Ready and Responsive App (App)

Too many vulnerable people died unnecessarily in care facilities during COVID19, despite 2009 CDC pandemic preparedness funding for health and education facilities.

We use All-hazard protocol to implement stringent responses, adjusting initial actions according to validated information. Our App, pre-populated by the facility manager and designated staff, generates plans for different types of emergencies and pushes out clear, situation-specific, action sheets to employees, in their preferred language. If Internet is down or an employee has no smartphone, alternatives exist to ensure each person understands their required sequence of critical actions. The App provides pre-planning and training reminders, as well as prompts for post-response updates.

Since the App response plans are pre-populated with localized data, they can be used for any type or size of vulnerable care facility, regardless of location. They generate clear, intuitive step-by-step responsibilities laid out for pre-identified essential workers, while pointing to local response resources.

Time, money and resources were lost in every community as the response to COVID19 stuttered to start. This should not have happened. Post 9/11, the Federal Government deployed All-hazard planning funds to help communities prepare for a range of emergencies, including up to three months pandemic-initiated social distancing and school closure. The reality is that governments and organizations change, and taxpayers forget. Skills learned and actions practiced are lost ten years out.

During COVID19, many entities ramped up their approach only when told to. The cat had already escaped the bag by then. Nursing homes and assisted living facilities (ALFs) quickly accounted for 42% of total COVID-19 deaths in the US. According to the CDC there are approximately 15,600 nursing homes (1.7 million licensed beds) and 28,900 ALFs with 1 million licensed beds. According to the National Institute on Aging, today’s 39.5 million over-65s will be joined by 75 million Baby Boomers by 2040.

Well-managed success stories were eclipsed by failures. Emergencies have a disproportionate impact on care-dependent individuals, and caregivers represent different social, educational and language backgrounds. Many facilities lacked All-hazard planning experience, and existing resources went unused or were inaccessible to staff.

https://khn.org/news/nursing-home-outbreak-spotlights-coronavirus-risk-in-elder-care-facilities/

https://apnews.com/2204d14408857278c842a4c590f3deb6

https://www.cpr.org/2020/04/10/elder-care-facilities-become-the-center-for-deaths-in-colorados-coronavirus-crisis/

Our solution uses previously developed and tested intelligent decision trees based on All-hazard planning. This allows organizations to build a response approach for any emergencies that concern them. It assumes the worst, deploying an emergency-standard approach. Responses are modified according to actionable information. The pre-event planning program allows individuals in different job categories to learn and integrate changes to their own work scope. By “owning” new responsibilities, required changes in activities are better understood.

The solution is delivered via an app, allowing each member of the organization to plan, prepare, respond, manage, pivot, and recover from common emergencies. It engages users through simple, step by step instructions, presented in preferred languages, that flow from a centrally populated planning tool.

The App is iterative and incremental. Resiliency and adaptation plans are built out as questions are answered. It has two modes: admin and user. In admin mode a designated individual at the organization is guided through questions about the facility. The responses allow the App to build a facility-tailored Emergency Management plan with a range of emergency response possibilities. Users log-in according to job function (cleaner, cook, admin, nurse) and type of emergency, and are guided through action checklists.

The target population includes: caregivers, the vulnerable populations they care for (individuals requiring assistance) and families. Our team has worked with caregivers in elder facilities, in homeless facilities and in school systems to understand what normal activities entail for each job description, and how these skills translate to activities critical during an emergency. We studied the impact of stress on decision-making abilities, on language recognition, and on individuals used to authority. 

As a result, as we developed All-hazard plans for institutions and agencies, we wrote one to walk management through the process; a “light version” with action checklists for different functions; and a pre-populated version to account for very local conditions and people. With training, this successfully mitigated against stress points that impeded useful action. 

The Office of Child and Family Services (NY) recognized us for maintaining their 30-second response to incoming requests, despite living through real emergencies. 

We are translating two decades of validated experience with numerous clients into an App, relying on locally entered information to populate plans suited to different situations. Being prepared and knowing what to do takes out the “emergency” from many situations. Familiarity with the process supported a pivot from panic to useful actions.

·       slow the spread of an emerging outbreak

The App prepares staff to act at the onset of “emergency” situations to minimize and mitigate against impact on individuals in their care

·       provide tools that support and protect health workers

Once employees understand their roles, “panic” mistakes are minimized. Focusing on practiced actions unites facility members, disrupting dangerous routines. We deployed a pre-App approach for NYC employees in 2009, significantly reducing influenza spread.

·       mitigation measures

Individuals who are prepared for most types of emergencies adapt better to new threats, containing their impact, while rapidly pivoting to a new normal. 

The App makes actionable emergency management tools accessible to individuals who work, live or have relatives in eldercare facilities. It generates clear action sheets for employees in their language of choice, according to job classifications. These instructions are based on All-hazard response requirements, using simple language to account for stress and fear. Situational chains-of-command and communication are generated by emergency type, using a logic tree paralleling decision trees used by first responders. This facilitates clear transmission of information, and residents and families are informed of actions being taken, from a single source.

The App fills the crucial gap between emergency mass communication tools and complex business continuity systems. While potential competitors, such as LiveProcess, and high-end systems like Agility Recovery, cover similar elements, we believe their approach is not equally inclusive. They don't encourage appropriate responses from the wide variety of people potentially affected in an eldercare scenario – from caregivers to non-medical workers to patients and their families.

There are State apps, such as California’s Association of Health Facilities Disaster Preparedness Program app on which a facility stores emergency preparedness information with pertinent public emergency information. This app does not deploy emergency-specific All-hazard plans or action-sheets for use by employees.

Our solution provides a new dimension of performance because it is simple, based on a combined 80 years of multi-disciplinary hands-on experience, and focused on stakeholder success. It is inexpensive, easy to deploy, keep up to date and use, and belongs to each facility.

·    The designated responsible person accesses the administrator component of the App on a laptop and is guided through a set of questions about the facility. Based on the answers the App generates a Comprehensive Emergency Management Plan (CEMP) tailored to the facility. 

·    The CEMP is pushed as an App update to the registered phones of employees and residents/patients using a Enterprise App Store. Thus, employees do not have to reach out to their employer to obtain the latest CEMP. In an emergency the administrator can push a notification to the phones after selecting a specific type of emergency.

·    Users login to an Android or iOS version of the App according to their role (e.g. login as patient, cleaner, cook, supervisor) and are guided through their duties during a given emergency. This includes modifications to how they should perform usual tasks (e.g. enhanced cleaning), additional tasks required (e.g. sanitize deliveries as they arrive), how to act in case of an acute emergency (e.g. evacuation procedures), and a communication directory (who to contact about what and how to reach them).

·    The administrator can opt to provide access to the App to fire, police, and other responders who can use it during an emergency.

A future version of the app will use a cloud-based centralized server that provides: a real time dashboard visualizing the status of the facility and the users, interactivity between users, and a temper-proof log of all activities performed during an actual emergency.

Mobile apps and distribution via Enterprise App Stores represent a proven technology that has been available for many years and is widely used. Our team has depth of experience mapping All-hazard approaches to distributed technology solutions. Those predate mobile phone apps but adhere to similar architecture patterns:

·    We first developed and tested the basis for our tools successfully in 2003 when working with New York City Office of Emergency Management to create a Logistics Management System that brought resources (human, materiel, infrastructure, and donated) together (from City Agencies, State and Federal Agencies, non-profits, corporations and others) for use in different types of emergencies. We created a simple to use, GIS-linked tool that could report on assets either via map or through reports, and keep track of assets deployed, decisions taken and costs (the core program is still in use today).

·    A similar All-hazard management system was created for the NYC Department of Education, based on interviews with some 500 job classifications (2004-2007) which identified response needs and decision-gaps, and allowed us to build tools to fill them. Built-in decision tools reduced emergency response time from 3 hours to minutes.

·    An auto-deployable app on a USB-drive was created in 2013 for community managers to pre-plan debris clearing, storage and removal post different types of emergencies. 

Each of these solutions built on the previous one, and used existing components in new, sometimes unique combinations.

An emergency is any event we are unprepared for, during which we depend on others for accurate information and actionable intelligence. All-hazard emergency management suggests individuals protect themselves, then others and property, regardless of emergency. We understand common “emergencies” (snowstorms, ice-storms, floods, hurricanes, social unrest), and know how to prepare. Others, like 9/11 or Superstorm Sandy, have an unfamiliar scale and stretch resources. Others are feared but never yet experienced. Most of us figure out what to do.

Individuals who for whatever reason (age, disability, dependency) need care, must depend on others to decide for them. In COVID19, 42 percent of the dead were in eldercare facilities; another emergency may have a disproportionate impact on another age-group. All-hazard planning sets out logical steps, based on established decision-trees, starting with Stop, Look, Listen (be calm and safe before you act).

Caregivers must be empowered to act and understand how their actions protect them and those in their care. Too often front-line caregivers and facility staff (cleaning, cooking, laundry) are paid minimum wage, live in shared housing, use public transportation, and may be refugees or recent migrants for whom English is not their native tongue. This diversity of individuals is critical to successfully managing an emergency. Including the “invisible” staff in our preparedness planning for NYC Schools created Building Response Teams still in use today. They showed us the real vulnerabilities of each facility – unknown to administrators and managers.

Our App is inclusive of immediate stakeholders for the facility, and results in clear actionable work and communication flows. By providing steps to take, appropriate to the type of situation, that are protective of all, panic is reduced. Roles are understood. Single messages are developed. Collaboration ensures critical elements are not forgotten. The App facilitates integration with existing emergency management resource information from the local area, so responses taken are not isolated. When we exercised an eldercare facility’s emergency plan, patients were evacuated to the north, files to the east (no one knew what medication to give), and computers shut down. It was an administrative, not a nursing decision, resulting in chaos. 

Our precursor projects (see prior sections), currently serve some 20 million people in the NYC, NJ, CT and PA areas, as well as 1.3 million grades K-12 schoolkids in NYC and an unknown additional number who have been given access to the tools.

The proposed App, building on prior initiatives, but deployed via smartphones and tablets, is not yet serving any populations.

The knowledge is there but the Application needs to be built out. The team has maintained connections with previous clients who still effectively use our material and are willing to provide references. With the spotlight on eldercare facilities post-Covid19, we could rapidly reach and work with ten nursing homes, average number of beds - 108 (utilization rate of about 80%), totaling 860 elderly people with one (1) family contact each, plus 774 staff (0.9 / patient), impacting 2500 people in the first year. Equally, we estimate deploying at ten assisted living facilities, average 43 units (40 residents), for a total of 400 elderly people and one (1) family contact each, plus 40 staff (0.1 / residents). Total reach: 3,330 (CDC Data).

By Year Five, we anticipate working with 500 nursing homes and 500 assisted living facilities, reaching 166,500 people in the US, and to have begun working outside the US.

These are conservative estimates, given the 15,600 nursing homes (1.4M patients) and 28,000 assisted living facilities (1 M residents) in the US today, with a ballooning in projected future numbers.

In the US, our target population in elder homes is naturally scaling due to the projected sharp increase in the over-65 Baby Boomers projected for the near future (Census Bureau). Our solution thus can scale without increasing the percentage penetration of the market.

The App can easily be adapted to rapidly aging European countries, which would roughly double the target population.

With minimal modifications to the App, and given the prevalence of smartphones, we can reach out to all dependent populations (day care, special needs, refugees, prisoners, asylum seekers, foreign workers, etc.), initially in the US, then in Europe, and finally globally.

This level of horizontal scaling requires working with distribution partners. In the US, there are many organizations we can approach, for example AARP, industry associations (e.g. nursing home association in every state), large senior living and senior care corporations that operate many facilities (e.g. Brookdale Senior Living, Inc operates 1066 facilities), as well as organizations that could act as promoters rather than distributors, for example www.seniorliving.org. Similar organizations exist elsewhere.

An additional critical impact resulting from preparedness planning is identifying potential pivots in mission during an emergency. For example, by transforming the Houston Independent School District school kitchen into a kitchen for emergency responders, some $850,000 worth of food were not lost in the next Hurricane to hit Houston, and workers could continue to be paid.

The ultimate goal is zero deaths in all dependent care facilities from exposure to controllable emergency events.

The first-year barrier is financial. We need funds to pay a team of specialists to design the App and contract app developers with experience in current mobile technologies. One of the key technical question is how to ensure that the App works across devices and operating systems, as well as special needs (e.g. voice interaction for visually impaired people). Role-based security (access permissions) must be managed carefully since data breaches can be especially harmful for dependent people.

Based on our past experience we do not expect the App to deal with many areas where there could be a risk of violating regulations established by Federal Agencies (FEMA, CDC, Coast Guard, HIPAA, etc.) and by state agencies, best management practices available in the dependent care space and other best management practices for All-hazard response. However, it will be prudent to seek legal advice in areas where that potential risk exists.

Development of a multi-lingual inclusive app will raise cultural questions from stakeholders that must be managed in stakeholder engagement sessions and reflected in the country / target population specific App design.

A large-scale go-to-market strategy requires enlisting partner organizations, as outlined previously. Our team has experience and contacts across the US, Africa, Europe, and in some parts of South Asia but we have not engaged in All-hazard planning in these regions - so if we expand globally, partners here would be critical.

We would be able to get our original core team of specialists together to design the App. We have already begun by creating a coalition of original team members and are mining resources to find others to join us who share the knowledge we have. We have the planning and policy side together and are beginning to look for financial resources to be able to pay the technical expertise we need, including project managers who already understand how we work. The company we all worked for was bought out, and team members are presently available.

Once we have secured initial funding, we can select an attorney from our network of legal counsels.

We have extensive experience with stakeholder engagement in large-scale international projects around the world, which allows us to manage the cultural barriers.

We also have extensive experience with product rollout through international channel partner organizations and could engage former colleagues who specialize in different regions of the world.

The solution team is currently organized as a special project within CSRspace LLC. Two of the team members are employed by CSRspace, the others work for different companies. Once we receive a commitment for funding we will create a separate legal entity for this project. 

From CSRspace we have two people, working part-time. 

From Dovetail Consulting, one person, part time.  

Dr. Glover is in an advisory capacity.  

Ms. Nermin Ahmad, Team Lead, has delivered inclusive Emergency Management solutions to government and private sector clients. She gained experience under USEPAs Superfund Tactical Assistance and Field Investigation Team programs, as well as on numerous Military Base Closures. Trained in policy and planning, she rapidly pivoted and deployed critical All-Hazard concepts into the post-9/11 preparedness paradigm, focusing on vulnerable populations. 

Mr. Gerhard Bayer has experience across advanced technologies, from start-ups to multi-nationals. This includes successful roll-out of 30 software product releases across more than 10 operating system platforms to over 2000 enterprise customers; leading matrix teams residing in two continents, spanning diverse corporate cultures; developing business plans, pitch-decks, and marketing strategies for start-ups; and managing relationships with alliance partners (IBM, Microsoft, etc.) including joint engineering sessions, technology transfer, marketing, and licensing agreements.

Dr. Richard Glover, Executive Director at NYPD, was the client lead for the NYC Department of Education, and for follow-on projects for John Jay College and CUNY. An early adopter of the need for All-hazard planning to inclusively span the talent of a wide and diverse range of employees, the projects he collaborated on with Ms. Ahmad became models for replication. 

Dr. Amy Mahl, patho-biologist, collaborated closely with Ms. Ahmad on developing approaches to risk management, preparedness planning and plan exercising, and identifying vulnerabilities and gaps in response readiness (including in nursing homes).  Dr. Mahl and Ms. Ahmad developed an approach to resilience planning for communities based on all-hazard planning, and focused on accessible plans for vulnerable populations.

We have not initiated any partnerships at this time. 

Each of us represents our own LLC, and together we cover Small, Women-owned, Minority Businesses, with an 8A element as well. We are working on creating a knowledge-networked coalition of the capable to create an App that is inclusive.

We are designing an App, accessible by phone and computer, for use in managing emergencies impacting eldercare facilities. It is available for use by designated emergency planners, facility managers, administrators, employees, residents / patients and their families.

The benefits to: 

Care facilities and their employees are:

-       Clear roles and responsibilities during an emergency

-       All-hazard protection of human life

-       Collaborative team response to complex situations

-       After action reports that allow cost recovery and improvement

Residents / patients are: 

-       Reduced likelihood of personal harm

-       An understanding of the emergency and actions to be taken

Family members are: 

-       Understanding the safety plans in place

-       A single clear message on actions being taken

The App will be used in an emergency, and not on a regular basis. This means there is no opportunity for advertising revenue. Subsidies (from federal and state governments, or foundations that are focused on health like Gates) are a possibility but could create a dependency that jeopardizes the longevity of the impact.

We decided to generate revenue by charging a subscription fee for the app (tiered by facility size/user count), paid for by the care facilities as the primary customers. 

Development of the first version of the App and business setup relies on use of existing material, grants and in-kind contributions from practitioners.

As soon as the App is fully functional, we can bring it to eldercare facilities, and begin to generate revenue. Once in the revenue stage we would use a demand dividend model to reach profitability and scale the business. We prefer this revenue sharing model over an equity model since it doesn’t rely on a liquidity event (exit) and is focused on long-term sustainability and impact, rather than the requirement for growth at all cost to achieve the multiples that are typically desired for VC returns. Our first goal is to protect lives.

It is anticipated that the App will be enhanced over the first few years, with additional responsiveness, emergency response tracking, and built-in feedback loops. There may be a need to add more languages, edit for cultural diversity, or become compatible with emerging first responder communications solutions. These changes will be covered from a mix of grants and revenue.

Over the longer term, financial sustainability will be based on a subscription model, as well as on royalties from channel partners.

We seek to become part of the Solver community because of the exposure it brings to our knowledge and the App we are proposing. Our expertise is hands-on, and succeeds by bringing the right mix of knowledge and expertise to bear on developing a solution. We have a track record of creating inclusive and accessible emergency management tools for organizations. This time we are trying to develop a solution accessible to a wider, eventually global, audience, to safeguard the most vulnerable members of our society.

Access to the MIT-backed network will give us access not only to additional knowledge, but to members of Solve's cross-sector community.  This will help us identify partnerships that we might not have thought about or known were accessible. It will keep us at a cutting edge of technical know-how, help us accelerate our work, and allow us to validate our impact and business models. It will also help us achieve strategic collaborations with channel sales partners, and provide us exposure to organizations such as AmeriCares or The Bill and Melinda Gates Foundation with a fundamental interest in safeguarding vulnerable people. 

We recognize becoming a Solver represents an invaluable opportunity to access in-kind support such as mentorship, technical expertise, media and conference exposure as well as business and entrepreneurship training. Equally, it allows us to share the breadth and depth of experience and knowledge we have with recognized individuals who may themselves benefit. 

While the team has a very clear understanding of the problem and how to construct the solution, we recognize that support and partnerships strengthen our approach to market and to scaling.

The eldercare marketplace is fragmented into all sizes, flavors and locations. It is changing rapidly to meet the onslaught of retiring baby boomers. Support with product distribution will be a huge logistical win.

Board members and advisors will be invaluable in providing the lift we need to demonstrate why we fit in the marketplace, where we belong, and how we fill a niche that is underserviced.

We seek to provide a service, with an important social impact. This means creating the right legal framework. Emergency Management work also requires strong understanding of legal vulnerabilities.

Our team of experts needs to partner with strong media, marketing and exposure specialists who can promote our work with a clear simple message.

I am a proven disruptor, able to "vision" collective responses to approaching major environmental and social problems. The advantage I had was working for a multi-disciplinary company using knowledge networks to building and implementing solutions to client problems. Professor Nevis (Sloan) studied our effectiveness for 25 years. I tapped into 85 in-house disciplines to successfully build out four practices in hazardous site remediation, sustainability, All-hazard management and resilience-building. The App team all have worked with or benefitted from this approach to solutions-engineering.

It would be remarkable to benefit from MIT's knowledge network. We could connect our depth of field knowledge to MITs resources, thereby accelerating App access for different vulnerable populations, globally, and serve people with staggering differences in backgrounds equally. 

As an MIT Solver we can approach the right partners - whether as Board Members, as distributors, as legal advisors, and more. Being an MIT Solver places us squarely on the first step of brand recognition and a leg up in marketing. We can speak with individuals (in the private sector and government) to whom we currently have no means of access, and ask them for advice, assistance, and mentoring.

Our App is not a gimmick, a palliative, a toy - it supports a shift towards a universal preparedness and adaptation culture which we believe is critical to safeguard vulnerable members of society going forward. Identifying the right Board members, who join because they understand this simple cultural shift in thinking, will speed up our release and adoption strategies.

Each team member can demonstrate ability to develop All-hazard approaches to safeguarding ourselves, vulnerable individuals in our care, and in the care of a range of clients through our work. This had a proven impact, where millions of people have benefitted directly and unknowingly from tools we promulgated to foster inter-operability, communications, inclusiveness, and care for vulnerable groups.

Our past work confirms the feasibility of our approach. The App provides a new dimension (not a new technology) as it enables accessibility for all individuals, regardless of socio-cultural, economic and educational background. Combined, they facilitate a broad cultural shift in preparedness planning. 

While the App is intended to have a strong social focus, it must be self-sustaining with a value (the right price) assigned to it (to avoid it being taken for granted). 

The ultimate expectation is to replicate the App across dependent care sectors, and scale access to anyone with vulnerabilities anywhere in the world so they (and those caring for them) are prepared for most unanticipated events.

Our current team has the knowledge, depth of experience, and track record required to build out the App, continuously improve it (part of All-hazard planning), replicate the work for different types of communities, and expand on the initial proposed offering in terms of scope, reach, and deploy-ability. These capabilities can only be enhanced through strategic partnerships which allow us to speed up the process and deploy the App in time for the next great emergency. Avoidable deaths are unacceptable.