Kathryn Hyer - US grants

Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Home and Assisted Living Facilities (SAFE HAVEN II Study PROJECT SUMMARY/ABSTRACT Over 12,000 nursing home residents and over 12,000 assisted living residents were evacuated from Texas and Florida facilities during Hurricanes Harvey and Irma. Older adults are especially vulnerable to harm during disasters because of their medical comorbidities, such as dementia, and functional impairments. A fundamental question in disasters is whether to evacuate residents or shelter in place. Our prior examinations of nursing home (NH) resident outcomes after the Gulf hurricanes from 2005-08 showed that significant morbidity and mortality occurred in the months following the storms, and that those who were evacuated suffered greater morbidity and mortality compared to those who sheltered in place. However, the response to Hurricanes Harvey and Irma in August and September of 2017 suggest a continuation of the trend toward long-term care evacuations that we first observed in the response to the Gulf storms a decade ago. It demonstrates a need for additional evidence to inform policies created to protect vulnerable NH residents in disasters. A particular need exists to examine the effect of disasters on assisted living (AL) communities, for which little evidence exists concerning the effect of disasters on resident health and safety. The overall goal of this research proposal is to understand more about evacuation vs. sheltering in place during hurricane emergencies. It includes an examination of the impact of doing one or the other on NH and AL resident mortality and morbidity. Our proposal examines the effect of the hurricanes on NH residents (Aim1). It utilizes a novel methodology to identify AL residents developed by our team through a recent NIA R21 and to examine their outcomes (Aim 2). It examines the experiences of AL administrators to better understand the impact of evacuation and sheltering in place in those communities (Aim 3). It will be among the first studies to understand the impact of disasters on the growing AL population. This proposal represents a rapid response to the recent disasters to ensure that appropriate and timely data are collected while events are fresh, and to guide disaster planners and responders in efforts to protect increasingly vulnerable NH and AL residents from harm in future disasters.

PROJECT SUMMARY/ABSTRACT Much of the research concerning the effect of disasters on older adults has focused on weather events and other natural disasters. The COVID-19 emergency provides critical evidence of the need for an all-hazards approach that includes more robust planning for pandemics. Currently, nursing homes (NHs) and assisted living communities (ALCs) face a mounting challenge from the COVID-19 virus. The reports of NH deaths raise the prospect that the 1.3 million NH residents will be among the most severely affected population. The risk is also believed to be high for ALC residents, where acuity has increased in the past decade. Of critical concern is the care of residents with Alzheimer's disease and/or related dementias (ADRD), who make up 50% of NH residents and 41% of ALC residents. Residents living with ADRD are potentially at great risk of harm from COVID-19 because of difficulty they may have understanding safety precautions (e.g. social distancing) and the trauma of usual care disruptions. We propose to supplement our current research into the effects of Hurricanes Harvey (Texas) and Irma (Florida) by examining the effect of and response to the COVID-19 emergency among NHs and ALCs in Florida, with a focus on residents with ADRD. The overall goal of our current research, SAFE HAVEN II, is to understand more about the effect of hurricanes on older adults in residential care. It conceptualizes disaster planning within the all-hazards framework. The Centers for Medicare and Medicaid Services requires all US NHs to develop all-hazards disaster plans that include preparedness for a pandemic. However, NH and ALC responses to the COVID-19 emergency suggest a great need for guidance concerning protecting residents and staff, maintaining staff, and managing stress caused by social distancing requirements and other disruptions. This supplement proposal builds on the parent application by employing the research infrastructure established for SAFE HAVEN II, including relationships with NHs and ALCs across Florida. Through this supplement, we propose a mixed methods approach to survey and interview NH and ALC administrators to better understand the impact of the COVID-19 emergency on their ADRD residents compared to other residents without ADRD (Aim1), and to define the morbidity and mortality of NH and ALC residents and how this varies for residents with ADRD vs. those without (Aim 2). Aim 1 results will be used to provide critical initial guidance on protecting residents from COVID-19 and additionally to generate hypotheses concerning the effect of and response to the virus in long-term care. Quantitative data collected and analyzed through Aim 2 will be used to test these hypotheses and confirm or refine guidance from the qualitative analysis. These results, combined with work from the parent project, have the potential to substantially strengthen the ability of NHs and ALCs to protect and care for their most vulnerable residents. Results will provide valuable guidance concerning residents with ADRD, potentially at greater risk of harm in a pandemic due to exposure, disruptions, and isolation.