's available for housing providers and then we'll take a closer look. First, there are various guidance documents and recommendations from the CDC that impact housing communities. Of course state and local health directives, but also health resources or partnerships through your health departments and other entities. Then HUD that's the Department of Housing and Urban Development has also issued COVID-19 FAQs for multi family housing providers, including those serving seniors. And that's in addition to regular HUD requirements. And also special COVID-19 waivers from HUD. Lastly, housing providers can utilize information from the EPA that's the Environmental Protection Agency. In particular, the EPA's list of disinfection products that are effective against COVID-19. Starting with the CDC, two different kinds of guidance are available here for housing providers. One is a resource specific for multi family housing providers, serving those at higher risk for the virus, based on age, and other factors. And the CDC has also issued guidance for settings, or populations, that are in many ways relevant to multifamily housing providers. Like guidance for congregate settings, workplaces for increased risk populations. This can help you navigate your employee practices for example, or help with distributing COVID-19 educational information to residents. Within the CDC's guidance, that's specific for owners and operators of multifamily housing providers serving a high risk population. The agency has recommended five steps you see on this slide. It starts maybe unsurprisingly with developing a response plan, but developing one that's considering the unique needs of the population you're serving. In terms of risk, ability, and capacity. So for example, your response plan, shouldn't solely rely on distributing information to residents via email. If many residents don't even have access to the Internet. It could also mean initiating your response plan earlier than a housing provider who is not serving at risk populations. So that you can set safety precautions in motion as soon as possible. And as you develop your response plan, the CDC is recommending that you collaborate with your health departments for more specific information for your area, and for help making decisions about when to scale up or relax prevention measures. Next, the CDC recommends promoting behaviours that reduce the spread of the virus. We'll go into this in depth later in the course but this could include closing common areas to encourage social distancing, requiring masks, stocking up on sanitation supplies like hand sanitizer to encourage disinfection practices. Once again through all of this an individualized approach may be needed for people with physical or intellectual disabilities, or for those with difficulty accessing information. Next is to maintain healthy environments and healthy operations. Healthy environments include steps like increasing air ventilation, and making sure even that the water supply is safe. Or modifying building layouts to ensure safety during an infectious disease scenario. And healthy operations relates to policies around unit turnover, visitation, and other property policies and more on that later in the course. Lastly, on the CDC recommendations is preparing for when someone does get sick. Either suspected or confirmed and being prepared for the steps that you as a staff and a community will take. In addition to those five CDC recommended steps for multifamily housing providers, property staff should also consider two things, state and local requirements and that could be for the residents or for the staff. So if your state has a requirement that all employees in a public space, wear a mask, you'll need to figure out how to implement that into your plans. Or a reporting requirement if you become aware of a confirmed case. And next are the HUD requirements that include the multifamily housing COVID-19 FAQs which by the way has grown to many pages over the past several months. And then chapter 38, which is the disaster response chapter in the HUD handbook. And while it has limited applicability to an infectious disease emergency, it still has requirements for housing providers to consider. And lastly, HUD has recommended the use of capacity building tools to help prepare your communities for a crisis, especially when considering the unique needs of the population you're serving. And we'll walk through those tools together. As you think about how to prepare for, and also learn from a crisis situation, you're focusing really on how to be better positioned in the future. In other words, you're building resiliency. And that's at various levels, operational resiliency, community resiliency and resident resiliency. What does that look like at each level? For operational resiliency a key piece is the ability to have a remote workforce. And this applies to a pandemic situation, but also to other kinds of emergencies like power outages or wildfires. You might consider the role of technology and connectivity to be able to access necessary files and systems, even when staff can't be on site. Flexible staffing arrangements are a big one here too. And we've seen how nimble housing providers have been throughout the crisis. By, for example, increasing pay for frontline staff, allowing flexible working hours for those whose kids are now attending school from home and need support, and moral support has also been key. Of course, consider task reassignments and cross training to cover gaps. Lastly, here in terms of building operational resiliency, our backup plans or reserves, and that's not just financially but also in terms of equipment, supplies and personnel. For community resiliency, you want to consider flexible programming, that you can put into place including virtual adaptations and other adjustments. And you'll also want to consider how rapidly you can adapt to community needs, for example by adjusting service coordination models from in-person resident checkings to phone calls. And by leveraging partnerships from the broader community. And, lastly, for the community resiliency is supply chain management and having a contingency plan in place not only if your current supply systems become disrupted, but also for new supplies and services that become necessary because of the current crisis. PPE isn't really the best example here. Finally, resident resiliency and this is the biggest goal for housing providers. The real reason we provide housing stability for older adults with low incomes. So that they can become more stable and resilient. And in order to build that resiliency, housing providers can help residents foster connections to resources, both within the community and externally. You can increase support systems and again, connectivity is a big one here in terms of access to technology for information and telehealth. One thing I want to just zoom in on and that's resources that you need to continue operating during the pandemic and other emergencies as well. So for resources, consider your PPE needs. And that's both for staff and residents. Your employees are a critical resource of course and more specific to COVID-19, testing and eventually vaccine access, as well as cleaning and disinfection supplies. Two other resources not to be overlooked during this crisis. And that's first information. Information as a resource has been critical and making sure it's timely and accurate. And that's both the information you receive and the information that you share with residents. And secondly, technology. And that's technology that needs to be both available and accessible. Now let's talk about what are called capacity building tools that can help you prepare for a crisis. A few things you might want to consider. We'll take a look at each of them together. First, prioritizing your workflow, in particular by utilizing job continuity planning. Next, adjusting your systems through risk assessments. And this is something that will be an ongoing task. Then assessing your capacity as early as possible through employee surveys, for example. And then identifying or continuing to identify lessons, for example, through staff debriefs. Let's take a look at the examples. Job continuity planning worksheets can be used for continued operations during an emergency and then during the recovery phases of the emergency. The worksheet can map out daily functions that should be maintained, adapted and even prioritized. Next, your risk assessment table. This is a tool that assesses your risks, weaknesses and strengths in operations. You can use it to generate an overall hazard rating and prioritise functions accordingly. On the right, I'm showing the use of the risk assessment table to generate a hazard rating for a common operation within housing communities that's movement. You can determine the hazard that might be exposure between the new resident and existing residents of the community. The scenario could, for example, be an interaction in a hallway while the new resident is moving in. In terms of opportunities for prevention, you could reduce the interactions by offering the new resident limited time slots to move in and entry paths to get into the building, and then notifying other residents to avoid that hallway during that time. This is also impacted by your existing mitigation strategies on site. Like the mask ordinances you might have, or screening tools you use for vendors or contractors, which in this case could mean the moving personnel. All in all, this generates a hazard rating of about medium. It's something you can control, but it still has a hazard associated with it. Next in terms of capacity building tools are an ADA compliant employee survey. ADA that's the Americans with Disabilities Act. And this is a worksheet for employers to plan for staff absenteeism during a pandemic. These include non medical reasons for being absent as well as medical reasons for being absent but it is all ADA compliant. A couple examples on the worksheet include if schools or daycare centers were closed, that employee might need to care for the child. Or if public transportation were unavailable, they may not be able to travel to work. The worksheet allows an employee to select yes for a scenario without specifying the specific factor that applies to them. This keeps it ADA compliant. Lastly, in terms of capacity building tools, our staff deeper use or what's called a hot wash template. Many of you are already familiar with this. This is a tool for staff to focus on deliberate and cooperative, restarting of operations. For example, on the right, I have a hot wash template example about staff interactions during the pandemic. Starting with things that worked, daily remote team check ins may have helped staff feel connected and part of the bigger solution. In terms of identifying areas for improvement, perhaps staff want to feel listened to and given the opportunity to provide feedback and decisions that are made. The overall comments received during the feedback may have included that staff continue to feel committed, but need continued moral support to do their jobs. Another example for the staff debrief could be for things that worked doing income recertifications with residents through an emailed copy of the signature which heard is temporarily allowed. But in terms of identifying areas for improvement, maybe not all residents were aware of their options for income recertification if they lost income during the crisis. This could be improved by increased communication, for example, using the resident brochure that HUD has made available for this. Under general comments, maybe the staff debrief generated that a certain community has almost caught up on all of their recertifications if they were delayed during the pandemic. All in all these capacity building tools provide some examples for communities to have stronger preparedness during and after the pandemic. Before we close this section, let's briefly review other emergencies that impact housing providers and how the response might have to be adapted in the context of the pandemic. These include natural disasters like wildfires and hurricanes, but also other emergencies like building fires or power grid disruptions. And another big one here, especially in this health context is flu season and making sure your residents are protected. So that they don't have to go to the hospital for the flu and risk exposing themselves to COVID-19. Each of these types of scenarios require different kinds of planning because of COVID-19. For example where in the past you may have hosted a flu shot clinic in a big common room, you might instead move it outside into the parking lot. Or set up time slots for each resident and set up one way traffic to and from the location in a common area. You also want to make sure that your hurricane or wildfire go-bags and those of your residents, include PPE and hand sanitizer. And that your evacuation plans are up to date with new or different information from the Red Cross and FEMA related to the pandemic. The CDC and FEMA that's the Federal Emergency Management Agency have issued recommendations for disaster preparedness during the pandemic. And of course, HUD's chapter 38 requirements are still in effect. Using all these strategies will help you, your staff and your communities get through this crisis together. [MUSIC]
