As long-term care providers around the nation, including assisted living communities and skilled nursing facilities, continue to optimize their emergency preparedness programs according to regulatory requirements and best practices, they have become very familiar with the concept of hazard vulnerability assessment, or HVA.

Common emergency management practices require individual facilities as well as entire communities and regions (county and state) to identify all of the potential threats and perils that potentially could affect their operations. Although the majority of these recognized hazards can be considered static or remain unchanged once they have been identified through a formal HVA process, a dynamic element of hazard recognition must be addressed when things do, in fact, change.

One such change includes the presence of construction within a facility or outside of the facility in the general community. Recent emergencies, including two devastating incidents that occurred during construction at both a healthcare facility and a non-healthcare facility, highlight the risks associated with “routine” construction projects.

In the incident involving a healthcare facility, in Texas, an apparent explosion during a construction project resulted in significant damage to several buildings and caused injuries as well as two fatalities. In the non-healthcare related incident, in Wisconsin, a massive explosion occurred on a city street when an excavating machine apparently ruptured a gas line, killing a responding fire captain and injuring several other firefighters, police officers and civilians.

External construction projects on or near a senior living community, as well as internal construction projects within a building, should be recognized as potential hazards. The presence of heavy machinery on the outside of a facility and associated excavating represents a potential hazard that must be recognized. Construction sites where foundations, walls, support beams and roofing elements are being installed should be considered hazardous during the various phases of completion. Unsupported building elements such as block walls can collapse in high winds, and structures in the early phases of construction that are not yet protected by a fire suppression system can burn.

Remodeling, renovation or new construction occurring on the inside or on the grounds of an existing healthcare facility also should be identified as a potential hazard. Fire suppression systems that have to be turned off during construction, electrical hazards and the potential need for any “hot work,” including the use of torches for plumbing component installation, should be recognized as potential hazards that must be addressed in the facility’s emergency operations plan. In the case of regulated long-term care facilities, in-patient hospice and hospitals, interim life safety measures may be required by regulations to address the presence these hazards. Be sure you and those involved with your project are familiar with applicable regulations.

Construction projects occurring near the facility, such as water and sewer projects where excavation is required, also represent a potential threat that must be acknowledged and accommodated. For example, if a primary or secondary emergency exit route out of a facility leads right into a construction zone, then alternate measures must be developed for the times when normal provisions of egress may be compromised. From another perspective, it is not uncommon for major construction projects to be occurring on an adjacent property, where the risks associated with a high volume of combustible material, such as wood framing, will present an extreme risk to the neighboring buildings if those building components should catch fire during the construction process.

The main take-away point from this article should be that HVA must be considered a dynamic process, not just a “one-and-done” deal. New emergency preparedness requirements from the Centers for Medicare & Medicaid Services mandate that regulated healthcare facilities conduct a risk analysis or HVA that is reviewed on an annual basis. In addition to annual review, an analysis of new risks must be completed when they emerge in or near a senior living property or healthcare facility.

Kaiser Permanente has developed a tool that is commonly used to conduct an HVA. The tool can be accessed at multiple sites online or can be downloaded here.

Potential threats and perils to your senior living community or nursing home are constantly changing. Make sure that your emergency preparedness efforts are dynamic and account for these changes when they occur. Once identified, adjust your emergency operations plan, even on a temporary basis, to provide appropriate emergency response protocols and contingencies to address all potential threats and perils.

Stan Szpytek, a regular contributor to McKnight’s Senior Living, is the president of consulting firm Fire and Life Safety Inc., in Mesa, AZ, and is the life safety / disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit or e-mail Szpytek at [email protected].