Senior living properties, including those providing assisted living services and memory care support, are being integrated into the greater community all around the nation. No longer are senior living communities confined to the outskirts of town; they now are being developed in local neighborhoods, downtown urban areas and even on college campuses, such as an innovative project on the campus of Arizona State University known as Mirabella at ASU.
Regardless of where those communities are located, senior living providers are compelled to develop plans for emergencies and disasters that can affect their operations. The development of an “all hazards” emergency management plan will help you identify the wide variety of threats and perils that you must be prepared to manage.
One threat that every senior living community, as well as every type of occupancy, must prepare for is the presence of an armed intruder or active shooter on campus. Whether the cause is civil unrest — including violent protests, criminal activity, domestic violence or armed robbery — or a mass shooting, there are ways that senior living communities can prepare, respond and recover from the unthinkable.
Unlike other occupations where, for the most part, individual employees simply can focus on their own personal safety in the workplace, the senior living environment clearly is different. Members of the workforce in senior living communities become connected with residents and, in times of peril, will not leave them to fend for themselves.
Security experts have developed protocols that focus on the nuances of the senior living “careforce.” Those simple protocols provide practical solutions and the options that can be considered, including a life-saving strategy known as the Four Outs, to effectively respond to fast-moving and unpredictable incidents.
Senior living communities are uncommon in the way they must approach preparedness for an armed intruder or active shooter. In most industries with an adult workforce, workers are trained in survival techniques based on “me focusing on me”; in other words, each adult takes care of himself or herself. In senior living, much like elementary schools, workers not only have themselves to worry about; they also have to worry about others who can’t take care of themselves and rely on them.
The Four Outs is a program that addresses this factor as it applies to senior living communities. Often compared to the Run-Hide-Fight protocol promoted by the US Department of Homeland Security, the Four Outs was developed by the team at Sorensen, Wilder & Associates as a program based on practical choices for those situations when one has to think about more than just himself or herself. The Four Outs must be applied with both the resident and the caregiver or other staff members in mind.
Broken down, the key elements of the Four Outs are as follows:
- Get out. Move residents and staff members out of and away from the building to a designated reunification point. Remember, the Occupational Safety and Health Administration, as well as licensure regulations, require a senior living community’s emergency evacuation plan to identify a designated reunification point(s) and provide for an immediate accountability of all employees and residents during an emergency evacuation.
- Hide out. When getting out isn’t possible, then Plan B is to hide out. Seclude yourself in a room, preferably with a locked door, where you can hide without being seen or heard. This includes taking steps such as covering interior windows and turning out lights.
- Keep out. Not all rooms have locks on the doors, and in some cases, locks even may be prohibited by regulatory standards. In those cases, such as in a resident’s room in a memory care unit where the door does not lock, you will have to create your own barriers. Doing so may include barricading the room’s door with a resident’s bed (remember to lock the wheels) as well as other furniture in the room. The more material barricading the door, the better. In other areas, you can use anything and everything available to create a wall of obstruction, such as in front of hallway smoke doors. Those temporary barricades are not intended to prevent the door from being opened (many swing in opposite directions). Rather, they are intended to create such an obstruction that the offender, who is looking for targets of opportunity, will choose to move on rather than set down his weapon and waste time trying to move all of the obstructions.
- Take out. As a last resort, and only as a last resort, you may have to fight back. This fight against the offender is truly a fight for your life. There are no rules; there is no “fair fight,” and your focus is on your survival by stopping the offender by incapacitating him or her. Use any weapon of opportunity available — such as scissors, a stethoscope, a fire extinguisher, a chair or a trouser belt — and be prepared to do whatever you must do to stop the offender and save yourself, up to and including the use of lethal force.
When someone is in a position of relative safety, as quickly as possible, the authorities should be called through the 911 system. A concept taught by the team at SWA and other security professionals is that there is no such thing as too many calls to 911 during those types of violent and fast-moving emergencies.
Additionally, many jurisdictions now have 911 texting capabilities, so emergency text messages, instead of voice communications, can be sent to the 911 center when hiding out. It is important to know whether this service is available in the jurisdiction where your senior living community is located. Once you have confirmed whether this option exists in your area, all members of your team should be trained on proper 911 procedures, including text messaging, if available.
The program developed by SWA also focuses on making the most difficult decision that may need to be considered in times of peril: whether to focus on yourself or your residents.
Identified as the Safety Transition Adjustment Formula, or STAF, protocol, caregivers are trained in what to look for in the initial moments of an event, to guide themselves to making the right decision based on personal and resident safety.
When a shot is heard, the normal (and expected) reaction is anxiety. That is understandable. But when that moment occurs, your first question needs to be, “Where am I in relationship to where the shot came from?”
If you are close to the shooter, then your personal safety comes first. If the shooter is a distance away from you — perhaps on a different floor or in a different building — then you can then focus on resident safety first, using the Four Outs to evacuate residents or secure them in place.
And remember, when the best option is placing yourself first, you aren’t being a coward or being selfish. If something happens to you, who will take care of residents and others?
The recovery aspect of a shooting incident often is the part of the preparedness continuum that is overlooked, considering that no organization or individual thinks that such an event really will happen to them. But if you are willing to accept the fact that an incident involving an armed intruder or active shooter really can occur at your senior living community, then you also must realize that when the initial incident ends, you must initiate the recovery process to eventually return to a state of normalcy.
For those who have experienced the unthinkable, they know that this is not as easy as it sounds. The recovery process must be addressed long before the first shot ever is fired. It requires the development of relationships with outside providers who likely will be needed to provide support after the incident. This support includes the restoration resources that may be needed to address physical damage to the community, as well as the emotional support that will be needed from mental health professionals to address the psychological trauma associated with this type of adverse incident.
Training, both in the didactic mode and the practical skills mode, are essential elements of an effective armed intruder / active shooter awareness program in a senior living community.
Although both authors of this article are strong supporters and allies of law enforcement, relying on your local police department or sheriff’s office for training may not give you the results you need. Law enforcement training focuses on law enforcement’s response to the threat. Your community’s training must focus on how to minimize casualties and maximize survivability from the moment the first shot is fired until the time police arrive on the scene. To do this, your community’s training should be provided by a qualified person who is intimately familiar with the senior living environment and the unique challenges you face.
The thought of an armed intruder or active shooter in a senior living community is difficult to imagine. Providers, however, must prepare their staff members for the unexpected by empowering them with the knowledge needed to exercise one of the Four Outs or take other appropriate action to protect themselves and those in their care should this type of emergency occur.
Stan Szpytek is the president of Fire and Life Safety Inc., a national consulting firm based in Mesa, AZ. He is a consultant for the American Assisted Living Association and is the life safety/disaster planning consultant for the Arizona Health Care Association, the California Association of Health Facilities and the Utah Health Care Association. 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 www.FLSafety.org or e-mail Szpytek at [email protected].
Steve Wilder is president and CEO of Sorensen, Wilder & Associates, a nationally recognized healthcare safety/security consulting group based in Bradley, IL. Since 2014, SWA has been the recognized leader in active shooter preparedness in the senior living and care industry. A retired fire chief in the suburbs of Chicago, Wilder was the 2019 recipient of the Leadership in Emergency Preparedness Award from the Illinois Security Professionals Association, for his leadership role following the murder of two residents in an assisted living community in Pennsylvania. For more information, visit www.swa4safety.com or contact Wilder at [email protected].
The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.
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