To evacuate or not to evacuate. lessons learned from Louisiana nursing home administrators following Hurricanes Katrina and Rita

Objectives: To evaluate the lessons learned by Louisiana Nursing Home (NH) administrative directors (ADS) forced to make decisions relating to resident evacuation before Hurricanes Katrina and Rita and determine how emergency planning has changed in those NHs. Design: Twenty in-depth telephone interviews followed by a focus group conducted in New Orleans. Setting: Louisiana NHs in parishes affected by Hurricanes Katrina and Rita. Participants: Twenty ADS employed by affected NHs during August and September 2005. Measurements: Qualitative data sources consisted of transcribed telephone and focus group interviews. Data were analyzed using narrative summary analysis and descriptive data were tabulated using an abstraction tool. Results: Nine of 20 NHs evacuated before the hurricanes and 11 sheltered in place. Six additional NHs evacuated following the storms. The most common perceived consequences related to the evacuation process were resident morbidity or mortality (6 of 15), transportation issues (5 of 15), and staffing deficiencies (3 of 15). Common findings among the NHs that sheltered in place included supply shortages (8 of 11), facility damage (5 of 11), and staffing issues (4 of 11). Conclusion: Respondents noted 4 general themes during the interviews and focus group session: (1) ADS felt abandoned by the state and federal emergency response apparatus during and after the hurricanes, and continue to feel that they are not a priority; (2) there is substantial physical and technical difficulty in evacuating frail NH residents; (3) staff retention remains a critical problem regardless of the evacuation decision; (4) there are key lessons learned that can be incorporated into future disaster planning.