Assisted Living Communities During Hurricane Irma: The Decision to Evacuate or Shelter in Place and Resident Acuity

Dobbs

June

et al. 2021

Innovation in Aging

Self Cite

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 Three 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, 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.

Section: Discussionsupporting

confidence: 53%

mentioning

confidence: 99%

“You Just Forge Ahead”: The Continuing Challenges of Disaster Preparedness and Response in Long-Term Care

Dobbs

June

et al. 2021

Innovation in Aging

Self Cite

“…CASPER provides facility‐level characteristics such as profit status, chain status, whether a NH is part of a continuing care retirement community (CCRC), availability of special care units, and bed size. FLHealthStat was an emergency reporting system instituted by the State of Florida to track healthcare facilities' evacuation status and is further described elsewhere 16 …”

Section: Methodsmentioning

confidence: 99%

“…Given the speed at which Hurricane Irma moved northward and the size of the wind bands, it was not until the evening on Monday, September 11, 2017, that the Florida was no longer affected. Due to Hurricane Irma's unpredictability, 16 strength, and size, 85 NHs evacuated. Many NHs that sheltered‐in‐place sustained flooding, wind damage, and power loss.…”

Section: Introductionmentioning

confidence: 99%

Effect of Hurricane Irma on daily direct‐care nurse staffing in nursing homes

Jester

Thomas

J American Geriatrics Society

et al. 2021

Self Cite

Objectives To examine the effect of Hurricane Irma on staff‐related financial expenditures and daily direct‐care nurse staffing levels. Design Retrospective cohort study. Setting September 3–24, 2017 in the state of Florida, United States. Hurricane Irma made landfall on September 10, 2017. Participants Six hundred and fifty‐three nursing homes (NHs), 81 evacuated facilities, and 572 facilities that sheltered‐in‐place. Measurements This study used data from Payroll‐Based Journaling (PBJ), Certification and Survey Provider Enhanced Reports (CASPER), and Florida's health providers' emergency reporting system. PBJ provided estimates of daily direct‐care nurse staffing levels for registered nurses, licensed practical nurses, and certified nursing assistants. CASPER reported facility‐level characteristics such as profit status, chain membership, and special care unit availability. Florida's emergency reporting system identified evacuation status during Hurricane Irma. Linear mixed‐effects models were used to estimate the unique contribution of evacuation status on daily staffing increases over time from September 3 to 10. Results Among all facilities, we found significant increases in staffing for licensed practical nurses (p = 0.02) and certified nursing assistants (p < 0.001), but not for registered nurses (p = 0.10) before Hurricane Irma made landfall. From 1 week before landfall to 2 weeks after landfall (September 3–24), an additional estimated $2.41 million was spent on direct‐care nurse staffing. In comparison to facilities that sheltered‐in‐place, evacuated facilities increased staffing levels of all nurse types (all p < 0.001). At landfall, evacuated facilities spent an estimated $93.74 on nurse staffing per resident whereas facilities that sheltered‐in‐place spent $76.10 on nurse staffing per resident. Conclusion NHs face unprecedented challenges during hurricanes, including maintaining adequate direct‐care nurse staffing levels to meet the needs of their residents. NHs that evacuated residents had an increase in direct‐care nurse staffing that was greater than that seen in NHs that sheltered‐in‐place.

“…States agencies should develop a template for AL communities as well as nursing homes for a COVID-19 comprehensive emergency management plans (CEMPs) similar to those required for disaster planning (Peterson et al, 2020). CEMPs are helpful planning tools and provide a framework that addresses emergency prevention, preparedness, response, recovery and mitigation.…”

Section: Recommendationmentioning

confidence: 99%

The Unique Challenges Faced by Assisted Living Communities to Meet Federal Guidelines for COVID-19

Dobbs

Journal of Aging & Social Policy

Hyer

2020

Self Cite

This perspective addresses the challenges that assisted living (AL) providers face concerning federal guidelines to prevent increased spread of COVID-19. These challenges include restriction of family visitation, use of third-party providers as essential workers, staffing guidelines, transfer policies, and rural AL hospitalizations. To meet these challenges we recommend that AL providers incorporate digital technology to maintain familyresident communication. We also recommend that states adopt protocols that limit the number of AL communities visited by home health care workers in a 14-day period, appeal to the federal government for hazard pay for direct care workers, and to extend the personal care attendant program to AL. It is further recommended that states work with AL communities to implement COVID-19 comprehensive emergency management plans that are well-coordinated with local emergency operation centers to assist with transfers to COVID-19 specific locations and to assist in rural areas with hospital transfers. Together, these recommendations to AL providers and state and federal agencies address the unique structure and needs of AL and would enable AL communities to be better prepared to care for and reduce those infected with COVID-19.