Citation
Organizational effectiveness and emergency planning in institutions housing the developmentally disabled

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Title:
Organizational effectiveness and emergency planning in institutions housing the developmentally disabled
Creator:
Le, Sopjia Kim
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
Publication Date:
Language:
English
Physical Description:
xii, 118 leaves : ; 28 cm.

Subjects

Subjects / Keywords:
Organizational effectiveness ( lcsh )
Emergency management ( lcsh )
Group homes for the developmentally disabled ( lcsh )
Developmentally disabled -- Housing ( lcsh )
Developmentally disabled -- Housing ( fast )
Emergency management ( fast )
Group homes for the developmentally disabled ( fast )
Organizational effectiveness ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (M.P.A.)--University of Colorado Denver, 2011. Public administration
Bibliography:
Includes bibliographical references (leaves 109-118).
General Note:
School of Public Affairs
Statement of Responsibility:
by Sophia Kim Le.

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Source Institution:
|University of Colorado Denver
Holding Location:
|Auraria Library
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
747032844 ( OCLC )
ocn747032844

Full Text
ORGANIZATIONAL EFFECTIVENESS AND EMERGENCY PLANNING IN
INSTITUTIONS HOUSING THE DEVELOPMENTALLY DISABLED
by
Sophia Kim Le
B.A.. University of Washington. 2008
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Masters in Public Administration
2011


This thesis for the Masters in Public Administration
degree by
Sophia Kim Le
has been approved by
Brian J. Gerber
Date
Deborah S.K. Thomas


Le. Sophia Kim (Masters in Public Administration)
Organizational Effectiveness and Emergency Planning in Institutions Housing the
Developmentally Disabled
Thesis directed by Associate Professor Brian J. Gerber
ABSTRACT
Catering to understand the needs of the disabled population has been an important
issue in the field of emergency management. However, there has been little research
on the developmentally disabled populations and of populations in long-term care or
institutional settings. Using organizational effectiveness theory, this research sets out
to determine emergency planning performance at state-run institutions housing the
developmentally disabled in four states: Washington. Colorado. South Carolina, and
New Jersey. These states were selected due to their variation in policy structure,
hazard risks, and rate of institutionalization. Emergency response plans from each of
the facilities in the four states were selected and then analyzed for common themes in
their content. In addition to this, a randomly selected institution from each state was
interviewed about emergency planning processes and how successful they deemed
themselves. It was discovered that there were various barriers that each state suffered
from in implementing emergency planning procedures, which ranged from resource
power to lack of structure. It w;as also found that increased hazard risk might drive
institutions to perform better at emergency planning. It is recommended that lesser
successful states examine their more successful counterparts and implement such
practices into their own departmental and institutional entities.


This abstract accurately represents the content of the candidate's thesis. I recommend
its publication.


DEDICATION
I dedicate this thesis to my family, who taught me the importance of education and
perseverance. I also dedicate this thesis to Carol Kirk and all of the staff at Frances
Haddon Morgan Center, for their work and passion to the developmentally disabled
community. Lastly. I dedicate this thesis to Matthew Kirk, for his unwavering support
during the duration of my academic career.


ACKNOWLEDGEMENTS
My special thanks to my advisor. Brian J. Gerber, for his intellect, sense of humor,
and support on this project. I also wish to thank Lloyd Burton and Deborah Thomas
for their valuable insight and words of wisdom. Lastly. Id like to thank the
Washington State Department of Social and Health Services in Washington; the
Colorado Department of Human Services, the South Carolina Department of
Disabilities and Special Needs, and the New Jersey Department of Human Services
for their willingness to participate in this research.


TABLE OF CONTENTS
Figures.......................................................... x
Tables........................................................... xi
CHAPTER
1. INTRODUCTION.................................................. 1
Background/Problem Definition.............................. 1
Research Questions......................................... 3
2. REVIEW OF THE LITERATURE...................................... 5
Social Vulnerability and Special Needs Populations......... 5
Definition of Disabilities and Approaches to Policy........ 7
Legislative History for Disabled Populations and
Emergency Management....................................... 8
Issues of Long-Term Care Facilities and Emergency
Management................................................. 10
The Developmental^ Disabled in History..................... 11
The Developmentally Disabled and Emergency
Management................................................. 15
3. CONCEPTUAL FRAMEWORK.......................................... 17
The Origins of Organizational Effectiveness................ 17
Government Performance & Why Management Matters............ 19
vii


Organizational Effectiveness and Emergency
Management............................................... 20
4. METHODOLOGY................................................. 24
Sample................................................... 24
Instrumentation.......................................... 24
Data Analysis............................................ 32
5. WASHINGTON.................................................. 34
Plans.................................................... 36
Interview................................................ 41
Analysis................................................. 46
6. COLORADO.................................................... 47
Plans.................................................... 49
Interview................................................ 53
Analysis................................................. 57
7. SOUTH CAROLINA.............................................. 58
Plans.................................................... 59
Interview................................................ 60
Analysis................................................. 64
8. NEW JERSEY.................................................. 65
Plans.................................................... 65
viii


Interview.............................................. 73
Analysis............................................... 77
9. OVERALL FINDINGS.......................................... 78
Overall Findings from All Emergency Plans.............. 78
Overall Interview Findings............................. 81
10. CONCLUSION............................................... 84
Policy Structure....................................... 84
Rate of Institutionalization........................... 85
Hazard Risk............................................ 86
Other Factors and Limitations.......................... 87
Policy Recommendations................................. 88
Summary................................................ 92
APPENDIX........................................................... 94
A. RECRUITMENT MATERIAL...................................... 94
B. CODING PROTOCOL........................................... 95
C. INTERVIEW SCRIPT.......................................... 99
D. OPEN PUBLIC RECORDS ACT REQUEST.......................... 102
E. HUMAN SUBJECTS APPROVAL.................................. 106
REFERENCES......................................................... 109
IX


LIST OF FIGURES
Figure
E.l University of Colorado Denver Human Subjects Approval.................106
E.2 Washington State Human Subjects Approval.............................. 107
x


LIST OF TABLES
Table
5.1 Number of themes in Washington plans...................................... 36
5.2 Top three prevalent themes in Washington plans............................ 37
5.3 Top three prevalent themes in Plan 133.................................... 38
5.4 Top three prevalent themes in Plan 199.................................... 39
5.5 Top three prevalent themes in Plan 145.................................... 40
5.6 Top three prevalent themes in Plan 184.................................... 40
6.1 Number of themes in Colorado plans........................................ 50
6.2 Top three prevalent themes in Colorado plans.............................. 50
6.3 Top three prevalent themes in Plan 835.................................... 51
6.4 Top three prevalent themes in Plan 842.................................... 52
6.5 Top three prevalent themes in Plan 862.................................... 53
7.1 Number of themes in South Carolina sample................................. 59
7.2 Top three prevalent themes in South Carolina sample....................... 60
8.1 Number of themes in New Jersey sample..................................... 66
8.2 Top three prevalent themes in New Jersey sample........................... 67
8.3 Top three prevalent themes in Plan 698.................................... 68
8.4 Top three prevalent themes in Plan 602.................................... 69
8.5 Top three prevalent themes in Plan 636.................................... 70
xi


8.6 Top three prevalent themes in Plan 674...................................... 71
8.7 Top three prevalent themes in Plan 616...................................... 72
8.8 Top three prevalent themes in Plan 683...................................... 73
9.1 Rank of most prevalent themes in entire sample............................... 78
9.2 Top three prevalent disasters cited in entire sample......................... 81
B.l Coding Protocol............................................................ 95
xii


CHAPTER 1
INTRODUCTION
Background/Problem Definition
The process of managing disasters has changed rapidly over the years from its
former focus in response to its current focus in planning and prevention. No longer
are emergency managers tasked only with the cycle of mitigation, preparedness,
response, and recovery; now there are numerous factors to consider when planning
and organizing for communities. One subject that has come to light due to recent
disasters is that some populations are more vulnerable than others. This has led
experts to study this concept more rigorously in order to determine how to best serve
their needs.
In understanding why some populations are more susceptible to hazards than
others, scholars use the concept of social vulnerability. Social vulnerability deals with
the idea that social factors affect a group's ability to respond to and recover from a
disaster and can involve the basic provision of health care, the livability of places,
overall indicators of quality of life, and accessibility to lifelines (goods, services,
emergency response personnel), capital, and political representation" (Cutter, 2006).
One group that has been focused on post-Hurricane Katrina has been the
disabled population. Literature has shown that these populations are more often than
not living independently and that there is a disproportion of resources for these
populations to utilize during emergency situations. Vulnerabilities could include
inadequate evacuation routes, lower income levels than that of general populations,
and a lack of social networks, to name a few. While there have been reforms in the
1


last few years that have encouraged local governments to address the visually and
hearing impaired in their communities, there has not been much work dealing with
other types of disabilities, such as the developmentally disabled. Even more troubling
is the lack of study for disabled populations that are housed in group-home settings or
institutions. Because of this, there are bound to be problems with this particular
population with the next large-scale disaster.
There are two issues with the current literature that encompasses disabled
populations and how they are treated in disaster situations:
1) The lack of research in developmentally disabled populations
The majority of the work in addressing disabled populations focuses solely on
physical handicaps. While there are guidelines that address populations with
cognitive difficulties in an emergency, these guidelines refer to cognitive disabilities
as someone who lacks memory and needs help remembering things, failing to
recognize developmentally or cognitively compromised populations with conditions
that "may affect a person's ability to listen, think, speak, read, write, do math, or
follow instructions'' (NCD, 2009). For example, one tip regarding communication
refers to [thinking] about what a rescuer might need to know about you and be
prepared to say it briefly" (Independent Living Resource Center San Francisco,
2010). However, this model does not address the variations encompassed within the
blanket term of cognitive disabilities. There are a number of people who have
developmentally disabilities living in institutions or group-homes, and the literature
has not addressed those individuals.
2) The reliance on institutional entities to emergency plan for their clients
2


Though federal guidelines exist for disabled populations that live independently
within a community, ensuring their civil rights, the protections of the American with
Disabilities Act do not address those that live within a state run group-home or
institution. It is assumed that because state institutions reside under other
organizational authority, they have reinforced emergency preparedness and response
guidelines to each institution. However, these settings are often underfunded and staff
members are busy with rehabilitation activities with their clients. Another potential
problem is that managers may not have the expertise to emergency plan effectively.
Lastly, it is unclear whether or not state governments are vigilant in ensuring that
these facilities are properly prepared for disasters.
Research Questions
The purpose of this thesis is to compare state jurisdictions and study how they
address emergency planning for their institutions that house the developmentally
disabled. By looking to see the ways in which these institutions succeed or not, we
can build a dialogue for how states can better reinforce guidelines for emergency
planning for this population.
Research Question 1:
What information is being included in emergency plans for state-run institutions
housing the developmentally disabled?
a. What parts of the emergency plan are related to the needs of the
developmentally disabled populations specifically?
Research Question 2:
3


How successful are facilities at implementing emergency preparedness and response
practices, and if they are not successful, why not?
a. What aspects of facility plans create conditions for facilities to succeed or
not succeed in implementation?
By looking at the emergency plans for state institutions that house the
developmentally disabled and analyzing what procedures they have in place, we can
understand the knowledge level of organizational entities and can gauge how
effective they are in implementing their emergency plans.
4


CHAPTER 2
REVIEW OF THE LITERATURE
In order to explore the complexities of this topic, it is necessary to understand
the origins of vulnerable populations and how they have impacted the emergency
management literature. Then, a comprehensive history of the disabilities policy and
its relation to emergency management will be discussed. Lastly, the history of long-
term care and developmental disabilities and its impact on emergency management
literature will be covered. This will shape the context of the research in order to
understand the deficits in the knowledge surrounding this particular population.
Social Vulnerability and Special Needs Populations
The concept of people and their vulnerability stems from the work of Blaikie
et. al (2004). where they describe the theory as "characteristics of a person or group
and their situation that influence their capacity to anticipate, cope with, resist and
recover from the impact of a natural hazard... [these impacts could] include class,
occupation, caste, ethnicity, gender, disability, and health status, age and immigration
status, and the nature and extent of social networks (p. 11). However, later research
has suggested that this definition of vulnerability has grouped populations together
that have little, if anything in common.
The concept of social vulnerability has prompted emergency management
policy to group these populations into what is referred to as special needs
populations. This is defined as:
5


[Populations] whose members may have additional needs before,
during, and after an incident in one or more of the following
functional areas: maintaining independence, communication,
transportation, supervision, and medical care. Individuals in need of
additional response assistance may include those who have
disabilities; who live in institutionalized settings; who are elderly;
who are children; who are from diverse cultures, who have limited
English proficiency, or who are non-English speaking; or who are
transportation disadvantaged" (U.S. Department of Homeland
Security, n.d..).
While this breaks down Blaikie's concept of vulnerability into specific subgroups that
could need additional help during a disaster situation, Kailes and Enders (2007)
conducted a demographic analysis that counted all of the groups deemed as
"vulnerable" or "special needs" together. They found that over 50% of the population
could be considered as vulnerable, therefore deeming a need for more specificity in
the definition (p. 232). More research must be done on each particular population
considered vulnerable in order to determine the nuances while maintaining a
framework that is flexible for all special needs populations.
A further understanding of vulnerability goes past particular characteristics.
While a person may be disabled, it is not that person's condition that makes them
vulnerable. It is instead:
.. .the failure of society to recognize that a condition such as poverty
means you cannot mitigate risk, live in a safer location, or afford to
evacuate when told to do so. When disaster managers and political
leaders fail to design warning systems that reach people who are deaf
6


or to provide paratransit systems to evacuate a wheelchair user, society
bears responsibility for the consequences. Social vulnerability thus
results from social inequalities and historic patterns of social relations
that manifest as deeply embedded social structural barriers that are
resistant to change (Phillips and Fordham, 2010, p. 4).
This quote embodies that it is the environment in which we exist that
exacerbates the vulnerability of particular conditions like disabilities, poverty, and
ethnicity when a disaster occurs. Social vulnerability, therefore, diverges from the
dominant view that disasters are a "result of nature impinging upon human society
[and] there can be little done to change the situation" (Phillips and Fordham, 2010.
pg. 7). It instead emphasizes that there are conditions within society that become
more exacerbated when a disaster occurs, such as those characteristics that are
described as "special needs" populations above.
Definition of Disabilities and Approaches to Policy
Part of this literature describing "special needs" populations points to the
disabilities community as one that is particular vulnerable to disasters. According to
the Americans with Disabilities Act of 1990, an individual is considered as disabled if
they:
1) [Have] a physical or mental impairment that substantially limits a
major life activity
2) [Have] a record of such impairment
3) [Are] regarded as having such an impairment.
7


Many models have been used when addressing the disabilities population, and
policies have followed suit. First, the medical model was used, which treated a
disability like a sickness and was solely handled by the health care system (Clive et.
al.. 2010, p. 192). This is in contrast to the socio-political model, which views society
as a problem, due to their lack of accommodation for the disabled and, subsequently,
prejudice and discrimination (Hubbard, 2004).
But the model that has taken a stronghold in the disabilities policy arena is the
functional model, which emphasizes the differences of the individual and the
necessity for communication between the disabilities community and planners to
determine their needs in a disaster and how to best meet them (Clive et. ah, 2010. p.
193). This allows for customization, as each person's needs and level of functioning
are different. As a result, the majority of literature is focused on ensuring that
individuals maintain their own independence and capabilities, rather than segregating
them into an inclusive group that is portrayed as "needy" (Hewitt. 1997; Kailes and
Enders. 2007). This had led to advances in how certain types of disabilities are
addressed in the emergency management literature, specifically those with physical
impairments.
Legislative History for Disabled Populations and Emergency Management
Traditionally, anyone with disabilities was grouped together as a way to
signify inclusiveness. This pattern was first acknowledged in the Americans with
Disabilities Act of 1990. Its purpose is to [prohibit] discrimination on the basis of
disability in employment, state and local government, public accommodations,
commercial facilities, public and private transportation, and telecommunication."
Sharona Hoffman (2009) writes that ADA, in combination with the Rehabilitation
8


Act of 1973. implies that not only should society not discriminate against the
disabled, but it should also accommodate their needs (p. 1522). While Title II of the
ADA relates to the disabled having the same level of access to public services as
others, it does not require state or local emergency management programs to take
actions that would fundamentally alter the nature of a program, service, or activity or
impose undue financial and administrative burdens."
While the ADA legislation does cover emergency management implicitly, this
issue did not become prominent until the 9/11 attacks, due to problems of evacuating
disabled populations in the World Trade Towers. This resulted in the creation of
Executive Order 13.347 in 2004. which established the Interagency Coordinating
Council on Emergency Preparedness and Individuals with Disabilities. The Council's
intention is to ensure that Federal policy supports individuals with disabilities in a
disaster. The Council's progress report for 2005-2006 lists recommendations that
would revise current emergency management frameworks to include special needs
issues and also addresses issues that were raised with disabled populations in
Hurricane Katrina (U.S. Department of Homeland Security, n.d.. p. 43). While
legislation has been amended to address inclusion issues of disabled populations in
disasters, it has yet to be seen if the U.S. can handle another major catastrophe.
While the ICC has made the federal government's role in implementing
policies a priority, the National Council on Disability has also played a prominent
role in raising awareness regarding disabled populations in emergency preparedness
and response. Created in 1978 as an advisory board to the Department of Education, it
became its own independent agency following the passing of the Rehabilitation Act in
1985. Since 2003. it has published reports on emergency preparedness. As a result of
their work, appropriations were made to require FEMA to employ a National
9


Disability Coordinator, along with work with NCD in partnership to engage
stakeholders in how to serve the disabled in emergency situations (NCD. 2009).
The most recent piece of legislation that addresses vulnerable populations in
disasters is the Post-Katrina Emergency Management Reform Act of 2006. This act
was an amendment to the Robert T. Stafford Act of 1988, and adds in language that
addresses disability issues explicitly. Section 689 states the guidelines for individuals
with disabilities, ensuring that these individuals are able to access emergency
management programs and services without discrimination. This law also establishes
the position of a National Disability Coordinator within the Department of Homeland
Security (Clive et. al 2010. pg. 195).
Though the federal government has taken notice of these gaps and enacted
policies that address the needs of disabled populations in disasters, state and local
governments have not nearly been studied enough to determine whether or not this
body of knowledge has informed their jurisdictions. The language in the ADA
legislation does not explicitly describe requisites that state and local governments
must follow in making public services accessible to the disabled. While it is normal
for federal government to delegate specificity to local jurisdictions, the clause
allowing states to not alter programs or go through financial burdens to maintain
these programs creates much ambiguity as to enacting such policies.
Issues of Long-Term Care Facilities and Emergency Management
While the majority of the issues discussed are concerned with the disabilities
population in a community, there is a deficit in research surrounding emergency
planning in long-term care or congregate care facilities. What will follow are the
10


ways that emergency planning and response for facilities housing disabled
populations differ than those for individuals with disabilities living independently.
While local government can recommend individuals in a community to
evacuate, long-term care facilities are often left out of this equation. These long-term
care facilities can house people with severe disabilities or elderly populations.
Because of the complications with moving large numbers of people, scholars
recommend that they be relocated to a facility with the same or higher-skilled
staffing and care capabilities" (Clive et. al., 2010. pg. 200). The individuals living in a
facility have much more severe disabilities and therefore rely mostly on direct care
providers. However, in an emergency they may be separated from their attendants,
which can leave them disoriented and confused.
The continuity of care principle is another issue with the emergency response
of long-term care facilities. Part of the recovery cycle of emergency management
involves resuming normal operations. However, for individuals that are part of an
organizational entity, it is much harder to sustain the same standards of care when
forced to evacuate to a new location without the guarantee of care from their assigned
care provider. There were numerous instances during Hurricane Katrina where
helpers abandoned their clients in order to tend to their families (Clive et. al., 2010.
pg. 204). This is an issue that has yet to be addressed on a broad level, making it
essential for emergency managers to reach out to the administrators of these long-
term facilities in order to plan ahead.
The Developmentally Disabled in History
11


According to the Developmental Disabilities Assistance and Bill of Rights Act
of 2000, the term "developmental disability" means a severe, chronic disability of an
individual that
(i) is attributable to a mental or physical impairment or combination of
mental and physical impairments;
(ii) is manifested before the individual attains age 22;
(iii) is likely to continue indefinitely;
(iv) results in substantial functional limitations in 3 or more of the
following areas of major life activity:
(I) Self-care.
(II) Receptive and expressive language.
(III) Learning.
(IV) Mobility.
(V) Self-direction.
(VI) Capacity for independent living.
(VII) Economic self-sufficiency.
Similarly, the National Council on Disabilities (2009) defines "developmental" and
"cognitive" disabilities as conditions that "[impact] a person's ability to listen, think,
speak, read, write, do math, or follow instructions" (p. 47). It has also been defined as
"a substantial handicap in mental or physical functioning, with onset before the age of
18 and of indefinite duration" (Council of State Governments, 2002).
Historically, the developmental^ disabled were treated either by their families
or by hospitals run by religious orders (Bloom. 1984, p. 7). President Kennedy shifted
the attitude towards developmental^ disabled populations and signed legislation was
12


intended to "provide assistance in combating mental retardation through grants for
construction for research centers and grants for facilities for the mentally retarded and
assistance in improving mental health through grants for construction of community
mental health centers (Community Mental Health Act of 1963)." This act addressed
mental retardation and encouraged a new model of services that focused on three
components: prevention, which focuses on prenatal care; community services, which
calls for the abolition of custodial-based services and emphasized more clinics and
rehabilitation services for this population; and research, which allocates funds for
scientific investigation of human development (Kennedy. 1963 ). This was the first
time that mental retardation and mental health were considered as significant policy
issues that needed to be addressed. President Kennedy's sister. Rosemary Kennedy,
had intellectual disabilities and their family's prominence started the movement to see
intellectual disabled individuals in a more positive light (John F. Kennedy
Presidential Museum and Library, n.d.).
This legislation was later amended into what became the Development
Disabilities Services and Facilities Construction Amendments of 1970, which were
intended to:
"Assist the States in developing a plan for the provision of
comprehensive services to persons affected by mental retardation and
other developmental disabilities originating in childhood, to
assist the States in the provision of such services in accordance
with such plan, to assist in the construction of facilities to provide the
services needed to carry out such plan, and for other purposes."
13


This bill has been amended many times, most recently as the Developmental
Disabilities Assistance and Bill of Rights Act of 2000. which appropriates more
support services and funding to states to care for these populations, guarantees
individuals with developmental disabilities their civil rights, appropriates grants for
universities engaged in research in intellectual disabilities, and offers program
support to direct care staffers who work with these populations.
Legislation also exists guaranteeing the civil rights of institutionalized
persons. This legislation was prompted by the seminal work of Wolf Wolfensburg
(1969), who hypothesized that social construction of developmentally disabled
individuals determined the models for the institutions or facilities built for their
residence. His theory is that these individuals were largely seen as deviant, or
"perceived as being significantly different from others in some overt aspect, and if
this difference is negatively valued" (Section 14). Because of this, this population has
been treated as subpar, which has affected the type and model of care given to them.
Wolfensburg's work prompted the passing of the Civil Rights of Institutionalized
Persons Act in 1980. which [allows] the Attorney General to uncover and correct
widespread deficiencies that seriously jeopardize the health and safety of residents of
institutions" (Department of Justice. 2006).
Today, residential facilities for the developmentally disabled practice
occupational therapy, which enable[s] people to participate in the activities of
everyday life. [This is achieved] by working with people and communities to enhance
their ability to engage in the occupations they want to, need to, or are expected to do,
or by modifying the occupation or the environment to better support their
occupational engagement" (World Federation of Occupational Therapists, 2004). This
14


gives individuals residing in these facilities the same opportunities to participate in
society and live a relatively normal life.
The Developmentally Disabled and Emergency Management
Because of the move to incorporate the disabled populations into general all
hazards planning, it has been assumed that the disabled residing in institutions are
covered under organizational jurisdictions. The developmentally disabled are one
group that has not been touched on in discussing emergency preparedness and
response. Emergency situations could affect a person's ability to understand
instructions, create fear of unfamiliar people, and lead to isolation in shelter
environments if separated from their family or caretakers, to name a few. Coupled
with the fact that some of these populations are in state-run institutions on little
money; such unpreparedness makes the organizational structure of these facilities
extremely vulnerability to disasters.
The emergency planning and evacuation guidelines were enacted as the
Omnibus Budget Reconciliation Act of 1987, which yielded extensive revisions of
standards for nursing facilities under Medicare and Medicaid. These regulations are
stated in Title 42 of the Code of Federal Regulations, under Part 483, which is
designated as the Requirements for States and Long-Term Care Facilities. The
regulations state that these facilities must develop and implement detailed written
plans and procedures to meet all potential emergencies and disasters such as fire,
severe weather, and missing clients.. .and must communicate, periodically review,
make the plan available, and provide training to the staff (42 U.S.C. §483.75).
However, the regulations regarding emergency planning are limited in comparison to
the details regarding evacuation drills and procedures and fire protection.
15


Scholars have addressed emergency preparedness in regards to the
developmental^ disabled by studying evacuation behaviors. Shields et al. (1999a)
conducted an unannounced evacuation at two residential care facilities in Northern
Ireland at 11:30 pm. These facilities had gone through routine drills in the daytime.
From the results, it was clear that skills learned in the daytime didn't transfer to
nighttime activities, and that training needed to be done to link learning difficulty
with predictable evacuation behavior (Shields et. al.. 1999a, p. 48). This need for
additional training in the developmentally disabled community has been echoed by
Rae and Roll (1985). who concluded in their evacuation drills that daily practice,
graduated guidance, and social praise were the key elements to reduce time spent
evacuating a building.
However, facilities may not have much manpower and/or time to train their
residents for evacuation procedures. Shields et al. (1999b) emphasize the need for
training not only those residing in the facilities, but also staff members. They argue
that there is not a benchmark for how staff will react in a realistic emergency versus a
drill, and recommend that staff members are the success factor in evacuating in an
emergency. While this may seem like an obvious solution, it is unclear whether or not
these facilities have the time to implement training their staff members on how to
react to an emergency properly.
While this problem has been recognized by the literature and legislation, it is
unknown whether or not states have recognized this policy and implemented it within
their jurisdictions. It is also unclear if these states are vigilant about making sure that
their long-term care facilities satisfy the requirements.
16


CHAPTER 3
CONCEPTUAL FRAMEWORK
The Origins of Organizational Effectiveness
While there has been an increase in policies that require states and long-term
care facilities to write emergency plans, there has been little study on whether the
facilities themselves have complied. In the context of a residential facility, evaluating
emergency planning is conducive to activities conducted within the entity itself,
otherwise known as organizational effectiveness. Organizational effectiveness is
loosely defined as the extent to which an organization as a social system, given
certain resources and means, fulfills its objectives without incapacitating its means
and resources and without placing undue strain upon its members" (Georgopoulos
and Tannenbaum. 1957, p. 536-537).
Scholars in organizational effectiveness have broken into two camps in regards
to their approaches. Some scholars focus on goal setting, which is defined by "a
desired state of affairs which the organization attempts to realize" (Etzioni, 1964).
Price (1972) further defines the concept as "[effectiveness] in terms of the degree of
goal-achievement. The greater degree to which an organization achieves its
goals...the greater its effectiveness" (p. 3). While research has criticized the goals
approach for its difficult to decide which goals an organization is to fulfill, there are
yet four things an organization can focus their research on in this model: major
decision makers, organizational goals, operative goals, and intentions and activities
(Price, 1972, p. 5-6). However, while goal setting can work very well for an
organization that has outputs such as profit to rely on, other organizations,
17


specifically non-profit and public organizations, do not have the same output
measurement.
The other method that was created in response to the goal setting's criticisms
is the systems approach, which states: "Inputs into an organization are more
important than their outputs because an organization's facility to maintain sufficient
resources for survival is the most important indicator of effectiveness" (Sowa et. al.,
2004, p. 713). Seashore and Yuchtman (1967) describe the systems approach with
more depth, stating, "systems are continuously engaged in processes of exchange
with their environments," therefore:
"Effectiveness in organizations can thus be viewed as the relative
bargaining position of organizations in relation to resources over
which there is competition. We define the effectiveness of an
organization as its ability to exploit its environments in the acquisition
of scarce and valued resources to sustain its functioning'' (p. 393).
While this approach is much easier to measure than the goal setting approach, it also
is wrought with criticism. Price (1972) criticizes the systems approach by stating.
"Optimization is not measured, few general measures are used, and the basic rule of
mutual exclusiveness with respect to the definition of effectiveness is seriously
violated" (p. 13).
There are other scholars who have claimed major problems within the body of
the organizational effectiveness literature. Steers (1975) has cited a number of
problems: construct validity, criterion stability, time perspectives, multiple criteria,
precision of measurement, generalizability. theoretical relevance, and level of
analysis. He suggests that a model of effectiveness must make sure that criterion
18


specification is flexible enough to account for diversity in goal preferences while
allowing for a differentiation in weight in evaluation criteria and optimizing the goal
by the feasibility of such criteria (p. 555).
While there has been much debate in the differentiation between measuring
organizational effectiveness in for-profit vs. nonprofit and public entities, the field
has branched off into studying these sectors separately. Because of the variation in
public and nonprofit organizations, it is difficult to pin down a theory of effectiveness
that can be applied to all organizations.
Government Performance & Why Management Matters
Pioneers in evaluating government performance are Ingraham et. al. (2003).
who assert:
Presuming that administrative structures and technologies may be
more or less coherent across governments and agencies, that leaders
may be more or less effectual, and that the degree to which integration
and a managing for results focus exist may also fluctuate, it is possible
to imagine that a government's or an agency's ability to manage
effectively varies dramatically (p. 24).
Using this assumption, they construct a government performance framework that
relies on four levers: management systems, leadership, integration and alignment, and
results focus. Management systems deal with four components: financial, information
technology, human resources and capital management. Leadership deals with the
influence held when setting priorities and the vision" of an organization. Integration
and alignment has to do with how leadership, use of information, and allocation of
resources all work together in order to execute an organization's vision. Results focus
19


deals with the environment they are working in, along with what type of units are
being used to measure effectiveness. These four concepts can be dissected and put
back together in order give us a more complete picture of an organization and how
their operations translate into success.
However, these assertions about how a governmental organization operates
are still not clear when applied to the context of the particular organization being
studied. An institutional setting for developmentally disabled populations has goals
that need to be met in order to contribute to the care and wellbeing of these
individuals. While emergency planning is a part of that care and wellbeing, it may be
neglected because of its specialized knowledge that most people do not have access
to. In order to know more about evaluating emergency planning on the organizational
level, it is necessary to examine how it has been done in the emergency management
literature itself.
Organizational Effectiveness and Emergency Management
While the field of organizational effectiveness in general can become
confusing when grappling with how to measure success in an organizational entity,
the same problem has plagued emergency managers. There are a few' problems
associated with measuring performance with emergency management. First, only a
limited set of cases can be used to examine performance due to the inability to predict
when a disaster or hazard will occur. Second, each disaster or hazard poses different
characteristics that may or may not have been encountered prior. Third, emergency
management can be the main goal of an organization (Such as a local government
emergency management office) or a segment of a larger organization (a business, a
hospital, or a school). Lastly, there are so many variables that create a particular
hazard, disaster, or vulnerability in a community. However, scholars have made
20


significant headway in the last ten years, building frameworks that provide a sense of
how success is measured when managing an emergency.
The majority of the research in evaluating emergency management programs
has come from a local government standpoint. There are many approaches that
scholars have taken to characterize the best methods to evaluate performance in
emergency management. Some have called for implementation guidelines (Perry and
Lindell. 2003). while some have called for qualitative principles that differentiate
good disaster planning from bad disaster planning (Alexander, 2002; Quarantelli.
1998). In contrast, there is a body of literature that relies heavily on indexes and
operational indicators in order to develop performance scores (Gillespie and Streeter.
1987; Simpson, 2006). Henstra (2010) compiles all of this literature into a framework
that defines quality as the extent to which a local government has adopted policies to
prepare for emergencies, mitigate their impacts, ensure an effective emergency
response, and facilitate community recovery" (p. 238). He breaks up the four parts of
preparedness, response, recovery, and mitigation into smaller segments and draws on
the principles and implementation guidelines that scholars have defined in order to
create a tool that local emergency management agencies can use to determine what
they succeed and/or fail at.
Alexander (2005) has expanded on his work regarding principles of
emergency planning and has asserted that he is concerned with the inconsistency
between local jurisdiction plans that are unified under a regional command. He cites
the problems that emergency planners are faced with (balance of flexibility and
rigidity to standards, integration into other organizational units, coordination with all
stakeholders) and calls for a list of eighteen points to keep in consideration when
developing a standard" for emergency planning for municipal or local jurisdictions
21


(p. 159-161). However, Alexander acknowledges that is difficult to develop standards
when the characteristics of jurisdictions vary and there isnt always an expert in
emergency management that jurisdictions can utilize to develop good plans.
In terms of residential facilities, emergency planning is only one part of the
services provided to the clients residing at these institutions. Generally, state agencies
have assigned guidelines for long term care facilities to follow, which include criteria
for each facility's written plan and activities to conduct in order to prepare staff for
the possibility of an emergency. These guidelines usually are limited to preparedness
activities, which consist of "planning, establishing resources, developing warning
systems, skills in training and practicing, and almost any pre-disaster action which is
assumed to improve the safety or effectiveness of disaster response" (Gillespie and
Streeter, 1987. p. 157). Quarantelli (1998) reiterates this by stating. "Preparedness
planning involves all of those activities, practices, interactions, and relationships,
which over the short and long term are intended to improve the response pattern at
times of disaster impact" (p. 2). With this view, it is important to satisfy not only the
guidelines of what is required of a w ritten emergency plan, but also the process in
which activities are conducted in the case of a hazard.
According to Gerber and Robinson (2008). there are three ways to evaluate
performance in emergency management: self-evaluation of stakeholders, analysis of
documents related to disaster preparedness, and a focus on actual preparatory
behavior. While each methodology paints a picture of one part of the planning
process, they also have limitations in their scope. Using methods that allow self-
evaluation of stakeholders can create biases due to some organizations' reluctance to
admit that they are unprepared, or a lack of knowledge about what preparedness
activities entail. Document analysis may be a question of whether the documents
22


reflect real preparative activities or capabilities'' (p. 350), and surveys focusing on
actual preparatory behavior may be quite specific and fail to account for the
diversity of preparedness activities" (p. 351). In order to counteract these pitfalls
associated with each performance evaluation method, it is recommended that a
combination of these tactics be used.
23


CHAPTER 4
METHODOLOGY
Sample
In order to answer the research questions, the emergency plans of residential
facilities in four different states were analyzed. This serves as a comparison to
determine similarities that other states can draw when planning for their own
facilities, while highlighting the nuances of how planning can differ by region due to
the relevance of certain catastrophic events in one area or another. These states were
selected also for their variation in institutional rates. Washington and Colorado utilize
state run institutions much less than South Carolina and New Jersey (Braddock.
Hemp, and Rizzolo. 2008). By comparing the jurisdiction in four different states, we
can compare and contrast how residential facilities plan for this special population as
part of their organizational duties.
Instrumentation
The study applies a two-pronged analysis. To answer the first research
question, each center's emergency plan will be examined by categories based on best
practices as defined by literature. A review of the literature will yield best practices
that make up a good emergency plan. Because staff at residential facilities have their
days full of rehabilitation activities with their clients, it is helpful to have a response
plan that they can refer to in case of an emergency.
Preparedness Elements
24


The following components reflect the preparation needed in order to activate a
plan in the face of a disaster on a residential facility level:
Disaster Exercises.
While training is a crucial element that gives staff the knowledge of how to
put the response plan to use, it is not enough to test their capacity to respond to an
emergency. In order to counteract this, facilities should conduct disaster exercises.
These exercises could range from tabletop exercises, which are simple to conduct and
are meant to evaluate coordination and organizational capacities in activating a
response plan, to a functional or full-scale exercise, which is more realistic in
simulating a high stress environment (Daines, 1991).
Emergency shelter arrangements.
Similar to mutual aid agreements, emergency shelter arrangements are needed
to establish a place of alternative residence for clients that may have to evacuate their
own residential facilities. It is crucial to know the needs of the clientele being served,
and connect with local government or communities to meet those needs (The ADA
and Emergency Shelters. 2007). Residential facilities should have arrangements with
other facilities or locations (such as a school gym). These arrangements are a type of
mutual aid agreement, and should outline procedures with respect to transfer of
residents, medical information, etc. (Daines, 1991. p. 176).
Evacuation drills.
25


Given the nature of these residential facilities, it is difficult to gauge the
learning curve of the residents at these facilities because of their intellectual
difficulties. One way to prepare them for a hazard or disaster is to conduct evacuation
drills. However, studies have found that residents have trouble transferring skills
learned during daytime evacuations to nighttime (Shields et. al., 1999). At the
minimum, facilities should conduct evacuation drills, but it is recommended that they
also incorporate evacuation training into their client's programs to overcome learning
difficulties.
Hazard identification and risk assessment.
In order to properly tailor response efforts. Perry and Lindell (2003) write that
these efforts should be based on knowing which threats are most relevant to that
particular program (p. 340). Because hazards can vary by location (Regional and
vicinity of where the facility), assessment tools are important to determine what
hazards are more probable than others to affect the particular facility. For the
purposes of emergency planning in residential facilities, the most helpful tool would
be the hazard identification tool, which consists of estimating the probability and
impact of certain types of hazards (Deyle et al.. 1998. as quoted in Henstra, 2010).
Interagency coordination.
Interagency coordination is related to mutual aid agreements (see below), but
is specific to the informal or formal relationship that a residential facility has with
local governmental entities such as the local emergency management agency in the
region that they reside in, and their jurisdictional authority above them at the state
level.
26


Mutual aid agreements.
The purpose of mutual aid agreements is to engage with other members within
and outside of the community in case a facility's resources quickly become
overwhelmed. These agreements can be with emergency medical services,
transportation services, or private businesses. It is best to acquire formal agreements
specifying when the facility can utilize services, establish a protocol, and agree on
adequate compensation (Cohn. 2005. as quoted in Henstra, 2010).
Planning Committee.
In order to properly respond to an emergency, staff members of these facilities
must be aware of the activities proposed and should thus be included when writing a
plan (Perry 1991. as quoted in Henstra 2010). Because there are various departments
that encompass a residential facility, the most effective planning committees
constitute a mix of direct care staff and higher-level administrators. This ensures that
the client needs are being met in the face of an emergency, while administrators can
plan for business-like aspects, such as the amount of cash and disaster supplies on
hand.
Resident Identification.
When faced with an evacuation, the developmentally disabled population is
much more difficult to transport due to unawareness of their surroundings. Some
residents are more competent than others, but if separated from their direct care
providers, it may be difficult for others to identify them. Identification information
should contain each resident's name, social security number, photograph, date of
birth, current drug/prescriptions being taken, food allergies, and next of kin contact
27


information, and should be transported in such a way so that the resident can be
identified easily (Missouri Department of Health and Senior Services. 2007).
Staff Training.
Without training, the response plan has no bearing on staff. Training within
the facility should "be on the concepts of operation and key components of the [plan]
that directly involve the group being trained, but an overview of the plan is also
necessary to ensure that participants understand how they fit into the big picture"
(Daines, 1991. p. 185). For those who are not involved with the planning committee,
this is a way to invest and inform them in maintaining care for the residents, despite
abnormal circumstances. The training should be required for all staff, with extra
training (whether in the form of FEMA or state emergency management courses)
designated for staff with leadership positions.
Response Elements
Elements associated with response include components that are immediately
needed to react to a disaster (Waugh. 2000, as quoted in Principles of Emergency
Management Supplement, 2007). Others refer to response as "actions taken a short
period prior to. during, and after disaster impact to reduce casualties, damage, and
disruption and to respond to the immediate needs of disaster victims'" (Tierney,
Lindell. and Perry. 2001, p. 5, as quoted in NCD. 2009). The following components
are essential for an effective emergency response.
Communication systems.
28


Communication systems should be utilized to coordinate response during a
hazard event (Missouri Department of Health and Senior Services, 2007). Not only
can staff members use these to communicate with one another, but they are also
helpful in contacting family members and local emergency response teams, along
with activating mutual aid agreements. A list of fax lines, analog phones, walkie
talkies, ham radios, etc. and instructions for how to use them should be in the plan.
Disaster supply storage.
Facilities should include enough food, water, clothing, bedding, and shelter
for all the residents and staff, stored in a safe place. While each jurisdiction varies in
its requirement, it is generally agreed upon that a minimum of 72 hours worth of
supplies should be in the disaster supply shed, though 7-10 days worth is ideal
(Missouri Department of Health and Senior Services. 2007).
Emergency Operations Center (EOC) Establishment.
An emergency operations center, or EOC. is a prearranged location from
which local officials can coordinate and communicate with responders, other levels of
government, and the public (Scanlon 1994, as quoted in Henstra. 2010). For
residential facilities, this is intended as a meeting places if a hazard were to affect
operations of the facility and enact the Incident Management System.
Employee responsibilities.
This element involves instructions and duties for staff members at the facility
at the time of an emergency situation- both those specific to position and in general.
Evacuation plan.
29


Because of the special needs of developmentally disabled residents, it is
difficult to decide whether or not an evacuation is necessary. Conducting an
evacuation involves moving and transporting residents and staff to alternative shelter
that may not possess the necessary items needed to sustain normal operations.
Therefore, an evacuation plan "inv olves establishing criteria for deciding whether to
evacuate residents, and determining how the evacuation will be executed" (Henstra,
2010, p. 240).
Incident Management System (ICS).
The Incident Management System is intended to designate "a clear chain of
authority that can quickly orchestrate collaborative operations by diverse
organizations that have had little or no previous operational relationships" (Christen
et al. 2001, 1). This translates to assigning roles for who is in charge if a disaster were
to happen at a residential facility.
Shelter-in-place.
The term "shelter-in-place" means to take immediate shelter wherever you
are" (CDC, 2007). This is an option typically used for when it is not safe to let
outside air in, but is a very probable option for the residential facilities in all disaster
settings, due to the difficulties associated with evacuation. This part of the plan would
detail what situations would constitute staying in place at the facility and utilizing
resources that currently exist on site.
Specific disaster directives.
30


This element involves the specific actions taken in certain kinds of disasters,
since the actions taken during an earthquake and a hurricane are dissimilar.
Recovery Elements
The stage of recovery is defined as putting a disaster-stricken community
back together (Mileti. 1999, as quoted in Phillips. 2007). For residential facilities,
this means the implementation of programs to restore or improve the quality of
life..." (Rubin. 1991, p. 226). The following components are important for a
residential facility to have in order to address the recovery process.
Continuity of Operations Plan.
In order to recover from a disaster, it is essential that communities have
procedures. Continuity of operations procedures includes identifying critical
government functions and services and developing strategies to quickly restore them
if they are interrupted in an emergency" (FEMA. 2004. as quoted in Henstra. 2010).
For residential facilities, this course of action would ensure the same standards of care
for the residents as if nothing had happened. Elements would include procedures for
inspecting the facility for structural damage; seeking assistance for food, shelter,
medical assistance, and supplies needed to care for the clients; and if needed,
applying for loans or grants (Missouri Department of Health and Senior Services,
2007).
Funding.
In the aftermath of a disaster, there are typically procedures to get funding
from jurisdictional entities for costs inflicted due to a disaster occurring. These funds
31


vary depending on how badly the region was affected. However, for major disasters.
FEMA has several grant programs that states can apply for (FEMA. 2010).
Mitigation
While there are preventative strategies that can be utilized when preparing for
a disaster, mitigation focuses on long-term measures for reducing or eliminating risk
(Haddow et. al. 2003).
Mitigation Plan.
A mitigation plan should consist of strategies [that] reduce the vulnerability
of people and property to hazards" (Henstra, 2010). This usually consists of structural
elements, such as reinforcing building codes and infrastructure to withstand natural
disasters. However, these strategies can be non-structural, targeting community
vulnerabilities (Godschalk and Brower, 1985, as quoted in Henstra. 2010).
Warning Systems.
Warning systems are intended to give people notification about an impending
hazard, so they can take action in order to protect themselves (Sorenson. 2000). These
consist of fire alarms and other types of alert systems that communicate emergencies
and. if need be. enact the emergency response plan.
Data Analysis
Using these categories, facilities from the four selected states had their
response plans analyzed. Particular attention was paid to how detailed the plans are
with respect to the above components. The details within each category were coded
32


into subcategories using NVIVO, a qualitative data analysis software package, to look
for common themes between facilities.
Because the response plan is only part of the picture, there are other elements
that are essential to establishing best practices of emergency management in
residential facilities. The second research question was answered by conducting three
to four follow up interviews with staff members at selected facilities, based on the
findings with the emergency plan content analysis. These interviews determined what
best practices they have found to be helpful in emergency planning for this particular
population, and probed for pitfalls that may have been encountered in the process.
Superintendents or directors were interviewed, and/or chose a staff member
based on their know ledge of emergency planning. These interviews were conducted
by phone, and were recorded for record-keeping purposes. The content in the
interview will be examined and coded for common themes within the state itself, and
overall. See Appendix A for the interview protocol.
33


CHAPTER 5
WASHINGTON
Washington State is located in the Pacific Northwest region of the United
States, in the very left hand corner of the country. According to a hazard analysis
conducted by the state emergency management division, Washington is most
vulnerable to severe storms, floods, and earthquakes, in that order (Washington State.
2010). Most of the emergency management jurisdiction lies within the state military
department. This clearly designates the powers of the governor, funding, and policy
definitions in Chapter 38.52 in the Revised Code of Washington (RCW), which lists
all of the permanent laws in effect. These policies trickle down and influence the
policies that the Department of Social and Health Services of Washington (DSHS)
designate for all of the organizational entities that they head, including the residential
facilities that house the developmentally disabled.
Under the Washington Administrative Code. Titles 275-39-635. 275-39-640.
and 275-39-645 dictate the emergency planning process, evacuation procedures, and
fire protection rules for all institutions residing under DSHS. The statutory authority
for these three titles is derived from the Administrative Responsibility Regulations
Clause, which designates the administrative powers and responsibilities of each
institution residing under DSHS. It states:
The department of social and health services, division of
developmental disabilities, shall bear all administrative responsibility
for the effective and rapid implementation of this controlled program.
The division shall promulgate regulations within sixty days after June
34


12, 1980. to provide minimum standards and qualifications for the
following program elements:
(1) Residential services;
(2) Medical services;
(3) Day program;
(4) Facility requirements and accessibility for all buildings in which
the program is to be conducted;
(5) Staff qualifications;
(6) Staff training;
(7) Program evaluation; and
(8) Protection of client's rights, confidentiality, and informed consent
(Wash.. Rev. Code § 74-26-040).
This law gives implicit responsibility to DSHS to establish regulations
for all institutions in terms of emergency planning. As of November 1. 2010.
administrative policy for emergency management states that each DSHS
location will develop a continuity of operations (COOP) plan based on
elements as determined by FEMA requirements, and that DSHS will provide
this template. There are also elements that detail the designation of a team in
charge of emergency operations, registration of the GETS system (a
government telephone communications services), training for staff members
on emergency management protocols, and recommendations to build
partnerships with other local emergency management agencies in each
35


location's region (Washington State Department of Social and Health
Services, p. 5-7).
While the author has been made aware that there is a Comprehensive
Emergency Plan for the DSHS. there was no directive that prompted the formation of
this plan. This plan was last updated in 2007, and as of this writing, has not been
made concurrent with the new administrative policies on emergency management
issued in November 2010.
Plans
There were four out of a possible five facilities that were able to participate in the
study. The results of how many themes were found in the three plans are located
below:
Table 5.1 Number of themes in Washington plans
Plan Reference # # of Themes from Codebook
133 19
199 16
145 9
184 9
36


A larger amount of variation between the number of themes used in Plan 133 and 199
exists in comparison to between Plans 145 and 184. This may have to do with the
lack of clarity in what is to be included in a facility's emergency plan, despite
DSHS's policy that there is a template to be followed when writing such a plan.
In the entirety of the Washington sample, it is also shown that the three
elements heaviest in volume of text are:
Table 5.2 Top three prevalent themes in Washington plans
Prevalent Themes Total % in WA Sample
Specific Disaster Directives 50%
Employee responsibilities 17%
Plan writing 7%
Other Elements 26%
The highest volume of text in the four plans in the sample comprised "Specific
Disaster Directives." which made up half of the sample. This suggests that
Washington state facilities are very focused on instructing their employees on the
nuances between responding to different types of disasters.
We will now examine each plan separately to look at the themes that were
included.
Plan 133
37


There were a total of nineteen themes used in Plan 133. The top three themes
used are outlined in the table below:
Table 5.3 Top three prevalent themes in Plan 133
Themes Total % in Plan 133
Specific disaster directives 34%
Employee responsibilities 22%
Plan writing 12%
Other 32%
Plan 133 was split almost exactly into thirds. Specific disaster directives' had the
most volume in the whole of the emergency plan. Employee responsibilities and plan
writing made up another 1/3. The rest of the sixteen themes used in the plan made up
the last 1/3 of the plan.
This plan is by far the most detailed and lengthy of the sample, which may
account for why the three most prevalent themes in this plan were reflected in the
examination of all of the Washington state plans. It also was the only one out of the
plans collected from all four states that contained directives for disaster mitigation
activities. Lastly, it also touched on issues of interagency coordination heavily, citing
specifically what the state's emergency response guidelines were and how they
related to the facility itself something that the other plans did not touch on.
Plan 199
38


There were a total of sixteen themes used for Plan 199. The top three themes
for the plan are outlined in the table below:
Table 5.4 Top three prevalent themes in Plan 199
Themes Total % in Plan 133
Specific disaster directives 40%
Employee responsibilities 15%
EOC Establishment 9%
Other 36%
The theme of "specific disaster directives" takes up almost half of the plan.
This is followed by "employee responsibilities" and "EOC establishment.'" The
remaining thirteen themes are scattered throughout the remaining 1/3 of the plan. This
distribution is similar to Plan 133. but is significant because its third most prevalent
theme involves text that established an emergency operations center.
Plan 145
There were a total of nine themes used for Plan 145. The top three themes for
plan are outlined below:
39


Table 5.5 Top three prevalent themes in Plan 145
Themes Total % in Plan 145
Specific disaster directives 53%
Employee responsibilities 21%
Disaster supply storage 9%
Other 17%
In Plan 145. the themes of specific disaster directives and "employee
responsibilities" are also in the top three more prevalent themes. The third most
prevalent theme in this plan is "disaster supply storage." which implies that this
facility understands the importance of having details about necessary supplies for
clients in case of a disaster or emergency. The last five themes are contained in a little
less than 1/5 of the plan.
Plan 184
Tike in Plan 145, there were also a total of nine themes used in Plan 184. The
top three themes are as follows:
Table 5.6 Top three prevalent themes in Plan 184
Themes Total % in Plan 184
Specific disaster directives 64%
Hazard identification 9%
Employee responsibilities 9%
Other 18%
40


Again, specific disaster directives" takes the top spot, filling a little over 3/5
of the entire emergency response plan. This is followed by hazard identification"
and "employee responsibilities." It is inferred that this plan is based mostly on
knowing what hazards affect the facility itself, what to do during specific types of
disasters, and setting rules and guidelines for what employees should be doing in this
type of situation. The other five themes used are spread out in less than 1/5 of the
entire emergency plan.
Interview
The facility that wrote Plan 133 was the one selected for an interview. The
staff members talked to were the superintendent, who is in charge of all facility
operations, and a director of nursing services, who supervises all medical care of the
clients at the facility. The most major disasters that had occurred in the last two to
three years were a sewer backup, a severe windstorm, and flooding that occurred
within the community. The hazards that this particular facility was most prone to
include severe weather related hazards and their aftereffects, along with earthquakes.
In terms of plan writing, there were a few factors that this facility had taken
into account when deciding who would write the emergency plan. A preexisting
safety committee led to the formation of a separate committee for emergency
planning, combined with directives from the department about what facilities should
be doing for disaster planning. People also opted in because of personal interest and
community connections, due to long-term care disaster drills that had occurred within
the community.
41


The references used for writing the plan involved those at the federal level
(NIMS, ICS, FEMA planning manuals, coursework), an all-hazards planning guide
issued from the department, and doing internet searches to see the resources of other
local entities and organizations. The factors that were taken into account for the
planning process involved physical geographical factors, the number of staff and their
skills and abilities, an internal self-assessment of how well they were able to respond,
financial issues regarding what money could be spent on preparedness, and possible
organizations to partner with. The most important factors cited in emergency planning
for this population were the actual individuals themselves and the resources that they
believe they will have in a disaster setting- specifically because of staff changes
throughout the day.
Themes
There are four themes that came up in the course of the interview with the
facility that wrote Plan 133. They will be described below.
Intention does not lead to action.
Throughout the interview, both staff members showed considerable
knowledge and commitment to the process behind emergency planning. However,
they noted that their commitment level and knowledge of importance did not
necessarily lead to the outcomes they desired. They cited time as a significant barrier
to emergency planning due to their other organizational commitments:
"I can speak to five or ten years ago, you would have not have seen that type
of organizational commitment to emergency planning as you do now...though
1 would not rate them as high on outcome because we're not there. From a big
42


picture perspective, there is a structure and organization in place, and people
that are doing their job.. .but we'd have to get to better outcomes in the field
to rate them higher. Commitment is there for it; up the administrative chain,
they get it."
We're chugging along, we get the basics out there, we get the new
employees oriented to it. but it's a very basic orientation. It is not as specific
as it could be.. .we're not as intense about doing as those drills as we could be
We check on people more randomly and intermittently and if we did more,
wed be better.
"We meet the requirements, but I think the difference is that we all know wre
could do better. We have more information than what other people have, and
we have not been able to get to the point to impart that knowledge to
everybody. We just haven't gotten there."
Well we have the plan started. Not completed. We have had drills and have
realized where were light and not. And it's in our mind all of the time.. .even
though we may not be getting everything done immediately, we are putting
information in when we've noticed that something could be done differently
after the committee has thought about it."
Variations in Staff Commitment.
Another theme that continually came up throughout the interview was that
there were variations in the level of commitment within the facility's staff. Both staff
discussed that the majority of staff were not prepared nor committed to being
prepared:
43


"We've heard that staff said, No, we won't be here. I'm going home. And
they say that in an emergency, 50% of your staff will leave or never come in.
And we saw that even in this last winter. We have terrible iced streets and it
shut down the town for 24 hours.. .and yet there were not people coming in. In
a true emergency, if it got hectic, we wouldn't be able to implement a good
evacuation."
[One of our barriers is] do we have enough staff on hand to keep the
residents safe? It has been pointed out by staff that if [the superintendent] said
we had to stay, it doesn't matter. They would leave and abandon.''
When we practice [disaster drills], it's a problem for us. [When we have
done them], unfortunately I don't think it has been taken that seriously by
staff...it does not seem to click."
When something happens, like a tabletop drill they'll come to that, but in a
long term sort of thing, once they walk out the door it's like 'Okay, one with
that.' It's short-sighted."
Lack of Direction.
Staff members expressed confusion regarding exactly what should be included
in the emergency plan. Despite the facility having a safety officer designated for this
role, there are variations in peoples' expertise. Staff emphasized the need for more
guidance from the department and federal government:
I don't know how many Internet searches I've done [to find resources to
write the emergency plan]...we also turned to the county emergency
44


preparedness office and local health department for what resources they had
available. [But] there is very little for developmental disabilities."
"I attended a week class that was sponsored by FEMA and came back
realizing that while FEMA is supposed to be all-knowing, they were not
knowing about people with intellectual disabilities."
[The department] could give us a better template that's more functional and
practical; whether that be a template thats simpler than the one that we have,
or guidelines, or an example. Any of those things would be helpful."
Lack of Organizations Wanting to Help and/or Partner.
Lastly, staff explained that when the facility reached out to the local
governmental agencies, they were not offered assistance or help. Rather, they were
confronted by those local agencies to provide emergency shelter in case they were in
need of assistance during an emergency:
The local health department did come and look at our facility, but the main
reason they were there was not how they would implement help for us, but
what they could do if they had people from homes on ventilators and things
like that; that they could come in and have staff take care of them."
Im glad we've built [community partnerships], because [it was good to get]
guidance from them saying. 'You guys are silly if you think you can depend
on us to come; weve got people living on oxygen and they're going to die,
we're going to them before we come to you guys, you figure it out, so it was
a good thing we made those partnerships.
45


Analysis
Looking at all of the plans, it is clear that there is inconsistency within the
number of themes in each emergency plan. This could be attributed to the fact that
Washington lacks a template for long-term care facilities to utilize when emergency
planning. While the interview revealed that there were an all hazards planning guide
manual issued post-Hurricane Katrina, it was not as functional as the facility
interviewed would have liked it to be. These factors could be explained by the lack of
policy structure that the department possesses in terms of emergency planning.
Taking all of themes from the interview into account, it seems that the
findings from the plan analysis align with interview data. This facility wants to be
compliant and prepared for the health and safety of their clients, but do not have the
partnerships they desire, the proper guidance from their department, a committed
staff, or the time and resources to emergency plan. It is obvious that there is a finite
amount of human and capital resource that this facility possesses. Combined with a
lack of information and support from other governmental agencies, they do not feel as
if they have the tools necessary to effectively emergency plan for their clients.
46


CHAPTER 6
COLORADO
Colorado is located in the Western region of the United States. According to a
recent draft of the Colorado State Mitigation Plan, governor declarations from 1980-
2010 came for a variety of hazards, including grasshopper infestation, drought,
wildfires, tornadoes, rock falls, floods, sinkholes, mudslides, and blizzards (State of
Colorado, p. 5). The state's emergency operations plan lists in the following order the
most common natural hazards: floods, tornados, and wildfires (State of Colorado, pg.
13).
There are two agencies that have jurisdiction at the regional centers for the
developmentally disabled. The first is the Department of Human Services, which is in
charge of ensuring the safety and wellbeing of its clients. In the Code of Colorado
Regulations. 2 CCR 503-1 16.000 is focused on Developmentally Disabled Services.
However, the only recognition of emergency procedures concerns the use of
restrictive constraints for clients to reinforce their safety, which is in Section 16.540
titled Requirements for Emergency and Safety Control Procedures.
The other agency that is in charge of emergency planning for these regional
centers is the Department of Public Health and Environment (CDPHE). Since these
regional centers are classified as Intermediate Care Facilities for the Mentally
Retarded (ICF/MR). they are classified as a health facility under the guidelines of the
federal government. 6 CCR 1011 -1 -8-8 deals explicitly with Emergency Services,
saying:
47


8.1 EMERGENCY CARE POLICIES. Statements of policies for the
care of residents in an emergency shall be developed and incorporated
into a manual for staff use. See Section 2.3. 3.1, and 3,7. The
manual should include but not be limited to: 1) Arrangements for the
necessary medical care when a resident's physician is not available
immediately: 2) Procedures and training programs which cover
immediate care of the resident: 3) Persons to be notified.
8.2 FIRE AND INTERNAL DISASTER PLAN, Written policies
and procedures shall be formulated for the protection of persons within
the building in case of fire, explosion, or other emergency in the
building, and shall consist of the following:
8 2.1 Brief, written instructions to be posted at appropriate places, of
persons to be notified, and other immediate steps to be taken before
the fire department or other assistance arrives.
8.2.2 A schematic plan of the building, or portions thereof, to be
posted at appropriate places showing evacuation routes, smoke stop
and fire doors, exit doors, and the location of fire extinguishers and
fire alarm pull boxes.
8.2.3 Other policies and procedures that need not be posted but -must
include: procedures for evacuating helpless residents, assignment of
specific tasks and responsibilities to the personnel of each shift,
provision for at least annual training and instruction sessions to keep
employees informed of their duties, and provision for conducting
simulated fire drills at least three times annually.
48


The above policies, procedures, and plan must be developed with the
assistance of qualified fire and safety experts.
8.3 MASS CASUALTY PROGRAM. Each facility for persons with
developmental disabilities should develop a written mass casualty plan
for the management of residents and the treatment and disposition of
casualties in the event of an external or community disaster. This
program should be developed in cooperation with other health
facilities of the area and with official and non-official agencies
concerned (p. 8-9).
In addition to having a policy that clearly outlines what is expected of each facility in
regard to emergency planning, there are many documents located on the department's
website that guide facilities in what they need to put into their written plans and
policies.1
Plans
There are a total of three facilities in Colorado, and all three were willing to
participate by allowing access to their emergency plan. The results of how many
themes were used from the codebook in each plan are below:
1 The templates can be found at
http://www.cdphe.state.co.us/hf/emergencyplanning/alr/ToolKit/index.html.
49


Table 6.1 Number of themes in Colorado plans
Plan Reference # # of Themes from Codebook
835 14
842 9
862 7
In comparison to Washington, Colorado's policies are much more explicit in
stating what a facility's emergency plan should consist of. However, out of the three
facilities, there is still a wide variation in how many themes were found within the
plans. Within the Colorado set. these three themes were the most prevalent:
Table 6.2 Top three prevalent themes in Colorado plans
Prevalent themes % in CO Sample
Specific Disaster Directives 49%
Evacuation Plan 16%
Continuity of Operations Plan 7%
Other 28%
50


Like Washington, specific disaster directives" is the most voluminous in text within
this set. However, the second and third most prevalent themes are evacuation plan"
and continuity of operations plan." which suggests that the Colorado facilities place
importance on teaching staff how to get their clients out of the facility and how to
continue providing care to them in abnormal circumstances like a disaster.
Plan 835
Plan 835 contains fourteen of the twenty-three themes in the codebook. The
top three themes used in this plan are in the table below:
Table 6.3 Top three prevalent themes in Plan 835
Themes % in Plan
Specific Disaster Directives 34%
Continuity of operations 22%
Plan writing 13%
Other 31%
This facility has "specific disaster directives" consisting 1/3 of the actual plan,
"continuity of operations" and plan writing" for another 1/3, and the other eleven
themes in the last 1/3 of the plan. This plan is the most detailed of the three in the
Colorado set, and focuses mostly on informing staff of what to do during specific
51


types of emergencies and making sure that care and normal activities pertaining to the
residents can continue to be carried out. regardless of an emergency situation.
Plan 842
For Plan 842, there were nine themes found in the plan. The table below
shows the three themes that were most prevalent:
Table 6.4 Top three prevalent themes in Plan 842
Themes % in Plan
Specific Disaster Directives 48%
Evacuation Plan 25%
Staff training 6%
Other 21%
It can be seen that "specific disaster directives" takes up almost half of the emergency
plan, and that "evacuation plan" takes up a quarter of it. The last quarter of the plan
consists of staff training and the other six themes. This particular plan shows that the
facility is concerned with giving information about how to react in different disaster
situations and the procedures for when to leave the facility if necessary. Staff training
is also a component that is important to this facility.
Plan 862
52


Plan 862 contained a total of seven themes. The top three themes are in the
table below:
Table 6.5 Top three prevalent themes for Plan 862
Themes % in Plan
Specific Disaster Directives 65%
Evacuation Plan 16%
Staff training 6%
Other 13%
Plan 862 is very similar to Plan 842, with the same top three themes in the plans, but
in slightly different proportions. "Specific disaster directives" consists of 2/3 of the
plan, with evacuation plan. "staff training", and the other four themes making up
the rest of the plan. Like Plan 842. this plan is concerned with the different nuances
between the disasters and how it's important to distinguish how to react to them.
However, it contains the least amount of themes in the Colorado set.
Interview
The facility that wrote Plan 835 was selected for an interview. The staff
members interviewed was the director, who is in charge of campus operations, and a
service and support coordinator, who is in charge of managing three group homes that
are part of the regional center and works on issues that clients may have. The last
53


major emergency that the facility encountered in the previous two to three years was a
snowstorm, but this was not significant because power was restored within a few
hours. Staff did not recall a major community emergency in the last two to three
years. The hazards that this particular facility is most prone to include flooding and
chemical spills due to their proximity to a railroad track.
The state department of health required the facility write an emergency plan
that met certain requirements. Each facility had to fill out and turn in specific
documents. The service and support coordinator was the main writer and facilitator of
the emergency handbooks, and received input from the management team. The
references used in writing the plan were mainly the templates provided by the state
health department, along with work through the county health department.
Themes
There were three themes that were gathered from the interview of this facility:
Rigorous state regulation.
One of the themes that emerged during the interview was the extent of the state
regulations that housed emergency planning. Earlier, it was discussed that the
Colorado Department of Health had issued very clear guidelines on what was to be
expected in all long-term care settings, and issued templates to be used to assist in
that process. This facility reiterated this finding:
"The Colorado Department of Health issued even more stringent requirement
and review of all emergency plans. There was a self-assessment that we had to
complete, which identified liabilities, response, and assets. Regulation also
54


mandated online FEMA training of all management team and middle
managers."
Emergency plans cover regulation required emergencies.. .everything from
bomb threats to flooding to severe weather.. .the contents of the plan are now
mandated by regulation, that you have to have some sort of mention or nod.
even if it might be low risk for our site.''
Limited staffing and resources.
Staff also expressed frustrations with time and resources not aligning with the
expectations and mandates issued by the state. These issues were various, from not
having enough staff to assist on meeting those emergency planning guidelines to not
having enough money to stock supplies for certain types of hazards:
Some agencies identify safety related or emergency management positions as
a fluff position.. .but it's enough work that you almost need a position
dedicated to it.. .1 rely on people doing safety things on the side. It takes away
from their primary job. so it's hard to get them to swim in the information and
be on top of everything. These are the type of positions that are the first to go
and I'm getting strong consideration to recreate the safety/emergency
response position...though the difficult decision in doing that would be
getting rid of a direct care position."
"I can get the time to get the regulations completed, but searching for
information to keep abreast of it... I haven't been able to time to do it. I'm
doing what I can, but not as efficiently as I should."
55


"We do tabletop training very well, regulations and best practices require that
you do a live drill. Easier said than done, part of it is the scope and having the
resources to pull that off for every living site... It takes someone to script the
whole thing, schedule to some extent."
"Preparing for pandemic...we don't have the money to stock those supplies.
It's not possible, we've done the calculations and what they recommend for
best practices and what we can afford is miles away. Then you have to worry
about keeping them current and well stocked."
Reactive policymaking.
The last theme that emerged was related to the staff members' reliance on the
state initiative to prepare for H1N1 last year. Both staff members discussed the
directive from the governor, and the activities that resulted after that, including
having a consultant come in to help them prepare for a pandemic. However, they have
reiterated that once the threat died down, the department has not discussed it since.
o "[The department] never talk about the emergency response until it becomes
some sort of mandate from higher above, like pandemic. And then suddenly
they're rushing in saying. "You need to do this, you need to do that," not
even considering what you have as a base. And then when that goes away,
they don't talk about it anymore.. .but now that pandemic has diminished,
there is no mention or review in emergency response."
56


Analysis
For the Colorado facility plans overall, it seems that giving information on
what to do during specific disasters seemed the most important, though the
proportions in each plan varied greatly ranging from 1/3 to 2/3. Also interesting was
the clear distinction between the plans. Plan 835 had the greatest amount of themes in
their emergency plan, but focused more on continuity of operations" and the policies
surrounding the writing of plan. This contrasts with Plan 842 and 862. which have a
secondary focus on evacuation planning and staff training. These plans also have
considerably less themes than Plan 835. While the regulation is in place in order for
all of these facilities to succeed in planning, there is something preventing them from
doing so.
With these three themes analyzed, it is obvious that for this particular facility,
they manage to meet all of the regulations required by the mandates, but still struggle
because of the limited time, staff, and resources on hand. Because this facility
possesses a plan that contains the most themes that should be in a complete
emergency plan, it is safe to assume that the remaining facilities also face the same
struggles with meeting these mandates. From the information gathered in the
interview, the structure and readily available information for facilities exists, but the
time necessary to comply with the standards is absent.
57


CHAPTER 7
SOUTH CAROLINA
South Carolina is located in the Deep South, on the coast of the Atlantic
Ocean. Its location makes the state particularly susceptible to hurricanes, followed by
thunderstorms and tornados (DDSN. pg. 7). The facilities that house the
developmentally disabled are under the jurisdiction of the Department of Disabilities
and Special Needs (DDSN). This department has also set up directives for disaster
planning for their regional centers housing people with disabilities or special needs.
In 100-25-DD. procedures are described as to how the department would react in an
emergency, who would be in charge, important contacts for resources and shelter, and
the elements in a disaster plan that every regional center or entity should include. This
document also provides directives in the case of a hurricane or a pandemic flu. This is
one of the states where the department has taken great care in ensuring that their
facilities are prepared for a disaster.
Not only has the department that manages the facilities created directives in
order to provide guidance, but the Department of Health and Environmental Control
has also set up licensing standards for all facilities housing mentally retarded persons.
An order in the standards makes it a requirement to have three things in the
emergency evacuation plan: a sheltering plan to house residents in an alternate
location, a transportation plan to move residents when necessary, and a staffing plan
to accommodate the residents in case of an emergency (South Carolina Department of
Health and Environmental Control. 2004). The document then asserts that each
facility is required to finish their emergency plan by June 1st and submit it to the
department for approval.
58


Plans
Because most of the plans for the five facilities were not easily accessible by
electronic format, a total of one plan was collected; however, this plan is interesting
because the facility in question is separated into two entities in different cities. Thus,
all of the hazards and vulnerabilities relevant to at least one of the facilities were
incorporated into the plan. The number of themes found in the emergency plan is
below':
Table 7.1 Number of themes in South Carolina sample
Plan Reference # # of Themes from Codebook
14
Out of a possible twenty-three themes. Plan 333 used fourteen themes, which is one
of the higher numbers in the entirety of the sample. Because the policies clearly state
what needs to be included, it may be that facilities are more likely to include more
themes in their plans.
Within their themes, Plan 333's three most prevalent themes were:
59


Table 7.2 Top three prevalent themes in South Carolina sample
Themes % in Sample
Employee responsibilities 35%
Specific disaster directives 29%
Disaster supply storage 9%
Other 27%
There is close to a 1:1 ratio between "employee responsibilities and "specific
disaster directives. "Disaster supply storage makes up the third most prevalent
theme within the sample, but the other eleven themes are spread out to make up
nearly 30% of the plan.
Interview
The interview with the facility in South Carolina was with the acting facility
administrator, who heads all campus operations, and the quality assurance
director/disaster preparedness coordinator, who is in charge of maintaining
compliance with licensure standards with the Department of Health and
Environmental Control. The quality assurance director was also the lead writer for the
emergency plan. In terms of major emergencies in the last two to three years, a
significant ice storm occurred last January that disrupted operations at the facility.
The other emergency was the H1N1 outbreak, which involved a few isolated cases
and was solved through quarantine.
60


The main writer of the emergency plan is the Quality Assurance Director, but
input is received from all of the head people within the organizational body. The
writers used resources from FEMA and DHS, local government emergency
management agencies, other facilities in the area, and references from Internet
searches. State meetings put on by the department that took place every June, right
before hurricane season, were also referenced. Factors that were taken into account
when writing the plan were client mobility and functioning levels, the environment
where the facility was located, previous weather conditions, and access to services.
Transportation and shelter limits in case of evacuation w ere the most important
factors cited in the planning.
Themes
During the interview, three themes emerged most noticeably:
Experience is key.
Both staff members interviewed continually referred back to the facility and
community emergencies that had occurred in the last two to three years. This
indicates that their knowledge base is from what they've actually encountered
themselves, and what major disasters the state as a whole has been through:
[Hurricane mitigation has been] implemented based on past experiences. The
big hurricane that hit South Carolina in 1989 was Hurricane Hugo. A lot of
what's in our disaster plan today is knowledge gained from that hurricane...it
prompted us to put things in disaster plans like tornados, loss of electricity,
that sort of thing.
61


We've improved [communication] in the past few years, between us and
other facilities, and within each other of the facilities to notify them if there is
an emergency or if we're having a drill.. .It's one of the things that years ago
when I was involved in hurricane evacuations, the problem was that
communication goes down quickly and you're left with nothing if you don't
have an alternate source as we do now."
The key thing that I find helpful is having someone that's been through an
emergency. That has past experience. That seems the most beneficial in
extracting useful information, life experiences, and scenarios because they
always identify areas that you didn't think of."
Strong relationships with other facilities and the main office.
Another theme brought up in the interview was the continual reference back to
the main department office, listing other facilities by name and the types of hazards
that they face, as w'ell as the partnerships that they have made within the community.
This indicated that the facility and all facilities within the state maintained contact
with each other in order to bounce off ideas and offer guidance. It also indicated that
the facilities were being encouraged to discuss these issues with the state and their
local FEMA office:
We meet as a state organization in June, once a year, right before hurricane
season, we meet as the entire state and discuss disaster preparedness,
readiness, and all of the facilities similar to ours, and within the community as
well. Just kind of a general review, any problems that have come up within the
past few' years, we discuss that. Gets everybody thinking about hurricane
season, is the motivator behind it.
62


- We also used the other facilities that we have a relationship with; to move
people to their location or provide service to them should they run into an
emergency. If a facility had a problem and we didn't, we would accept them
and make plans for them."
"We attended the state-wide FEMA disaster preparedness meetings, which the
FEMA representatives were there and reviewed our plans."
Any agency that serves vulnerable adults of any age is supposed to get prior
evacuation notification so that we can get out ahead of the mass, so to
speak.. .that's what we're told and that's what we plan for."
"We've also actual ability to communicate during a disaster. We implemented
a radio system with HAMM radios; they can communicate with main office
and other of the regional centers, along with private and state wide hospital
networks."
Easier to Stay Than Leave.
The last theme that came up throughout the interview was the procedures in
place that designated when an evacuation was to happen or not. Staff discussed that
for the specific population, it was much easier to remain in their facility rather than
evacuate to an emergency shelter:
Our structures are built pretty strong, so we've built into our plan that it has
to reach a certain level of intensity before we're actually going to leave. We're
better off hunkering down on-site than most people would be. Another facility
would not consider leaving until a Category 3 storm is reached. They have
63


hurricane protection there to withstand anything below that. They won't leave
until they get word it's going to be a big storm."
If we ever have to start discussing moving our individuals, [transportation
limitations' are the number one thing that pops up. How are we going to get
them moved quickly and safely?''
We have emergency generators, increased food storage during hurricane
season. We make those provisions because of that factor that in a lot of cases,
we're a lot safer where we are than hitting the road and not having access to
medical services, medications, and water."
Analysis
Because the sample size is so small for this state, it is unclear if South
Carolinas licensing standards and directives for emergency planning have made a
difference for the state facilities as a whole. However, the high number of themes
used in this plan relative to the other plans discussed bodes well for this particular set
of facilities.
From the information gathered in the interview, it is clear that South Carolina
facilities have the resources and structure in place in order to plan adequately for
emergencies. Combined with the licensing standards that require facilities to revise
their plan every June and the state meetings before hurricane season, it is obvious that
these facilities have resources that they can draw from should they need assistance in
planning.
64


CHAPTER 9
NEW JERSEY
New Jersey is a state located in the Northeastern part of the United States, on
the coast of the Atlantic Ocean. According to FEMA, the biggest hazard to the state is
flooding, which can be caused by either hurricanes or severe weather storms (Federal
Emergency Management Agency. 2004). The state's mitigation plan also cites
flooding as one of the biggest natural hazards, followed by hurricanes and
"nor'easters" (State of New Jersey, pg. 4).
New Jersey's regional centers that house the developmentallv disabled are
under the jurisdiction of the Department of Health and Senior Services. The directives
for emergency planning in these regional centers are under the New Jersey
Administrative Code. Title 8. Chapter 39, titled Standards for Licensure of Long-
Term Care Facilities. Subchapter 31.6 is referred to as Mandatory Fire and
Emergency Preparedness and outlines the type of staff training that should be
conducted, how many drills to conduct a year, emergency and evacuation procedures,
and what to consider when writing an emergency operations plan. It is also important
to note that this statute was edited in 2007, and slated for renewal in 2012.
Plans
There are a total of seven facilities housing developmentally disabled
individuals in New Jersey. Six of the seven facilities were able to provide plans in
electronic format. The table below shows the breakdown of the number of themes
used in the emergency plans collected:
65


Table 8.1 Number of themes in New Jersey sample
Plan Reference # # of Themes from Codebook
698 16
602 14
636 12
674 10
616 9
683 3
The range of themes used in the plans varies greatly, from 9-16.
The three themes that were used most within the sample are in the table
below:
66


Table 8.2 Top three prevalent themes in New Jersey sample
Themes % in Sample
Specific disaster directives 35%
Employee responsibilities 24%
Evacuation Drills 5%
Other 36%
Again, specific disaster directives" and employee responsibilities" top the list as
being the theme most discussed with the emergency plans, making up over half of the
sample. Evacuation drills was the third most frequently used theme, but that was
closely followed behind with other themes.
Now we will look at the characteristics of each plan, by theme.
Plan 698
Plan 698 had the most themes used, with a total of sixteen themes. The
breakdown of which themes were used is in the table below:
67


Table 8.3 Top three prevalent themes in Plan 698
Themes % in Sample
Employee responsibilities 23%
Disaster supply storage 17%
ICS/Evacuation plan 9%
Other 42%
"Employee responsibilities" makes up nearly a quarter of the plan, followed by
"disaster supply storage," ICS," and "evacuation plan." These four themes make up
a little more than half of the plan, with the remaining twelve themes making up the
rest of the plan. The foci on this plan rely on informing staff of what their duties are
and who to report to. what supplies they can utilize in case of an emergency, and how
to leave the facility if need be.
Plan 602
Plan 602 had the second most themes with fourteen. The breakdown of
themes used is in the table below:
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Table 8.4 Top three prevalent themes in Plan 602
Themes % in Sample
Employee responsibilities 49%
Specific disaster directives 12%
Disaster supply storage 9%
Other 30%
"Employee responsibilities" takes up nearly half of the plan. "Specific disaster
directives,7' "disaster supply storage," and the remaining eleven themes make up the
other half of the emergency plan. This plan is noteworthy because unlike the other
plans discussed, this is the first where "employee responsibilities" heavily outweighs
"specific disaster directives." This shows that the facility is more focused on giving
their staff instructions on what to do in a general context rather than what to do during
a specific type of emergency.
Plan 636
Plan 636 has a total of twelve themes. The top three themes used are broken
down in the table below:
69


Table 8.5 Top three prevalent themes in Plan 636
Themes % in Sample
Specific disaster directives 57%
Employee responsibilities 19%
Funding 7%
Other 17%
"Specific disaster directives" takes up more than half of the overall plan, followed by
"employee responsibilities." and "funding." The remaining 1/5 of the plan consists of
the other nine themes used in the plan. This plan is different than the others because
of the emphasis on how to get or access money before and after a disaster.
Plan 674
Plan 674 used a total of ten themes, and the top three used are in the table
below:
70


Table 8.6 Top three prevalent themes in Plan 674
Themes % in Sample
Specific disaster directives 53%
Employee responsibilities 10%
Evacuation plan 8%
Other 29%
"Specific disaster directives takes up a little over half of the plan, followed by
"employee responsibilities" and "evacuation plan." The last seven themes are spread
out in the remaining nearly 1/3 of the plan. This facility is very focused on response
tactics, with a heavy emphasis on what to do in specific instances, a general
explanation on what staff members should be doing in any emergency, and how to
leave the building if necessary.
Plan 616
Plan 616 used a total of nine of themes, and the top three used are highlighted
in the table below :
71


Table 8.7 Top three prevalent themes in Plan 616
Themes % in Sample
Specific disaster directives 28%
Employee responsibilities 25%
Evacuation plan 17%
Other 30%
Like Plan 674 above. Plan 616 has the same top three themes used in their emergency
plan "specific disaster directives." "employee responsibilities." and "evacuation
plan." However, the ratios are far more equal than that of Plan 674. The top three
themes are broken down into three quarters, while the remaining six themes make up
the last quarter of the plan. While this plan doesn't use as many themes as other plans
in the state, it is clear that the facility has a fairly good grasp of the different elements
of a successful emergency plan.
Plan 683
Plan 683 had a minuscule total of three themes used; and those are broken
down in the table below:
72


Table 8.8 Top three prevalent themes in Plan 683
Themes % in Sample
Specific disaster directives 58%
Resident identification 20%
Employee responsibilities 19%
Other 3%
Like Plan 674 above. Plan 683 has "specific disaster directives" for over half of the
document. However, the broad emphasis on "resident identification" themes is
equally interesting, which take up 1/5 of the entire plan. This is followed up by
"employee responsibilities," which also takes up 1/5 of the plan. While this facility
has a heavy emphasis on instructing staff what to do in specific instances of an
emergency, there is also emphasis on how to keep track of the clients and their
medical records if an evacuation were to happen.
Interview
The staff member that interviewed was from the facility that wrote Plan 616.
and is the CEO. The last disaster at this facility was severe weather related: back-to-
back blizzards resulted in 40 inches in snow. The facility is most prone to severe
weather, hurricanes, and severe nor'easters. They are also classified as a soft target
for homeland security, because of the large population of people in a concentrated
area.
73


In terms of preparation in writing, the CEO decided which of his staff
members would participate and went to a conference in Texas that offered the ICS
courses. They used those outlines, the New Jersey emergency management system,
and research on Hurricane Katrina in order to guide them. The factor that was most
taken into account was traffic flow because of the region's focus on tourism. The
most important factor that was cited in planning for this particular population was
grasping an understanding of the potential and being able to react to the specific
situation.
Themes
There were a total of three themes found in the interview.
Survival and Instinct.
One of the themes that emerged from this interview was that of survival and
instinct. The CEO allowed for more of a focus on how to act in the moment of an
emergency rather than having a specific emergency plan. The CEO believes that it
has worked for their facility because it allows them to think on their feet, without an
over-reliance on their department.
"When stuff has gone down. Eve been the only one here. I don't get folks
coming down from central office level immediately. They come down after
the fact."
Having understanding of the potential.. .these plans, I don't care what plans
you have; if you just have an outline or guideline to follow, it's probably a
better approach than to have it spelled out in specificity or identifying
individuals that do certain tasks. When the emergency happens, at that point
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are what resources you have, what the issues are, what the variables will
be.. .and then you put yourself forward. Bottom line is, we look at these plans
as exercises as to identify the possibilities, not something we have to follow
chapter and verse.'
"Were still here, were still certified, and we're still moving forward. We
have faced some incredible stuff in the past for years so our plans are pretty
successful."
Political issues.
The second theme that emerged dealt mainly with the politics involved with
other authorities making decisions on what action to take when a major community
emergency takes place. There were also issues of people making decisions who are
not necessarily well versed or familiar with the population at hand, which impedes the
implementation of the emergency plan.
"It's frustrating because certain things come up and give us a nod to step up to
take this, or ask us to open up a building and nothing happened. When it
comes down to it. it was a politician that made the call...it's frustrating over
having that relationship, but if stuff hits the fan, I'd have enough support from
the county and state to manage this facility."
You run into scenarios at things are being done best at the time at youre
doing it. versus worrying about what they'll say or what they have to say.
Some of the folks in the state believe a full evacuation of this facility can be
done. You actually work at this facility; you realize that a full evacuation is
next to impossible without jeopardizing the lives of a few' hundred people.
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You're in a situation here.. .by the time it's hitting Virginia, it's 48 hours out
from landfall with us. 48 hours isn't a whole lot of time to get out of the
county. So you wait for politicians to make the call whether or not they're
going to go or not. So we're all in a holding pattern.. .waiting on them to
decide about how much it's going to cost and the loss because the tourism
season will be shot. It's a mentality.. .it's that atmosphere that is a deficiency
in making these plans go off without a hitch.
Resource power and lack thereof.
The last theme that emerged was the concept of resource power. While the
facility is very willing to work with the local county emergency management
agencies to provide their buildings as a resource, there is an increasing need for more
resources in the form of money or equipment to be more successful" in preparing
for disasters.
"We have said all along that we would be a resource to the community. We
proved that last year during our blizzard when we were able to 150 people for
a weekend and give them a place to live and reestablish themselves. That was
part of our plan, and we got the opportunity to implement."
"Funding, federal funding, equipment, dollars and sense. We operate on a
shoestring, because of state budget issues. We'd like to have some better,
newer equipment, but we don't have it so we deal with what we have.
More resource to develop redundancies in equipment. It'd be nice to have
emergency generators that you could depend on that weren't 35-40 years old.
And that the switch is there not hit a switch and cross your
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fingers.. .mechanical areas that would allow us to be truly self sufficient for an
extended period of time.
We face challenges all the time and when the budget gets tighter.. .this is one
of the easier places to take a look at and cut back X amount of dollars and
how to do what fve always been doing with less."
Analysis
Based on the plans alone, it is difficult to tell what problems and barriers exist
in emergency planning for this particular population. However, due to the wide
variation in themes in the emergency plans collected, it is clear that there are some
gaps in knowledge between facilities. The six facilities are nearly split down the
middle between "specific disaster directives" and "employee responsibilities"
constituting the most volume w ithin their emergency plans.
According to the interview, this particular facility felt it necessary to not rely
so heavily on the use of an emergency plan, but rather to train the staff to be more
instinctive about what they would do in a disaster situation. However, the barriers that
were encountered mainly dealt w ith the lack of resources in terms of equipment and
funding in order to be self-sufficient in an emergency, and the political nature of
decision making that happens within the state.
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CHAPTER 9
OVERALL FINDINGS
Overall Findings from All Emergency Plans
Number of Themes in Content
The collection of the emergency plans was restricted by which facility was
able to provide an electronic copy of their plan. As a result, there were a total of
fourteen facilities out of the four states that were able to participate. After data coding
and analysis, the number of plans that each code was represented in is in the table
below:
Table 9.1 Rank of most prevalent themes in entire sample
Label # of Plans Mentioned In
Specific Disaster Directives 14
Plan writing 12
Employee Responsibilities
Incident Command System 11
Evacuation Plan
Disaster Storage Supply
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Table 9.1 Cont.
Warning Systems
Communication Systems 10
Staff Training 9
EOC Establishment 7
Interagency coordination
Planning Committee 6
Mutual Aid Agreements
Emergency Shelter Arrangements
Hazard identification and risk 5
assessment
Evacuation Drills 4
Shelter-in-place 3
Funding
Continuity of operations plan
Disaster Exercises 2
Mitigation activities
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The table shows that text detailing what to do during specific disasters
(denoted in the code specific disaster directives") was the most prevalent to include
in this sample of emergency plans. This was included in nearly all of the emergency
plans, save for one facility. The next most prevalent theme was "employee
responsibilities." and "plan writing." The least prevalent themes in the sample were
"mitigation activities." and "disaster exercises."
In examination of the plans, it is obvious that there are inconsistent themes
throughout each state. Washington. Colorado, and New Jersey all faced significant
problems in inconsistency of their emergency plans, with the number of themes
ranging from 3-19. While this can account for certain elements of emergency
planning (such as resident identification) being in separate non-emergency
management related documents, it would be helpful if each facility considered all the
possibilities and obstacles faced and integrate those issues all into one document.
South Carolina's sample was too small to make conclusions about whether the policy
structure is working for the success of their emergency plan writing.
Emphasis on Employee/Disaster Directives
The themes that were most prevalent in all of the states were "specific disaster
directives" and "employee responsibilities. These types of directives give the reader
a checklist or list of criteria regarding what to do in an emergency whether that be
related to the specific disaster faced at hand or the organizational position of that
person. This shows an emphasis on using the emergency response plan like a training
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manual. It's not necessarily a document that outlines policies and procedures, but
more a document that staff can utilize in the heat of the moment.
Because "specific disaster directives' has such prominence on the entire
sample of emergency plans as a whole, the type of disaster that was most discussed in
the plans is analyzed in the table below.
Table 9.2 Top three prevalent disasters cited in entire sample
Top Three Disasters/Hazards % in Disaster Directive Code
Disease, Infection Control, and 27%
Pandemic
Fire 23%
Security 15%
Prevention tactics and response directives associated with disease, infection control,
and pandemic were the most mentioned within the "specific disaster directives" code.
Followed by this were issues of pandemic, disease outbreak, and infection control.
The third most prevalent type of disaster that was discussed in the plans were security
threats, which consisted of issues such as workplace violence/lockdown, war. bomb
threats, terrorism, and general homeland security. These top three disasters high
percentages can be accounted for due to the fact that these disasters are common to all
facilities, which explain their prevalence within all of the plans.
Overall Interview Findings
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When examining the interviews conducted as a whole, it was very clear that
the government performance framework was at work. The components of the
government performance framework were reiterated as being most important to a
facility's emergency plan and included: leadership, management systems, integration
and allocation, and results focus. It was very evident that all leadership personnel
were committed to the quality of their emergency planning, but were stopped in some
way due to issues of resources in which staffing, equipment, and financial burdens
were cited as barriers to being more successful in emergency planning. This finding is
linked to the integration and allocation element, where leadership, resources, and
information all work together to execute the organization's goal or vision (Ingraham
et al. 2003). The facilities interviewed have made it clear that their goal for being
prepared for emergencies is not being reached due to a shortfall in resources.
Other similarities between the facilities interviewed included an awareness of
the risks posed to them. All facilities were able to name off the disasters that they are
most prone to. along with the risks that they face due to their proximity to certain
hazards within their communities. There was also a strong attachment to the specific
needs of their clients: Colorado cited that they tailor their emergency plan manuals to
the individuals living at each house/site, while South Carolina and Washington
discussed the integration of their clients into the fire/disaster drills. New Jersey did
not emphasize this as much.
Finally, when asked about training, all facilities discussed the need for doing
drills both the requisite fire drills once a month and disaster drills, ranging from a
tabletop drill to a full-scale drill. Other versions of drills that were used were silent
drills (where staff members are tested on paper) and emergency generator drills
(where the facility runs on generator power to test their function without utility
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power). All facilities understood the importance of scripting different emergency
scenarios every year to keep their employees trained and thinking about the
possibility of a disaster.
Overall, the interviews with facilities allowed for the understanding of how
the policy structure of each state impacts the emergency planning process. The
emergency plans were notable in that they showed the inconsistencies in training and
information across the board, but the interviews were what helped to illustrate how
the state has or hasn't taken an initiative on emergency planning, and how it has
affected the facility's attempts to be prepared for an emergency.
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CHAPTER 10
CONCLUSION
Given what the literature and data present, efforts to meet the needs of
disabled populations in disasters have been too reactive and top-dow'n in nature. The
majority of the federal legislative policies that affect disabled populations are due to
major disasters occurring. While these efforts are promising for disabled populations
that live independently, they do not explicitly effect those disabled populations
residing in long-term care settings. Grouping all types of disabilities under a blanket
also hampers these efforts, an act that fails to comprehend the nuances between
distinctive disabilities. Someone with a physical disability has different impairments
than someone who has a cognitive disability, and the literature has only recently
begun to reflect this difference.
This research sought to compare how institutions housing the developmentallv
disabled pursued emergency planning in four different states. The comparative factors
were the states' policies governing emergency planning guidelines for these
institutions, the type of most relevant hazards, and their varying rates of
institutionalization. These factors will be discussed to see if they had an effect on how
well institutions implemented emergency planning activities.
Policy Structure
Because these facilities are often understaffed and short on finances, it is safe
to assume that stringent regulations on emergency planning drive some institutions to
be more compliant than others. When each state's policy structure was analyzed, it
was evident that some states had more stringent requirements than others.
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Washington and New Jersey had the least amount of regulation regarding emergency
planning for these facilities, while Colorado and South Carolina had the most
stringent regulations. However, the facility interviewed in Colorado struggled with
finding time to emergency plan due to staff shortages. Thus, the success of
emergency planning relied on staff members willing to take on extra work alongside
their regular jobs at the facility. In contrast, the facility interviewed in South Carolina
deemed itself to be successful in emergency planning, some of that success due in
part to the entire department's devotion to it by conducting a meeting every year
before hurricane season. This indicates that more stringent regulation of emergency
planning guidelines does not necessarily guarantee the success of an institutions
emergency planning activities.
Rate of Institutionalization
As earlier stated, Washington and Colorado were more deinstitutionalized
than South Carolina and New Jersey (Braddock. Hemp, and Rizzolo, 2008). A
reasonable hypothesis would be that states with higher institutionalization rates would
be better attuned to the difficulties of emergency planning. However, the facilities in
South Carolina and New Jersey differed greatly in implementation practices.
Facilities interviewed in both states were responsible for 100+ clients, but the facility
in New Jersey was not nearly as successful as the facility in South Carolina. One
particular difference involved the need for facility coordination with their
departments and state governmental entities in order to determine evacuation. In
South Carolina, facilities housing the developmentally disabled, along with other
"vulnerable entities (hospitals, other long-term care facilities) are notified before the
general public in order to give them time to evacuate first. In contrast, New Jersey
facilities must wait on political authorities to make the decision on when to evacuate
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the region. While this may differ by region, it is clear that higher rates of
institutionalization do not necessarily correlate with better emergency planning and
preparedness at these institutions.
Another interpretation suggests that the deinstitutionalization movement has
made it more manageable for administrators to plan for emergencies because the
facilities are significantly smaller. The facilities interviewed in Washington and
Colorado featured significantly different models as Washington utilized smaller-scale
institutional settings and Colorado utilized group-home models. However, both
facilities cited significant obstacles that impeded their success in implementing their
emergency plans. According to the states studied, it can be concluded that
deinstitutionalization also does not determine whether an institution is successful at
emergency planning.
Hazard Risk
Lastly, the hazard risks respective of each state's facilities were compared.
When asked about the types of hazards that the facility was most prone to,
Washington's facility cited severe weather and flooding; Colorado's facility cited
flooding and chemical disasters; South Carolina's facility cited hurricanes and
tornadoes; and Newr Jerseys facility cited severe weather, hurricanes, nor'easters, and
homeland security threats. While data was not recorded on how severe and frequent
these hazards occur in these specific regions, South Carolinas facility was very
aware of the risks posed to them every hurricane season. This was shown by their
efforts to stockpile disaster supplies every hurricane season, the yearly meetings in
June with the entire department, and their buildings being able to withstand up to a
Category 3 storm due to mitigation efforts. Though New Jersey's facility was not as
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successful at emergency planning as South Carolina's, their recognition of the risks
posed to their location if a large-scale hurricane or nor'easter were to occur is noted.
This is shown through the CEO's concern with the difficulties of having to evacuate
the facility if instructed to. In contrast. Colorado and Washington's facilities have
been fairly hazard-free. In the case of these case studies, type of hazard and frequency
of such hazard may have an impact on how well facilities prepare themselves and
how much additional support in emergency planning is provided by the state.
Other Factors and Limitations
This research analyzes the emergency planning approach at institutions
housing the developmentally disabled from the implementation perspective. This was
to determine whether the latest federal directives on disabilities policy and emergency
management have impacted whether state-run institutions are successful or not in
implementing procedures for their residents. The data reflects that their information
sources and directives to conduct this type of planning come predominantly from the
state level and that each state has its own host of problems in implementing such
planning. In addition to the budget cuts currently affecting state governments, it is
difficult to prioritize emergency planning activities when a facility is not at risk for a
large-scale disaster. Faced with the organizational responsibilities of providing care to
their clients, these facilities understandably struggle with allocating time and
resources for emergency planning.
This data is not without limitations, however. Because of the variation in
content themes in the facility emergency plans, it is unclear whether plans with less
thematic content are less successful than plans with more thematic content. The
sampling methodology of the interview process prompted only one interview to
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represent an entire state for the purposes of the case studies. More research is
necessary in order for a broader understanding of how well other states emergency
plan for their institutions housing the developmentally disabled. These shortcomings
can be resolved by interviewing state-run institutions from other states to determine if
a higher rate of hazard risk is the factor driving institutions to be more successful than
others in emergency planning.
Policy Recommendations
The data collected tells us that a number of facilities are struggling to make
time and allocate resources in order to emergency plan effectively. From the analysis
of facility emergency plans, it was clear that there were inconsistencies over what
information should be included in a good'' emergency plan. Beyond this, the bulk of
the information about the successes and failures of emergency planning was revealed
through the interview process. It has been noted above that the facility in South
Carolina was most successful at implementing their emergency planning. Flowever.
there were important aspects from the other state facilities that helped them
accomplish what they have in place. Therefore, the following are policy
recommendations that could potentially improve the quality of emergency planning in
these institutions.
Standardized Templates
Despite some states' rigorous instruction in what should be included in a
facility's emergency plan (Colorado and South Carolina had the most rigorous
standards for this), state facilities plans had wide variations in the types of content
included. This is not characteristic of South Carolina's facilities, due to lack of
sample size. However, it can be concluded that facilities should have some sort of
88