Nursing Home Evacuations Should not Be “All or Nothing,” Says GSA Member in Senate Testimony

For Immediate Release
September 20, 2017

Contact: Todd Kluss
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Speaking before the U.S. Senate Special Committee on Aging today, University of South Florida professor Kathryn Hyer, PhD, MPP, FGSA, urged lawmakers to support actions that enable nursing homes and assisted living communities to better serve their residents in times of disaster — and noted that evacuation is not always the best option.

Hyer is a fellow of The Gerontological Society of America (GSA) and serves as director of the Florida Policy Exchange Center on Aging at the University of South Florida. She joined three other experts at a hearing titled “Disaster Preparedness and Response: The Special Needs of Older Americans.”

“While everyone suffers in disasters, our data indicate that exposure to natural disasters such as Hurricanes Harvey or Irma clearly results in excess death and hospitalizations among frail populations,” Hyer said. “Evacuations should not be all or nothing. We need a much more nuanced and better-researched understanding of who should evacuate before, and how people can be sustained appropriately.”

She reported to the committee that among 36,389 nursing home residents exposed to Hurricanes Katrina, Rita, Gustav, and Ike, their 30- and 90-day mortality/hospitalization rates increased considerably compared to non-hurricane control years regardless of whether they evacuated or sheltered in place. The very act of evacuation prior to the storm increased the probability of death at 90 days by 2.7 to 5.3 percent and increased the risk of hospitalization by 1.8 to 8.3 percent, independent of all other factors.

For the past 13 years, Hyer has studied the effect of disasters on the frail older adults living in nursing homes and assisted living communities. Her testimony was jointly prepared with David Dosa, MD, MPH, a GSA member who is an associate professor of medicine & health services, policy & practice at Brown University and the associate director of the Center of Innovation for Long Term Services & Supports at the Providence VA Medical Center.

The purpose of the hearing was to review what has been learned from past experience and what more can be done to ensure the health, safety, and resilience of older Americans during and after disasters, such as hurricanes.

Hyer provided explanations for why it may be more dangerous for nursing home and assisted living residents to evacuate than to shelter in place. She also gave eight recommendations to the committee to improve outcomes for these older adults. Among them were calls for generators and fuel to support air conditioning and other medical needs; better education about emergency plans; more disaster preparedness oversight in assisted living communities; more research on what types of patients will benefit from evacuation or sheltering in place; construction of facilities in places that minimize flooding risk; identification of and prioritization for nursing homes and assisted living communities by state and local management organizations; litigation protection for facilities that abide by regulations and provide care during disaster scenarios; and continued commitment to geriatric education programs.

“Our country needs ongoing geriatrics training,” Hyer said. “We need consistent research funding to evaluate disasters. We know that disasters will continue to occur, and we must be prepared.”

Along with their testimony, Hyer and Dosa also submitted a number of supporting journal studies that formed the basis for their findings and recommendations. The lead authors of these articles included Hyer and Dosa, as well as GSA members Kali S. Thomas, PhD, of Brown University and Lisa M. Brown, PhD, FGSA, of Palo Alto University. Brown was a presenter on two late-2016 GSA webinars on disaster preparedness and response; these resources can be found at


The Gerontological Society of America (GSA) is the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society, and an educational unit, the Academy for Gerontology in Higher Education.


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