A Comparison of the Nursing Home Evacuation Experience Between Hurricanes Katrina (2005) and Gustav (2008)

Background: One of the tragic legacies of Hurricane Katrina was the loss of life among Louisiana (LA) nursing home (NH) residents. Katrina revealed a staggering lack of emergency preparation and understanding of how to safely evacuate frail populations. Three years later, LA braced for Hurricane Gustav, a storm heralded to rival Katrina's power. Although its magnitude of destruction ultimately paled to Katrina, the warnings and predicted path preceding Gustav yielded a process of NH evacuations similar to Katrina. The goal of this article was to ascertain whether NH administrative directors (ADS) felt more prepared to evacuate before Gustav. Methods: In 2006, Dosa et al(5) (J Am Med Dir Assoc, 3/07), interviewed 20 NH ADS by qualitative telephone survey to evaluate their lessons learned from Katrina. Administrators at these 20 participating nursing homes were contacted and asked to participate in a follow-up survey to compare hurricane preparedness between 2005 and 2008. Specifically, ADS were asked if they evacuated before Gustav, their destination, and about logistical issues with evacuation (eg, transportation, injuries). ADS were asked to rate their confidence with state assistance, hurricane transportation, and evacuation preparedness on a 10-point scale (10 = most confident) and compare their preparedness to Katrina. Results: Sixteen of the 20 NHs that participated in 2006 agreed to be surveyed-11 of whom held the same position before Katrina. Unlike Katrina, when only 45% evacuated before the storm, all 16 NHs evacuated before Gustav (56% to another NH and 46% to a church, gym, college, or other facility). Overall, ADS rated their confidence in preparedness for Gustav as a mean of 8.3 (range 5 to 10) compared with a mean of 5.4 (range 3 to 8) for Katrina, a 54% improvement. Of the 11 ADS employed pre-Katrina, 73% reported improved collaboration with the state and 55% noted improved transportation. Nevertheless, 7 ADS noted significant logistical problems during evacuation (mostly transportation); 4 noted resident injuries (2 hip fractures, 1 traumatic fall, and 1 cerebrovascular accident); and 2 noted resident posttraumatic stress. Conclusions: NH ADS felt more prepared to evacuate their residents for Gustav, owing partly to improved communication and collaboration with state agencies; however, significant morbidity and logistical problems remain with evacuating frail NH residents before hurricanes. (J Am Med Dir Assoc 2009; 10: 639-643)