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RRP 06-134 – HSR&D Study

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RRP 06-134
Evacuation of Veterans from Nursing Homes Due to Katrina and Rita
Aram Dobalian PhD MPH JD
VA Greater Los Angeles Healthcare System, Sepulveda, CA
Sepulveda, CA
Funding Period: May 2006 - September 2007

BACKGROUND/RATIONALE:
Existing research within and outside VA does not adequately address health issues for frail and/or mentally ill elders during evacuations, and this is particularly true within nursing homes. Limited research on evacuation exists in other settings (e.g., hospitals). This exploratory project evaluated the evacuation of veterans from nursing homes in areas affected by Hurricanes Katrina and Rita. The evacuation of New Orleans and surrounding areas following Hurricane Katrina was the largest non-military evacuation of civilians in the United States. The healthcare systems in many of these areas were also further affected by a secondary event, Hurricane Rita. Katrina led to the permanent closure of the Gulfport VAMC, and the temporary closure of the New Orleans VAMC. A third VAMC in Biloxi, MS was significantly damaged.

OBJECTIVE(S):
(1) To understand the processes related to variations in evacuation and effective disaster-response in VA nursing homes following Hurricanes Katrina and Rita. (2) To understand the impact of the evacuations on the care of veterans who were residents in these facilities.

METHODS:
Data were collected via semi-structured key respondent interviews with organizational representatives (healthcare providers, administrators, and policymakers) from VA. We conducted 13 interviews with key respondents from four VA Medical Centers. We used computer software, ATLAS.ti, designed specifically for narrative interview and/or field notes, to synthesize the qualitative data. This process involved reviewing the interview transcripts, assigning content themes, reviewing the derived themes, and coding the interviews.

FINDINGS/RESULTS:
We found that (1) administrators primarily relied on local resources, prior experience, and local planning rather than state and federal emergency response systems; (2) there is substantial difficulty in evacuating frail nursing home residents; (3) it is difficult to retain staff and a viable organization during and after a disaster; and (4) key lessons learned could be incorporated into future planning. Although VAs response to Hurricanes Katrina and Rita was generally viewed as positive, most respondents stated that some of this success was the result of good fortune. All voiced concerns regarding what might occur during the next disaster. Despite local and regional efforts to improve preparedness for future disasters in the time since the hurricanes, respondents identified a number of substantial unaddressed preparedness needs that remain.

IMPACT:
These disasters provided a unique opportunity to examine the VA's ability to respond to system-wide challenges and ensure access to high-quality services. The devastating scope of these two disasters allowed us to better understand the health needs of residents during and after evacuation, and examine a range of system, coordination, and integration issues related to the post-disaster delivery of health services for frail and elderly veterans in nursing homes. The two hurricanes brought unanticipated challenges and pointed out potential operational flaws in existing disaster response plans. Future research could focus on VA emergency preparedness practices that might be effectively integrated into routine practice. Over time, these systematic, evidence-based practices could be implemented and subsequently evaluated after future disasters.

PUBLICATIONS:

Journal Articles

  1. Heslin KC, Stein JA, Dobalian A, Simon B, Lanto AB, Yano EM, Rubenstein LV. Alcohol problems as a risk factor for postdisaster depressed mood among U.S. veterans. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors. 2013 Mar 1; 27(1):207-13.
  2. Claver M, Dobalian A, Fickel JJ, Ricci KA, Mallers MH. Comprehensive care for vulnerable elderly veterans during disasters. Archives of Gerontology and Geriatrics. 2013 Jan 1; 56(1):205-13.
  3. Dobalian A, Claver M, Fickel JJ. Hurricanes Katrina and Rita and the Department of Veterans Affairs: A Conceptual Model for Understanding the Evacuation of Nursing Homes. Gerontology. 2011 Apr 27.
Conference Presentations

  1. Dobalian A, Claver ML, Fickel JJ. Hurricanes Katrina and Rita: Evacuating Veterans from VA Nursing Homes. Poster session presented at: Natural Hazards Research and Applications Annual Workshop; 2010 Jul 13; Broomfield, CO.
  2. Dobalian A. Overview of VA and VA evaluation and research funding for non-VA researchers and practitioners; Discussion of VHA Comprehensive Emergency Management Program Evaluation and Research Agenda; Evacuation of Veterans from Nursing Homes Due to Katrina and Rita. Paper presented at: VA Comprehensive Emergency Management Program Evaluation and Research Conference; 2010 May 4; Baltimore, MD.


DRA: none
DRE: none
Keywords: none
MeSH Terms: none

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