Evacuations Can Be Deadly For Nursing Home Residents, Research Says

Oct 17, 2019
Originally published on October 18, 2019 9:20 am

Nearly 100 nursing homes and assisted living facilities were evacuated along Florida's East Coast ahead of Hurricane Dorian.

At the time, officials said the decisions to leave were based on the need to protect lives.

Two years earlier, 12 people died after a nursing home in Hollywood Hills lost its air conditioning during Hurricane Irma.

But researchers studying past hurricanes have found that evacuating comes with its own risks. Their research has found that evacuating sick and frail residents at nursing homes and assisted living facilities can lead to more deaths than sheltering in place.

The University of South Florida has been involved in some of that research and is currently studying the impacts of evacuations during Hurricane Irma.

USF's Lindsay Peterson sat down with Health News Florida's Julio Ochoa to discuss the study.

Can you begin by telling us briefly about your study?

Our study is focusing on the implications of a hurricane on assisted living and nursing home residents. We are looking at what happened in Florida after Hurricane Irma in 2017. We're going to be analyzing Medicare data to see if their health was effected differently based on whether they evacuated or whether they sheltered in place. In addition to that, we are interviewing the administrators of these facilities to learn about why they either evacuated or sheltered in place and what happened as a result of that. Our overall goal is to try to understand how to do it better.

Research has found that both choices evacuating or sheltering in place presents risks. Why is that so?

About 10 years now, Kathryn Hyer, who is (a professor) here at the University of South Florida, was part of a grant working with Brown University to study what happened to nursing home residents after the hurricanes that occurred in the Gulf states between 2005 and 2008 – hurricanes Katrina, Gustav, Rita and Ike. They analyzed Medicare records to understand. What happened to the people who were evacuated and then also to look at what happened to the people who sheltered in place. And what they found was that the residents of these nursing homes in the areas affected by these hurricanes who were evacuated were more likely to die and they were more likely to be hospitalized in the days and weeks and months after the hurricanes.

For a long time, people in long term care have known of transfer trauma. That's when you move a nursing home resident, they often react very badly. They might even die just as a result of the move under the best of circumstances. And so when you think about what's happening in a hurricane, people are being moved sometimes in a great rush, often to a place that is not necessarily equipped for them. Even if it is equipped for them, there might already be 50 or 60 or 100 people there, so they're going to have to be in a hallway. They might miss their medications, they might be suffering from dementia and become very, very disoriented and upset. So all of these things accumulate and then when the residents come back, you won't notice it. It's not like some of the well-known incidences that we think of because they die later and they die sort of quietly in a nursing home. It's just that more of them die than would have died otherwise.

What is different about this study that USF is doing now?

What's different is that we're adding assisted living communities to it. The study from before just looked at nursing homes. Also, we're looking at Hurricane Harvey, which happened the same year as Irma. The outcomes, as they say, for nursing home and assisted living residents in Texas after Harvey and in Florida after Irma. Additionally, in Florida we are interviewing nursing home and assisted living administrators to understand why did they do what they did? How did they prepare? It might help explain the results of the Medicare analysis.

Are your findings consistent with the previous research? Is it more dangerous to evacuate residents?

We don't have the data yet on whether the nursing home and assisted living residents affected by Harvey and Irma were more likely to die or be hospitalized after those two hurricanes. We have some early indications, looking at the early data that, yes. But we just can't be sure yet from our interviews. We're hearing the same things that the people who were interviewed 10 years ago said about how evacuation affects residents.

What sort of data is your team looking at to determine which is safer evacuating or sheltering in place?

It's the Medicare data. That's the main thing that we're looking at. These are the full records – de-identified -- of the hospital visits. The outcomes. What a person went to a hospital for, what happened to them in the hospital, if they died? Also, with the assisted living residents, we're going to be looking at whether they were more likely to be moved into a nursing home afterwards.

During Hurricane Dorian, more than 90 nursing homes and assisted living facilities in seven hospitals on Florida's East Coast evacuated. What are you learning from that storm?

We're learning that people are more frightened by the weather than they've ever been before.

Do you think that the deaths that happened during Irma at the Hollywood Hills facility had an impact on evacuations during Dorian?

I really don't think that the deaths at Hollywood Hills affected their evacuations. Now, overall, I think their experiences during Hurricane Irma and the greater awareness that came about through that maybe did cause more evacuations. When we look more closely at what happened with Dorian, which we plan to do, we might find that a lot of people sheltered in place. What came out of the Hollywood Hills tragedy is that many more assisted living communities and nursing homes now have the ability to have air conditioning, and that's basically what it boiled down to at Hollywood Hills. They lost their air conditioning. If you can, whatever you need to do to enable you to shelter in place is probably going to help your residents if you're not in a place that's going to be flooded.

Do you know if there are any deaths that can be attributed to Hurricane Dorian evacuations?

I have not heard of any.

What should managers of long term care facilities and nursing homes think about when considering whether to evacuate or shelter in place?

The very first thing they do think about is the health of their residents. Some people are able to move much more easily than others. So that's the first consideration. The next is: Can they withstand the storm?

If you're going to shelter in place, you need to know where the storm is going to hit. You need to know something about the structure of your building. You need to know what kind of supplies you need. Can you get all those supplies in addition to the welfare of your residents?

Has the research looked at all about whether it's better to leave early than to too late?

A lot of people who leave early, as what happened in the East Coast during Irma, leave before we really know where this storm is going to hit. And they run right into the storm. Or they don't need to evacuate at all and they just end up having to go back. So that's not really the answer. The other problem with leaving early is that's just that much more time that your residents are away from home and in a place that, you know, even in the best of times might not be the best place for them because it's already got people there. It's temporary, it might not even be a nursing home. It might be a school, it might be a public shelter.

So leaving early, there are problems with leaving early. It's kind of like the three bears. You don't want to leave too early. You don't want to leave too late. There is a proper time to leave and when that is, it's hard to know. These are very, very hard decisions.

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