日期：106 年 02 月 16 日
一、參訪及考察過程
01 月 16 日 Tampa 市區 walking tour
第一天的行程在了解坦帕市(Tampa)的現況及未來之發展方向。由曾任職該是政 府的僑胞 Eric Yao 帶領，前往市中心了解其歷史及地理發展。
1. 行車經由 public housing，了解中低收入家庭所居住的社區與環境(圖 1 及 圖 2)。
圖 1 Tampa 市區-1 圖 2 Tampa 市區-2
2. Walking Tour: Tampa Riverwalk
沿著市中心的 Tampa waterfront 的 Riverwalk 概念自 1970 年代以來一直存在。
2003 年，Tampa 重新強化了 waterfront 的發展，以提高 Tampa 的美麗和獨特的形象。
民眾可在 Riverwalk 享受步行、慢跑或騎車，沿著從 Hillsborough River 東側到 Tampa Heights 這條連續的通道，可見到行人設施，藝術和解說元素、零售和餐館、公園和 開放空間。作為關鍵的發展元素之一，Riverwalk 可謂重振了城市的心臟，突顯了 Tampa city 最有價值的資源之一(圖 3 及圖 4)
(https://www.tampagov.net/riverwalk/about-us)。
計畫編號 MOST 105-2625-M-006 -011
計畫名稱 長期照顧機構建築防洪韌性與避難居住環境規劃設計之研究(III) 出 國 人 員
姓名 姚昭智 服 務 機 構
及職稱 國立成功大學建築系 出國時間 106 年 1 月 15 日至
106 年 1 月 22 日 出國地點 美國，佛羅里達州，坦帕
圖 3 Tampa Riverwalk-1 圖 4 Tampa Riverwalk-2
01 月 17 日，參與 FHCA 防災小組會議
FHCA（ Florida Health Care Association 佛羅里達健康照護協會）成立於 1954 年，成立的信念是相信透過集體合作的力量一方面可以為長者提供較好品質的照顧，
另一方面也可以對政策的形成產生影響力。
這個組織的成員包括了支持性住宅、護理之家等各種長照機構，也包括學生會 員。如今這個協會有上千的個人會員及將近六百個照護機構。全州超過百分之八十 的此類機構都是會員。會員機構包括了佛羅里達州裡下列種類 skilled nursing, post-acute and sub-acute care, short-term rehabilitation, assisted living and other services to the frail elderly and individuals with disabilities。 FHCA 還有超過 400 家提供長期照 顧的贊助會員及公司。FHCA 一方面標榜提昇業者服務的品質，另方面其達到提昇 服務品質的方法旦藉著對政策的倡導與影響。
FHCA 有各種任務小組，其中的緊急應變小組（Emergency Preparedness Council) 任務在透過積極的教育、評估、規畫、訓練、實用工具、研究及領導等支持長照機 構的災害應變能力。同時他們的使命也在於倡導引起公共安全與災防及各種緊急應 變部門關注長照機構在災害中的脆弱性。
2017 年元月 17 日我們參加 FHCA-QF emergency Preparedness Council 的例行會 議，根據協會提供我們的過去會議資料，我們約可以推論出本緊急應變小且的會議 大約每季召開一次。
因為成員以各種長照相關業務的業者為主，為了避免利益衝突，開會前主席要 先宣示組織的反托辣斯政策，與會者不可在會中為特定業者進行有利的宣傳，如有 此類情形需被制止。開會前與會者也要先一起宣讀本小組使命宣言（如前段介紹）。
會議由上午九點半報到開始至下午三點半結束。由於會議地點在 Pinellas County 的公共安全大樓（含防災中心、911 電話呼叫中心等單位，縣政府特別安排與會者 參觀該大樓的防災中心及 911 中心(圖 5)。
圖 5 縣防災中心
本次會議與會人士大約卅人，成員包括長照機構業者、政府部門代表，大學，
電力公司代表（因為災害發生往往涉及電力的中斷與恢復），還有與災害預防及應變 有關的顧問公司亦參與本次會議。會議從介紹成員及來賓開始。我們意識到雖然我 們是遠從台灣來的交流團隊固然是生面孔，但 FHCA 既是全州的機構且成員眾多，
因此與會者還是有許多是彼此不熟悉的。
本次會議之進程除了例行的宣讀組織使命及反托拉斯聲明之外，還包括了一些 防災資訊的回顧，介紹對災防有用的資源網頁，檢討既有的防災計畫中有沒有要增 加的提醒及防災計畫在災害發生時之效果。其中一件被討論得激烈的是 FHCA 建議 應該要與運輸公司簽定合約，而且至少要有三家簽約。但仍然發生了災害發生時簽 約的公司無法依約派遣撤離用車的問題。在檢討的部份並且提到備用電力及其與室 內配電銜接的問題，電力公司特別提醒除了有發電機之外，其與既有電路之配接也 需要特別注意檢查以免屆時無法發揮作用。另外電力公司的代表也介紹當災害發生 時他們的作業程序是什麼，藉此機會讓業者知道他們可以期待以及需要應變的可能 是什麼。
本團隊應邀在會中簡介台灣長照機構一般近況，由溫如慧老師代表說明並接受 詢問(圖 6)。由於時間緊湊，團隊和與會者的交流在會後才有較多個別的機會。
圖 6 温老師在會議中報告本研究團隊的研究內容
另一個主題是政府對緊急應變的規定 CEM （comprehensive emergency
management plan）。由於政府對於機構的應變計畫之規定頗為民間顧問公司在會中介 紹政府檢查項目及他們可以怎樣協助，這是在政府規定繁複或服務需求複雜後應運
題。這些都是業者及 FHCA 在運作時必然遭遇的議題。
01 月 18 日，拜會南佛大(University of South Florida, USF)
本日上午與 USF Prof. Hyer 教授及其團隊相約在 USF 老人研究中心會面， 相互 交流研究主題相關心得。
由本研究團隊姚教授率領進行公開會議簡報。 分為三組報告，主題如下；
子計畫一 A Research in Flood Resiliency of LTC Facilities
子計畫二The Maintenance of LTC Institutions’ Care Quality in Complex Disaster 子計畫三 A Study of Networking and Utilization of Resources for Long Term Care Facilities in Flood Disaster Affected Communities II
會議交流席間， 美方學者提出多項問題共同討論， 包括瞭解台灣面對水患針 對長期照護機構的相關法令及行政規範；因水患造成的機構斷水、斷電以及進行撤 離之相關統計報告； 以及台灣在水患因應的演習及備災做法等。雙方交流充分， 我 們並得自美方在颶風因應上的處理經驗及相關資訊。以下為自美方 USF 收集到的相 關資訊。
F.S. 429.41 Rules establishing standards.
(1) It is the intent of the Legislature that rules published and enforced pursuant to this section shall include criteria by which a reasonable and consistent quality of resident care and quality of life may be ensured and the results of such resident care may be demonstrated. Such rules shall also ensure a safe and sanitary environment that is residential and noninstitutional in design or nature. It is further intended that reasonable efforts be made to accommodate the needs and preferences of residents to enhance the quality of life in a facility. Uniform firesafety standards for assisted living facilities shall be established by the State Fire Marshal pursuant to s. 633.206. The agency, in consultation with the department, may adopt rules to administer the requirements of part II of chapter 408. In order to provide safe and sanitary facilities and the highest quality of resident care accommodating the needs and preferences of residents, the department, in consultation with the agency, the Department of Children and Families, and the Department of Health, shall adopt rules, policies, and procedures to administer this part, which must include reasonable and fair
minimum standards in relation to:
(b) The preparation and annual update of a comprehensive emergency management plan. Such standards must be included in the rules adopted by the department after consultation with the Division of Emergency Management. At a minimum, the rules must provide for plan components that address emergency evacuation transportation; adequate sheltering arrangements; postdisaster activities, including provision of emergency power, food, and water; postdisaster transportation; supplies; staffing; emergency equipment; individual identification of residents and transfer of records; communication with families; and responses to family inquiries. The comprehensive emergency management plan is subject to review and approval by the local emergency management agency. During its review, the local emergency management agency shall ensure that the following agencies, at a minimum, are given the opportunity to review the plan:
the Department of Elderly Affairs, the Department of Health, the Agency for Health Care Administration, and the Division of Emergency Management. Also, appropriate volunteer organizations must be given the opportunity to review the plan. The local emergency management agency shall complete its review within 60 days and either approve the plan or advise the facility of necessary revisions.
58A-5.026 Emergency Management.
(1) EMERGENCY PLAN COMPONENTS. Pursuant to Section 429.41, F.S., each facility must prepare a written comprehensive emergency management plan in accordance with the “Emergency Management Criteria for Assisted Living Facilities,” dated October 1995, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04010. This document is available from the local emergency management agency. The emergency management plan must, at a minimum, address the following:
(a) Provision for all hazards;
(b) Provision for the care of residents remaining in the facility during an emergency, including pre-disaster or emergency preparation; protecting the facility; supplies; emergency power; food and water;
staffing; and emergency equipment;
(c) Provision for the care of residents who must be evacuated from the facility during an emergency including identification of such residents and transfer of resident records; evacuation transportation;
sheltering arrangements; supplies; staffing; emergency equipment; and medications;
(d) Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies;
(e) Identification of residents with Alzheimer’s disease or related disorders, and residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation;
(f) Identification of and coordination with the local emergency management agency;
(g) Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for residents, transportation, and reporting to the local emergency management agency the number of residents who have been relocated, and the place of relocation; and
(h) The identification of staff responsible for implementing each part of the plan.
(2) EMERGENCY PLAN APPROVAL. The plan must be submitted for review and approval to the local emergency management agency.
(a) If the local emergency management agency requires revisions to the emergency management plan, such revisions must be made and the plan resubmitted to the local office within 30 days of receiving notification that the plan must be revised.
(b) A new facility as described in Rule 58A-5.023, F.A.C., and facilities whose ownership has been transferred, must submit an emergency management plan within 30 days after obtaining a license.
(c) The facility must review its emergency management plan on an annual basis. Any substantive changes must be submitted to the local emergency agency for review and approval.
1. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive revisions for the purposes of this rule.
2. Changes in the identification of specific staff must be submitted to the local emergency management agency annually as a signed and dated addendum that is not subject to review and approval.
(d) The local emergency management agency is the final administrative authority for emergency management plans prepared by assisted living facilities.
(e) Any plan approved by the local emergency management agency is considered to have met all the criteria and conditions established in this rule.
(3) PLAN IMPLEMENTATION.
(a) All staff must be trained in their duties and are responsible for implementing the emergency management plan.
(b) If telephone service is not available during an emergency, the facility must request assistance from local law enforcement or emergency management personnel in maintaining communication.
(4) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so directed by the local emergency management agency.
(a) The facility must report the evacuation to the local office of emergency management or designee and to the agency within 6 hours of the evacuation order. If the evacuation takes more than 6 hours, the facility must report when the evacuation is completed.
(b) The facility must not be re-occupied until the area is cleared for reentry by the local emergency management agency or its designee and the facility can meet the immediate needs of the residents.
(c) A facility with significant structural damage must relocate residents until the facility can be safely re-occupied.
(d) The facility is responsible for knowing the location of all residents until the residents have been relocated to another facility.
(e) The facility must provide the agency with the name of a contact person who must be available by telephone 24 hours a day, seven days a week, until the facility is re-occupied.
(f) The facility must assist in the relocation of residents, and must cooperate with outreach teams established by the Department of Health or emergency management agency to assist in relocation efforts.
Resident needs and preferences must be considered to the extent possible in any relocation decision.
(5) EMERGENCY SHELTER. In the event a state of emergency has been declared and the facility is not required to evacuate the premises, the facility may provide emergency shelter above the facility’s licensed capacity provided the following conditions are met:
(a) Life safety will not be jeopardized for any individual;
(b) The immediate needs of residents and other individuals sheltered at the facility can be met by the facility;
(c) The facility reports the number of individuals over its licensed capacity and the conditions causing it to the Agency Field Office within 48 hours or as soon as practical. As an alternative, the facility may report to the Agency Central Office at (850) 412-4304. If the facility will continue to be over capacity after the declared emergency ends, the agency will review requests for excess capacity on a case-by-case basis; and
(c) The facility reports the number of individuals over its licensed capacity and the conditions causing it to the Agency Field Office within 48 hours or as soon as practical. As an alternative, the facility may report to the Agency Central Office at (850) 412-4304. If the facility will continue to be over capacity after the declared emergency ends, the agency will review requests for excess capacity on a case-by-case basis; and