Nursing Homes and Assisted Living Facilities: Planning and Decision Making for Sheltering in Place or Evacuation

Abstract

Both options carry risks. Although significant progress has been made in disaster preparedness since the devastating 2005 hurricane season in the Gulf Coast states, unique challenges remain for long-term-care providers in nursing homes, assisted living facilities, and continuing-care retirement communities. All of these facilities are responsible for the safety of vulnerable residents during disasters. During the 2005 season, poor management of evacuation efforts contributed a significant number of deaths: more than 139 nursing home residents during Hurricane Katrina, and twenty-three residents in a bus accident during Hurricane Rita (Polivka-West, 2006). Retrospective reviews of the 2005 emergency preparedness activities before, during, and after these two storms made landfall indicate that emergency programs protect older and disabled people from the effects of hurricanes were inadequate and poorly managed and required change (Office of the Inspector General, 2006; U.S. General Accounting Office [GAO], 2oo6c; 20o6d; Hyer et al., 2006; Dosa et al., 2007). This article specifically addresses the challenges those in charge of long-term-care facilities face as they decide whether to stay or go -evaluating risk residents from potential evacuation, weighing storm path and intensity projections, and reviewing their emergency preparedness plans. Sheltering in place or evacuating both carry significant risks. As one administrator put it after evacuating residents from a nursing home in Mississippi as Katrina moved in, Absolutely, without any question, it's the toughest decision. LESSONS LEARNED IN THE HURRICANE SEASONS OF 2004 AND 2005 Because of Florida's extensive experience with disasters and evacuation, lessons learned in Florida illustrate important points that are relevant in many locations. Florida coped with eight major hurricanes in the years 2004 and 2005, yet reported no evacuation-related deaths. During those storms, more than 10,000 residents of nursing homes, assisted living facilities, and continuing-care retirement communities were evacuated in 2004 (Hyer et al., 2006), with 2,997 nursing home and assisted living residents in 2005. In large part, the lack of deaths can be attributed Florida's emergency preparedness infrastructure and policies that had evolved significantly during the previous decade because of the state's experiences in coping with multiple hurricanes. One of the basics of emergency planning is the idea that all disasters are and therefore best managed by the first line of defense: local fire, police, medical, and emergency management personnel (Brown, Hyer, and Polivka-West, in press). Florida has a strong emergency communications system monitor each local jurisdiction's capabilities as it copes with a disaster. If the local government is without sufficient resources adequately respond a severe disaster, the state provides necessary resources. Similarly, when the state's capabilities are strained or insufficient cope with a particular situation, the governor requests federal and regional assistance under the 2000 Robert T. Stafford Disaster Relief and Emergency Assistance Act (Public Law 93-288) obtain resources carry out disaster relief and recovery activities. Florida illustrates the workings of a strong partnership between state and local emergency preparedness operations centers. This partnership makes it possible supplement knowledge about specific community health needs with information from long-term-care community providers as represented by their professional associations. A key ingredient in facilitating this collaboration is an information system created by the state regulatory agency, Agency for Health Care Administration (AHCA), over the 2004 and 2005 hurricane seasons. The system includes a database developed help providers safely manage resident care during disasters. In 2005, both Louisiana and Florida state emergency operation centers (EOCS) recognized long-term-care entities as healthcare facilities-in contrast most other states, in which they are not recognized as such. …