A Business Continuity Planning Case Study
CONTINUITY UNDER FIRE
HOW HOME HEALTH & HOSPICE KEPT CARE GOING AMID THE 2025 SOUTH CALIFORNIA CALIFORNIA WILDFIRES
Presented by: ANDREW PAGSISHAN
All Care Provider (Home Care, Home Health, Palliative and Hospice)
LA COUNTY DHS HEALTHCARE COALITION · BUSINESS CONTINUITY PLANNING WORKSHOP
What We'll Cover
The Scale of the Crisis
January 2025 – a disaster of historic proportions
1
BCP Activation: What We Did
Alert triage, patient accounting, resource deployment
2
Continuity of Care in Action
183 displaced patients, field staff, supply chain
3
Partnerships & Coalition Response
Health plans, facilities, local leaders, agencies
4
Lessons Learned & Recommendations
Improving response for next time
5
Palisades Fire
Jan 7
Eaton Fire
Jan 7
Sunset Fire
Jan 8
Lidia Fire
Jan 8
Archer Fire
Jan 10
Hughes Fire
Jan 22
35+
1,000+
183
4
THE SCALE OF THE CRISIS — JANUARY 2025
Southern California Wildfires: A Cascading Disaster
Facilities
Evacuated
Residents
Displaced
All Care
Patients Affected
All Care Staff Members
Displaced
Why Home Health & Hospice BCP Is Different
HOSPITAL / FACILITY
Fixed location — shelter-in-place option
Patients come to the resource
Central command & control
Co-located staff & supplies
Institutional redundancy built-in
HOME HEALTH & HOSPICE
Distributed — patients ARE the locations
Care must travel to the patient
Decentralized rapid decision-making
Staff & supplies must be rerouted
Every displaced patient = a new care plan
KEY INSIGHT: OUR BCP MUST BE MOBILE, PATIENT-CENTRIC, AND PARTNER-DEPENDENT.
BCP Activation: Alert & Triage System
TOOLS USED: CALFIRE.CA.GOV · WATCHDUTY · GOOGLE MAPS · CALFIRE CAMERA NETWORK
RED ZONE
Evacuated / Confirmed Affected
Voice call — immediate
Deploy search team
Notify: Physician, Health Plan, POA
YELLOW ZONE
Evacuation Warning — Potential
Text + Voice contact
Prepare medical supplies for evacuation
Staff on standby
SMOKE: Shelter-in-place guidance sent
POWER: Check power redundancies in place
GREEN ZONE
Monitor — Stand-By
Text notification
Staff aware & available
Ready to escalate
SMOKE: Monitor air quality advisories
POWER: Identify power-dependent patients
GEOGRAPHIC TRIAGE DROVE OUR INITIAL RESPONSE SPEED
First 24 Hours: A Timeline
KEY TOOL: CALFIRE CAMERA NETWORK ENABLED REAL-TIME SMOKE DIRECTION AND WIND SHIFT TRACKING
Jan 7
10:30 AM
Palisades Fire ignites
11:05 AM
All Care alert activated
Initial population scan
11:35 AM
2 patients confirmed
affected — contacts made
within 30 minutes
Jan 7
6:18 PM
Eaton Fire ignites
32 patients affected
High winds overnight
Jan 8
2:00 AM
Santa Ana winds shift west
"Explosive" expansion
32 → 169 patients
4:00 AM
La Cañada Flintridge
+14 patients
Total: 183 displaced
Patient Accounting & Continuity of Care
183
Patients Displaced
4 field clinicians · 3 office staff
also affected by fires
Only 2 Discharges
Patients displaced to: hotels, other homes,
facilities, evacuation centers — all required replanned care visits
Highway access affected: 14, 10, 5, 405 freeways
created clinician routing challenges
IV antibiotics: time-sensitive bedside mixing windows
maintained; non-urgent care rescheduled
Social workers deployed (agency + health plan)
for stress, adjustment, and discharge prevention
Consistent contact maintained through displacement;
planned repopulation or permanent rerouting
Partnerships in Action — The Coalition Mattered
Health Plan Partners
Facilities & Evacuation Sites
Government & Community Leaders
Suppliers & DME
Scale of Facility Evacuations — Eaton Fire
HOME HEALTH AND HOSPICE AGENCIES WERE REQUIRED TO LOCATE, RE-ASSESS, AND REDIRECT CARE
TO EVERY PATIENT DISPLACED FROM THESE FACILITIES AND SURROUNDING HOMES.
35+ FACILITIES EVACUATED — INCLUDING NURSING HOMES AND ASSISTED LIVING COMMUNITIES
Pasadena Park Healthcare
94 residents evacuated — facility destroyed
The Terraces at Park Marino
95 residents evacuated — facility destroyed
Two Palms Care Center
45 residents evacuated — facility destroyed
Montrose Springs SNF
138 residents — largest single evacuation
Pasadena Highlands
240 residents — Civic Center + multiple sites
The Kensington Sierra Madre
100 residents evacuated to Sheraton Ontario
Lessons Learned — Improving Our BCP
01
Multi-Channel Alerting
Expand from voice-only to simultaneous Email + SMS + Voice. Contacting 183 patients with voice calls alone at 2:00 AM was a monumental burden.
02
Auto-Escalation Protocols
Non-answer contacts should trigger auto-escalation to next contact on list. Rapid aggregation of 'unaccounted' population to mobilize search teams faster.
03
Expanded Contact Database
Update patient records with multiple emergency contacts: family, friends, and backup contacts. Educate patients and caregivers on contact priorities.
04
Patient Emergency Preparedness Education
Integrate emergency plan education into onboarding and care plans. Ensure patients know to gather medical supplies and have an evacuation destination ready.
05
Supplier & DME Pre-Agreements
Establish emergency supply agreements in advance. Displacement surges create shortages. Pre-arranged rerouting with pharmacies and DME suppliers is critical.
BCP Applied: The 5-Pillar Framework
HOW ALL CARE'S RESPONSE MAPPED TO BCP CORE CONCEPTS
Risk Assessment
Zip code triage, fire perimeter monitoring, wind shift modeling, route impact
Impact Analysis
183 patients triaged, 35 facilities evacuated, supply/DME chains disrupted
Recovery Strategy
Multi-tier alert, staff redeployment, care plan replanning, partner activation
Plan Development
After-action documentation, multi-channel communication protocol revisions
Testing & Exercises
Lessons from 2009/2019 fires, real-time simulation during event, post-event review
Building on Experience — Prior Fire History
ALL CARE'S BCP WAS SHAPED BY HARD-WON EXPERIENCE FROM PRIOR SOUTHERN CALIFORNIA DISASTERS
Year | Fire | Highway Impact | Home Health Lesson |
2009 | Station Fire | Hwy 2 | First major test of HH coordination in mountain evacuations |
2018 | Camp Fire | Statewide | Mass displacement of rural patients; supply chain collapse lessons |
2018 | Woolsey Fire | 101 / PCH | Coastal evacuation; high patient vulnerability in Malibu corridor |
2019 | Saddleridge Fire | I-5 | Rapid urban spread; short-notice patient contact protocol refined |
2022 | Route Fire | I-5 | Major corridor shutdown; clinician routing around I-5 closure |
2024 | Bridge Fire | Hwy 39/2 | Most recent precursor — protocols re-tested just months before Jan 2025 |
Engaging Home-Based Care in the Coalition
HOME HEALTH AND HOSPICE AGENCIES ARE READY TO BE ACTIVE PARTNERS
Coalition BCP Exercises & Tabletops
Engage Home-based care agencies to the table. Our distributed patient population represents a unique and under-represented segment in these planning exercises.
Build Mutual Aid Networks Across Care Settings
Integrate health systems into cross-sector mutual aid: shared supply chains, DME coordination, and displaced patient handoffs during activations.
Grow Home-Based Care Agency
Engage more home health, hospice, palliative care, and private duty nursing agencies to participate. We serve the community's most vulnerable outside of faculties — the Coalition is stronger with more voices and ideas.
Introduce New Home-Based Care into Coalition Infrastructure
Introduce new home-based care in coalition frameworks, after-action reviews, and preparedness resources.
Summary — Continuity Under Fire
The Crisis
8+ simultaneous wildfires in Jan 2025. 35+ facilities evacuated, 1,000+ residents displaced. All Care: 183 patients, 7 staff affected.
BCP Activation
Red/Yellow/Green geographic triage. Smoke & power outage protocols by zone. Alerts initiated within 35 min of Palisades ignition.
Timeline
Palisades: 2 patients (11:35 AM). Eaton ignites: 32 patients (6:18 PM). Wind shift: 169 by 2 AM. Total 183 by 4:00 AM Jan 8.
Continuity of Care
183 displaced patients replanned across hotels, homes, facilities & evac centers. Only 2 discharges. IV antibiotic windows maintained.
Partnerships
Health plans pushed medications to evac sites. Government leaders activated emergency transport. All Care co-located staff at Pasadena Civic Center.
Lessons Learned
Multi-channel alerting (SMS + Voice + Email), auto-escalation, expanded contact database, patient emergency education, pre-arranged DME agreements.
BCP Framework
All 5 BCP pillars activated: Risk Assessment, Impact Analysis, Recovery Strategy, Plan Development, and Testing — in real time.
Coalition Integration
Engage Home-based care must be in Coalition BCP exercises. Build mutual aid across all care settings.
Care Doesn't Stop When Disaster Strikes.
Home health and hospice agencies are the last line of care continuity for the most vulnerable patients in our community. With the right BCP, we kept care moving — even through the most devastating fires in LA County history.
Andrew | COO — All Care Provider�LA County Healthcare Coalition · CAHSAH Board Member · National Alliance for Care at Home
THANK YOU · Q&A