The Effects of Hurricanes on Nursing Home Residents

As hurricane season begins the first day of June, emergency preparedness planning activities swing into full gear.  Since 2010, the United States has declared 77 major hurricane-related disasters.  For persons in long-term care facilities, hurricane season brings additional challenges.  Of the approximately 1.1 million individuals in the United States who live in nursing homes, almost half of the residents live in 1 of the 18 Gulf and Atlantic Coast states most likely to be affected by a hurricane.  In Florida, we have 684 nursing homes with an estimated 72,000 residents at any given time.  Florida also has the dubious distinction of having been hit by more storms than any other U.S. state. Since 1851, only eighteen hurricane seasons have not had some kind of an impact on the state, e.g., flooding and destruction of infrastructure. 

Who lives in nursing homes?  Many older people and people with disabilities who need long-term care services live in nursing homes.  Nursing homes also care for an increasing number of complicated post-acute hospital care patients, who may be recovering from strokes or hip and pelvic fractures.  Any of the residents may have one or more physical, psychological, or cognitive limitations, ranging from frailty, lack of mobility, vision and hearing difficulties, depression, or dementia.  The stresses associated with hurricane season are complex and may have far-reaching consequences on the mental and physical health of the residents, whether residents are evacuated or sheltered in place.

After the 2005 hurricane season (with five hurricanes striking Florida),  Drs. Lisa Brown and Kathryn Hyer, at the College of Behavioral and Community Sciences, found that few nursing homes had ready access to disaster mental health clinicians.  In response to this need, Psychology Beyond Borders funded a project to develop an evidence-informed disaster mental health intervention that could be used by staff with distressed residents.  Developed by an international team of experts, the Psychological First Aid Field Operations Guide for Nursing Homes can be used by staff pre and post disaster.

As research with colleagues at Brown University post-Gustav revealed that there was a 2.8 percent increase in death at 30 days and a 3.9 percent increase in death at 90 days for residents with severe dementia who evacuated prior to the storm. The ability to offer and intervention that has the potential to reduce risk of hospitalization, morbidity, and mortality of nursing home residents is important.  This is particularly true for residents with severe cognitive impairment, who may be more easily agitated with changes in routine.  Drs. Brown and Hyer suggest that managing the environment to reduce stressors can include simple actions that have potentially profound effects.  Little things, such as turning off the television to limit exposure to continual storm updates, may reduce psychological distress.  

Drs. Brown and Hyer suggest that psychological first aid training should be made available to nursing home and assisted living facility staff.  With appropriate training, psychological first aid can be readily used by staff and volunteers as events unfold.  Even better, the Psychological First Aid Field Operations Guide for Nursing Homes  is available to the community on the CBCS website.   The second edition includes behavioral interventions that are appropriate with residents with moderate-to-severe dementia, with people receiving palliative and end-of-life care, and to help older adults deal with significant life changes, events, or losses.

For more information on disaster research occurring at the College of Behavioral and Community Sciences, please contact Dr. Lisa Brown lmb@usf.edu and Dr. Kathryn Hyer khyer@usf.edu


Psychological First Aid Field Operations Guide for Nursing Homes, 2nd edition.

A pilot study evaluating the feasibility of psychological first aid for nursing home residents 

Effect of forced transitions on the most functionally impaired nursing home residents

The effects of evacuation on nursing home residents with dementia

To evacuate or shelter in place: Implications of universal hurricane evacuation policies on nursing home residents

Effects of Hurricane Katrina on nursing facility resident mortality, hospitalization, and functional decline

Emergencies, disasters, and catastrophic events: The role of rehabilitation nurses in preparedness, response, and recovery

Helping nursing homes prepare for disasters

Establishing and refining hurricane response systems for long-term care facilities