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Hua CL, Patel S, Thomas KS, Jester DJ, Kosar CM, Peterson LJ, Dobbs D, Andel R, Dosa DM. Evacuation and Health Care Outcomes Among Assisted Living Residents After Hurricane Irma. JAMA Netw Open 2024; 7:e248572. [PMID: 38669016 PMCID: PMC11053374 DOI: 10.1001/jamanetworkopen.2024.8572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Evacuation has been found to be associated with adverse outcomes among nursing home residents during hurricanes, but the outcomes for assisted living (AL) residents remain unknown. Objective To examine the association between evacuation and health care outcomes (ie, emergency department visits, hospitalizations, mortality, and nursing home visits) among Florida AL residents exposed to Hurricane Irma. Design, Setting, and Participants Retrospective cohort study using 2017 Medicare claims data. Participants were a cohort of Florida AL residents who were aged 65 years or older, enrolled in Medicare fee-for-service, and resided in 9-digit zip codes corresponding to US assisted living communities with 25 or more beds on September 10, 2017, the day of Hurricane Irma's landfall. Propensity score matching was used to match evacuated residents to those that sheltered-in-place based on resident and AL characteristics. Data were analyzed from September 2022 to February 2024. Exposure Whether the AL community evacuated or sheltered-in-place before Hurricane Irma made landfall. Main Outcomes and Measures Thirty- and 90-day emergency department visits, hospitalizations, mortality, and nursing home admissions. Results The study cohort included 25 130 Florida AL residents (mean [SD] age 81 [9] years); 3402 (13.5%) evacuated and 21 728 (86.5%) did not evacuate. The evacuated group had 2223 women (65.3%), and the group that sheltered-in-place had 14 556 women (67.0%). In the evacuated group, 42 residents (1.2%) were Black, 93 (2.7%) were Hispanic, and 3225 (94.8%) were White. In the group that sheltered in place, 490 residents (2.3%) were Black, 707 (3.3%) were Hispanic, and 20 212 (93.0%) were White. After 1:4 propensity score matching, when compared with sheltering-in-place, evacuation was associated with a 16% greater odds of emergency department visits (adjusted odds ratio [AOR], 1.16; 95% CI, 1.01-1.33; P = .04) and 51% greater odds of nursing home visits (AOR, 1.51; 95% CI, 1.14-2.00; P = .01) within 30 days of Hurricane Irma's landfall. Hospitalization and mortality did not vary significantly by evacuation status within 30 or 90 days after the landfall date. Conclusions and Relevance In this cohort study of Florida AL residents, there was an increased risk of nursing home and emergency department visits within 30 days of Hurricane Irma's landfall among residents from communities that evacuated before the storm when compared with residents from communities that sheltered-in-place. The stress and disruption caused by evacuation may yield poorer immediate health outcomes after a major storm for AL residents. Therefore, the potential benefits and harms of evacuating vs sheltering-in-place must be carefully considered when developing emergency planning and response.
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Affiliation(s)
- Cassandra L. Hua
- Department of Public Health, University of Massachusetts, Lowell
| | - Sweta Patel
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Kali S. Thomas
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Massachusetts
| | - Dylan J. Jester
- Women’s Operational Military Exposure Network Center of Excellence, VA Palo Alto Health Care System, Palo Alto, California
| | - Cyrus M. Kosar
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Lindsay J. Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix
- Memory Clinic, Department of Neurology, Charles University, Second Faculty of Medicine and Motol University Hospital, Czech Republic
| | - David M. Dosa
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Salas RN, Burke LG, Phelan J, Wellenius GA, Orav EJ, Jha AK. Impact of extreme weather events on healthcare utilization and mortality in the United States. Nat Med 2024; 30:1118-1126. [PMID: 38424213 DOI: 10.1038/s41591-024-02833-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.
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Affiliation(s)
- Renee N Salas
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard Global Health Institute, Cambridge, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Laura G Burke
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, MA, USA
| | - Jessica Phelan
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Boston University School of Public Health, Center for Climate and Health, Boston, MA, USA
| | - E John Orav
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ashish K Jha
- Brown University School of Public Health, Providence, RI, USA
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Gao S, Wang Y. Anticipating older populations' health risk exacerbated by compound disasters based on mortality caused by heart diseases and strokes. Sci Rep 2023; 13:16810. [PMID: 37798365 PMCID: PMC10556062 DOI: 10.1038/s41598-023-43717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
The health of older populations in the Southeastern U.S. receives threats from recurrent tropical cyclones and extreme heat, which may exacerbate the mortality caused by heart diseases and strokes. Such threats can escalate when these extremes form compound disasters, which may be more frequent under climate change. However, a paucity of empirical evidence exists concerning the health threats of compound disasters, and anticipations regarding the health risks of older populations under future compound disaster scenarios are lacking. Focusing on Florida, which has 67 counties and the second-largest proportion of older populations among U.S. states, we calibrate Poisson regression models to explore older populations' mortality caused by heart diseases and strokes under single and compound disasters. The models are utilized to estimate the mortality across future disaster scenarios, the changing climate, and the growing population. We identify that under multiple hurricanes or heat, current-month hurricanes or heat can affect mortality more heavily than previous-month hurricanes or heat. Under future scenarios, co-occurring hurricanes and extreme heat can exacerbate the mortality more severely than other disaster scenarios. The same types of compound disasters can coincide with an average of 20.5% higher mortality under RCP8.5-SSP5 than under RCP4.5-SSP2. We assess older populations' future health risks, alerting health agencies to enhance preparedness for future "worst-case" scenarios of compound disasters and proactively adapt to climate change.
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Affiliation(s)
- Shangde Gao
- Department of Urban and Regional Planning and Florida Institute for Built Environment Resilience, University of Florida, Gainesville, FL, 32611, USA
| | - Yan Wang
- Department of Urban and Regional Planning and Florida Institute for Built Environment Resilience, University of Florida, Gainesville, FL, 32611, USA.
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Thomas KS, Smith L, Gadkari G, Hua C, Cornell P. Identifying a National Cohort of Medicare Beneficiaries Residing in Assisted Living Settings: An Updated Method. J Am Med Dir Assoc 2023; 24:1513-1517.e3. [PMID: 37268016 DOI: 10.1016/j.jamda.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Present an updated approach to identifying Medicare beneficiaries residing in licensed assisted living (AL) settings in the United States. DESIGN Retrospective cohort study using a national list of licensed AL settings, US Postal Service (USPS) data, and enrollment, claims, and assessment data from the Centers for Medicare and Medicaid Services. SETTING AND PARTICIPANTS A total of 403,326 beneficiaries residing in 29,905 licensed AL settings. METHODS We identified every ZIP+4 code affiliated with each AL address. We then identified all of the Medicare beneficiaries with that ZIP+4 on January 1, 2019, and excluded beneficiaries in nursing homes and hospitals on that date. We identified beneficiaries who were "definitively" and "very likely AL residents" according to the number of addresses corresponding to the ZIP+4 in the USPS data, the capacity of the AL setting, and the presence of a claim or assessment indicating services were delivered in AL. We compared beneficiaries excluded during our new capacity restriction step (ie, "possibly neighbors") to those included as being "definitively" and "very likely AL residents" using standardized mean differences. RESULTS The cohort excluded (ie, "possibly neighbors") using our new step in the identification process appears to be younger and healthier than the cohorts we include as being "definitively" and "very likely AL residents." In addition, the cohort we identified through our added step of supplementing with claims and assessment data have similar demographics to the other cohorts we include, although they appear to be in poorer health. CONCLUSIONS AND IMPLICATIONS Leveraging licensed capacity information and supplementing with claims and assessment data produce greater confidence in the ability to accurately identify AL residents using ZIP+4 codes reported in Medicare administrative data.
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Affiliation(s)
- Kali S Thomas
- Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA.
| | - Lindsey Smith
- Brown University School of Public Health, Providence, RI, USA
| | - Gauri Gadkari
- Brown University School of Public Health, Providence, RI, USA
| | - Cassandra Hua
- Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
| | - Portia Cornell
- Brown University School of Public Health, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA
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Dosa D, Jester D, Peterson L, Dobbs D, Black K, Brown L. Applying the age-friendly-health system 4M paradigm to reframe climate-related disaster preparedness for nursing home populations. Health Serv Res 2023; 58 Suppl 1:36-43. [PMID: 35908191 PMCID: PMC9843084 DOI: 10.1111/1475-6773.14043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- David Dosa
- Providence VA Medical CenterProvidenceRhode IslandUSA
- Warren Alpert School of MedicineBrown UniversityProvidenceRhode IslandUSA
- School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Dylan Jester
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
- Sam and Rose Stein Institute for Research on AgingUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Lindsay Peterson
- Florida Policy Exchange Center of AgingSchool of Aging Studies, University of South FloridaTampaFloridaUSA
| | - Debra Dobbs
- Florida Policy Exchange Center of AgingSchool of Aging Studies, University of South FloridaTampaFloridaUSA
| | - Kathy Black
- School of Aging StudiesUniversity of South Florida Sarasota‐Manatee CampusSarasotaFloridaUSA
| | - Lisa Brown
- Risk and Resilience LabPalo Alto UniversityPalo AltoCaliforniaUSA
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McCann ZH, Szaflarski M. Differences in county-level cardiovascular disease mortality rates due to damage caused by hurricane Matthew and the moderating effect of social capital: a natural experiment. BMC Public Health 2023; 23:60. [PMID: 36624492 PMCID: PMC9830798 DOI: 10.1186/s12889-022-14919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND As the climate continues to warm, hurricanes will continue to increase in both severity and frequency. Hurricane damage is associated with cardiovascular events, but social capital may moderate this relationship. Social capital is a multidimensional concept with a rich theoretical tradition. Simply put, social capital refers to the social relationships and structures that provide individuals with material, financial, and emotional resources throughout their lives. Previous research has found an association between high levels of social capital and lower rates of cardiovascular (CVD) mortality. In post-disaster settings, social capital may protect against CVD mortality by improving access to life-saving resources. We examined the association between county-level hurricane damage and CVD mortality rates after Hurricane Matthew, and the moderating effect of several aspects of social capital and hurricane damage on this relationship. We hypothesized that (1) higher (vs. lower) levels of hurricane damage would be associated with increased CVD mortality rates and (2) in highly damaged counties, higher (vs. lower) levels of social capital would be associated with lower CVD mortality. METHODS Analysis used yearly (2013-2018) county-level sociodemographic and epidemiological data (n = 183). Sociodemographic data were compiled from federal surveys before and after Hurricane Matthew to construct, per prior literature, a social capital index based on four dimensions of social capital (sub-indices): family unity, informal civil society, institutional confidence, and collective efficacy. Epidemiological data comprised monthly CVD mortality rates constructed from monthly county-level CVD death counts from the CDC WONDER database and the US Census population estimates. Changes in CVD mortality based on level of hurricane damage were assessed using regression adjustment. We used cluster robust Poisson population average models to determine the moderating effect of social capital on CVD mortality rates in both high and low-damage counties. RESULTS We found that mean levels of CVD mortality increased (before and after adjustment for sociodemographic controls) in both low-damage counties (unadjusted. Mean = 2.50, 95% CI [2.41, 2.59], adjusted mean = 2.50, 95% CI [2.40, 2.72]) and high-damage counties (mean = 2.44, CI [2.29, 2.46], adj. Mean = 2.51, 95% CI [2.49, 2.84]). Among the different social capital dimensions, institutional confidence was associated with reduced initial CVD mortality in low-damage counties (unadj. IRR 1.00, 95% CI [0.90, 1.11], adj. IRR 0.91 CI [0.87, 0.94]), but its association with CVD mortality trends was null. The overall effects of social capital and its sub-indices were largely nonsignificant. CONCLUSION Hurricane damage is associated with increased CVD mortality for 18 months after Hurricane Matthew. The role of social capital remains unclear. Future research should focus on improving measurement of social capital and quality of hurricane damage and CVD mortality data.
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Affiliation(s)
- Zachary H. McCann
- grid.189967.80000 0001 0941 6502Department of Environmental Health, Rollins School of Public Health-Emory University, Atlanta, Georgia
| | - Magdalena Szaflarski
- grid.265892.20000000106344187Department of Sociology, University of Alabama at Birmingham, Birmingham, AL United States
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Ghosh AK, Demetres MR, Geisler BP, Ssebyala SN, Yang T, Shapiro MF, Setoguchi S, Abramson D. Impact of Hurricanes and Associated Extreme Weather Events on Cardiovascular Health: A Scoping Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:116003. [PMID: 36448792 PMCID: PMC9710380 DOI: 10.1289/ehp11252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The frequency and destructiveness of hurricanes and related extreme weather events (e.g., cyclones, severe storms) have been increasing due to climate change. A growing body of evidence suggests that victims of hurricanes have increased incidence of cardiovascular disease (CVD), likely due to increased stressors around time of the hurricane and in their aftermath. OBJECTIVES The objective was to systematically examine the evidence of the association between hurricanes (and related extreme weather events) and adverse CVD outcomes with the goal of understanding the gaps in the literature. METHODS A comprehensive literature search of population-level and cohort studies focused on CVD outcomes (i.e., myocardial infarction, stroke, and heart failure) related to hurricanes, cyclones, and severe storms was performed in the following databases from inception to December 2021: Ovid MEDLINE, Ovid EMBASE, Web of Science, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. Studies were then qualitatively synthesized based on the time frame of the CVD outcomes studied and special populations that were studied. Gaps in the literature were identified based on this synthesis. RESULTS Of the 1,103 citations identified, 48 met our overall inclusion criteria. We identified articles describing the relationship between CVD and extreme weather, primarily hurricanes, based on data from the United States (42), Taiwan (3), Japan (2), and France (1). Outcomes included CVD and myocardial infarction-related hospitalizations (30 studies) and CVVD-related mortality (7 studies). Most studies used a retrospective study design, including one case-control study, 39 cohort studies, and 4 time-series studies. DISCUSSION Although we identified a number of papers that reported evaluations of extreme weather events and short-term adverse CVD outcomes, there were important gaps in the literature. These gaps included a) a lack of rigorous long-term evaluation of hurricane exposure, b) lack of investigation of hurricane exposure on vulnerable populations regarding issues related to environmental justice, c) absence of research on the exposure of multiple hurricanes on populations, and d) absence of an exploration of mechanisms leading to worsened CVD outcomes. Future research should attempt to fill these gaps, thus providing an important evidence base for future disaster-related policy. https://doi.org/10.1289/EHP11252.
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Affiliation(s)
- Arnab K. Ghosh
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Michelle R. Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
| | - Benjamin P. Geisler
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Shakirah N. Ssebyala
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Tianyi Yang
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Martin F. Shapiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Soko Setoguchi
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - David Abramson
- Center of Public Health Disaster Science, School of Global Public Health, New York University, New York, New York, USA
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Dobbs D, June JW, Dosa DM, Peterson LJ, Hyer K. Protecting Frail Older Adults: Long-Term Care Administrators' Satisfaction With Public Emergency Management Organizations During Hurricane Irma and COVID-19. THE PUBLIC POLICY AND AGING REPORT 2021; 31:145-150. [PMID: 34691480 PMCID: PMC8500148 DOI: 10.1093/ppar/prab019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Debra Dobbs
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Joseph W June
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - David M Dosa
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Providence VA Medical Center, Providence, Rhode Island, USA
| | - Lindsay J Peterson
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, Tampa, Florida, USA
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
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Peterson LJ, Dobbs D, June J, Dosa DM, Hyer K. "You Just Forge Ahead": The Continuing Challenges of Disaster Preparedness and Response in Long-Term Care. Innov Aging 2021; 5:igab038. [PMID: 34805555 PMCID: PMC8600546 DOI: 10.1093/geroni/igab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Protecting nursing home and assisted living community residents during disasters continues to be a challenge. The present study explores the experiences of long-term care facilities in Florida that were exposed to Hurricane Irma in 2017. RESEARCH DESIGN AND METHODS We used an abductive approach, combining induction and deduction. Interviews and focus groups beginning in May 2018 were conducted by telephone and in person with 89 administrative staff members representing 100 facilities (30 nursing homes and 70 assisted living communities). Analyses identified themes and subthemes. Findings were further analyzed using the social ecological model to better understand the preparedness and response of nursing homes and assisted living communities to Hurricane Irma. RESULTS 3 main themes were identified including: (1) importance of collaborative relationships in anticipating needs and planning to shelter in place or evacuate; (2) efforts required to maintain safety and stability during an unprecedented event; and (3) effects, repercussions, and recommendations for change following the disaster. DISCUSSION AND IMPLICATIONS Preparing for and managing disasters in nursing homes and assisted living communities involves actions within multiple environments beyond the residents and facilities where they live. Among these, community-level relationships are critical.
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Affiliation(s)
- Lindsay J Peterson
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Debra Dobbs
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Joseph June
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - David M Dosa
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center of Aging, School of Aging Studies, University of South Florida, Tampa, Florida, USA
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McNabney MK. How Should Assisted Living Be Using Emergency Departments? J Am Med Dir Assoc 2021; 22:899-900. [PMID: 33832713 DOI: 10.1016/j.jamda.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
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