Emergency Plan Manual

AHCA Form 3110-1022, Rev March 2013 Rule 59A-8.027, Florida Administrative Code http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Home_Care/HHA/index.shtml#other . Page 18 of 54 APPENDIX B: INFORMATION FOR HOME HEALTH AGENCY PATIENTS The following information should be supplied by the home health agency to those patients registered with the special needs registry, so they will be prepared prior to an evacuation to a special needs shelter. Please note: The special needs shelter should be used as a place of last refuge. The evacuee may not receive the same level of care received from staff in the home, and the conditions in a shelter might be stressful. (1) If the patient has a caregiver 1 , the caregiver must accompany the patient and must remain with the patient at the special needs shelter. (2) The following is a list of what special needs patients need to bring with them to the special needs shelter during an evacuation: x Bed sheets, blankets, pillow, folding lawn chair, air mattress x The patient’s medication, supplies and equipment list supplied by the home health agency, including the phone, beeper and emergency numbers for the patient’s physician, pharmacy and, if applicable, oxygen supplier; supplies and medical equipment for the patient’s care; Do Not Resuscitate (DNRO) form, if applicable; x Name and phone number of the patient’s home health agency x Prescription and non-prescription medication needed for at least 72 hours; oxygen for 72 hours, if needed. x A copy of the patient’s plan of care x Identification and current address x Special diet items, non-perishable food for 72 hours and 1 gallon of water per person per day x Glasses, hearing aides and batteries, prosthetics and any other assistive devices x Personal hygiene items for 72 hours x Extra clothing for 72 hours x Flashlight and batteries x Self-entertainment and recreational items, like books, magazines, quiet games. (3) Shelterees need to know the following: x If the patient has a caregiver, the caregiver must accompany all special needs shelterees. A special needs shelter can accommodate one caregiver at a time, and other family members, friends, etc. should go to a regular shelter. x The shelteree caregiver will have floor space provided. The caregiver must provide his or her own bedding. x Service dogs are allowed in the shelter. However, check with your local Emergency Management office to see if other pets are permitted. x Bring personal snacks, drinks, and any special dietary foods for 72 hours. It is possible only sparse meals will be provided. x Caregivers who regularly assist the patient in the home are expected to continue to do the same care in the shelter. . 1 Caregivers can be relatives, household members, guardians, friends, neighbors and volunteers. Angel Home Care Services, Inc.