Effective Emergency Plans Keep Hospices Running in a Disaster

A disaster or severe weather event like recent tornadoes in Missouri and Ohio can shut a hospice down or cause suspension of operations, leaving patients without support and severely cutting into a provider’s bottom line. When hospices engage in effective emergency planning, they can mitigate risks to patients as well as their own financial health.

The U.S. Centers for Medicare & Medicaid Services, the primary payor and regulator of the hospice industry, requires a coordinated, systematic approach to emergency preparedness and operations through a 2017 final rule.

Hospice providers in emergencies often go to great lengths to reach patients and ensure that care continues. Local media reports following major events regularly feature headlines about hospice nurses canoeing through floodwaters or hiking through a blizzard on snowshoes to reach patients’ homes.


“The regulation does a good job of getting the hospice to communicate with the community emergency responders,” said Barbara B. Citarella, national healthcare disaster professional and

President or RBC Limited Healthcare and Management Consultants. “That’s the subtle brilliance of the document, because now the hospice is actually at the table with the disaster preparedness agencies; now we are a major player in the process. It gives us more clarity in our role during an event.”

Communication with local first responders, emergency managers, and incident commanders is essential to an effective disaster response as well as a key to complying with the CMS rule, which requires a written emergency operations plan that includes provisions for communicating with local, state, and federal agencies, as well as the hospice’s own staff.


Response agencies need to be notified if the hospice cannot continue operations or if patients or staff need rescue or evacuation. The hospice would notify their state emergency management office, local first responders, their department of health, and other stakeholders.

“The mechanism always starts at the local level and then escalates up,” Citarella told Hospice News. “So it is important for hospice agencies to know who is in charge of managing the event, who the incident commander is, where is the emergency operations center is located. That is an area where I see the most weakness in the field, hospice providers don’t always know the mechanism for who to contact.”

CMS requires the hospice’s emergency operations plan to address the five areas of disaster preparedness: Hazard identification—anticipating potential risks that could impact operations, hazard mitigation—actions taken in advance to minimize identified risks, as well as preparedness, response, and recovery.

Plans need to take into account not only the hospice’s short-term operations, but also the long term should disaster conditions persist.

“In 2019 weather-related events are going to be a real test for hospices treating patients in the home,” Citarella told Hospice News. “As an industry hospice does well during short-term events like severe storms or heavy snows, but they can struggle during events that may require a longer amount of time for recovery. That will be the challenge, how to continue to provide essential services to those patients.”

A key component of developing a plan is testing and training staff on their roles in an emergency. The CMS rule requires two emergency drills each year. These can include tabletop drills led by a facilitator, functional tests, or a full-scale exercise or participation in a community-wide exercise. Some hospices also perform drills in partnership with other area health care providers for a comprehensive assessment of how providers can collectively fulfill the community’s health care needs.

Though CMS doesn’t require it, Citarella recommends an additional step.

“Once a quarter the hospice can do a mini drill, a deep dive into one small aspect of their emergency operations,” she said. “For example, how quickly can they locate their staff who are out in the field, or how quickly can they get a patient census. Because the [CMS] surveyors will come in and ask, what is your primary way of communicating, and if that doesn’t work what is your secondary method? The hospice has to have answers to those questions.”