Assisted Living Communities During Hurricane Irma: The Decision to Evacuate or Shelter in Place and Resident Acuity
Assisted Living Communities During Hurricane Irma: The Decision to Evacuate or Shelter in Place and Resident Acuity
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DOI：
10.1016/j.jamda.2020.01.104
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发表时间：
2020-08-01
影响因子：
7.6
通讯作者：
Hyer, Kathryn
中科院分区：
文献类型：
--
作者：
Peterson, Lindsay J.;June, Joseph;Hyer, Kathryn
目的：调查佛罗里达州辅助生活社区(ALCS)在2017年飓风伊尔玛(Irma)时是否被疏散或庇护的相关因素，重点关注许可证类型作为护理敏锐度的替代指标。设计：使用州政府通过其紧急报告系统和飓风后调查收集的数据进行横断面研究。背景和参与者：分析纳入紧急报告系统中的所有3112个ALC。完成调查的1880人的子集提供了补充数据。方法：使用CHI(2)测试来检验ALC特征(许可证类型、规模、支付方式、利润状况、农村位置、地理区域和处于疏散命令下)与是否疏散之间的差异。结果：在3112个社区卫生服务中心中，560个已疏散，2552个已就地避难。双变量分析发现，疏散状态与疏散顺序、许可证类型(精神卫生保健)、报酬和地区之间存在显著关联。在调整后的分析中，中等和较大的ALC比床位少于25张的ALC疏散的可能性分别低43%(P<；.001)和53%(P<；.001)。与东南部的ALC相比，几乎每个地区都更有可能撤离，其中中西部的可能性最高(优势比1.76，95%可信区间1.35-2.30)。在疏散命令下的ALC疏散的可能性是8倍(P<；.001)。我们没有发现疏散状态与拥有提供高级护理的许可证之间的关系。结论和启示：先前强调疏散相关危害的研究导致了建议，长期护理机构在疏散决策时要仔细考虑居民的损害。有证据表明，小型ALC更有可能疏散，拥有高级护理许可证与疏散可能性无关，这表明需要进行研究，以了解ALC在决定疏散或避难时如何权衡居民风险。(C)2020年AMDA--急性后和长期护理医学学会。
Objectives: To investigate the factors associated with whether assisted living communities (ALCs) in Florida evacuated or sheltered in place for Hurricane Irma in 2017, focusing on license type as a proxy for acuity of care.Design: Cross-sectional study using data collected by the state through its emergency reporting system and a post-hurricane survey.Setting and Participants: Analyses included all 3112 ALCs in the emergency reporting system. A subset of 1880 that completed the survey provided supplementary data.Methods: chi(2) tests were used to examine differences between ALC characteristics (license type, size, payment, profit status, rural location, geographical region, and being under an evacuation order) and whether they evacuated. Logistic regression was used to test associations between characteristics and evacuation status.Results: Of 3112 ALCs, 560 evacuated and 2552 sheltered in place. Bivariate analysis found significant associations between evacuation status and evacuation order, license type (mental health care), payment, and region. In the adjusted analysis, medium and larger ALCs were 43% (P < .001) and 53% (P < .001) less likely to evacuate than ALCs with fewer than 25 beds. Compared with ALCs in the Southeast, nearly every region was more likely to evacuate, with the highest likelihood in the Central West (odds ratio 1.76, 95% confidence interval 1.35-2.30). ALCs under an evacuation order were 8 times more likely to evacuate (P < .001). We found no relationship between evacuation status and having a license to provide higher care.Conclusions and Implications: Prior research highlighting harm associated with evacuation has led to recommendations that long-term care facilities carefully consider resident impairment in evacuation decision-making. Evidence that small ALCs are more likely to evacuate and that having a higher-care license is not associated with evacuation likelihood shows research is needed to understand how ALCs weigh resident risks in decisions to evacuate or shelter in place. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.