SAFEHAVEN: Decision Support for Nursing Home Resident Disaster Evacuations

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DESCRIPTION (provided by applicant): Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Homes (SAFE HAVEN Study). Since the events of September 11th 2001, billions of federal dollars have been devoted to improving the country's preparedness posture and public health infrastructure. Most of the attention has focused on traditional first responders (i.e. fire, police, EMS) and hospital preparedness and less to preparedness among non-acute healthcare facilities such as nursing homes (NH). Emergency planning for vulnerable populations constitutes a major element of community disaster preparedness and the elderly represent a most vulnerable group. NH residents are especially vulnerable, as they have extensive care needs and therefore, higher disaster-associated risks. However, NHs have not traditionally been incorporated into disaster planning at any level, a deficiency that must be remedied to avert a recurrence of the tragic events that occurred in connection with Hurricanes Katrina and Rita and to prevent similar tragedies when hurricanes are bound to strike. Our proposal is a direct response to NIH Program Announcement 06-454 "Behavioral Research on Disasters and Health". The announcement calls for applied research that can be directly utilized in the development of public health structures and interventions designed to redress the current lack of attention focused on health care institutions that serve the vulnerable elderly. Using Medicare claims, quarterly NH resident assessment data, longitudinal facility files and geo-coded data on each hurricane hitting Florida and the Gulf coast states between 2004 and 2007, we propose to estimate the impact of hurricanes on NH residents' morbidity and mortality. Furthermore, using the distance between the nursing home and the predicted path of the hurricane as an instrument, we will estimate the effect of the decision to evacuate or shelter in place on residents' outcomes. Dissemination of study findings will be designed for major medical and public health journals as well as more applied and practitioner oriented outlets including web sites. We will also convene an advisory group of stakeholders associated with the annual Hurricane Summit to assist us with dissemination of results to maximize the likelihood that both state nursing home regulators as well as emergency response coordination officials are alerted to the results of the study. PUBLIC HEALTH RELEVANCE: Hurricanes have a devastating effect on nursing home residents since they may be adversely affected either by being transferred to another setting or by sheltering in place. Using existing nursing home data from multiple sources, this study seeks to understand the consequences of hurricanes and evacuation decisions, providing the first evidence base to inform the creation of evacuation guidelines.