摘要：Objectives. We examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. Methods. Five weeks after Hurricane Katrina, and again 15 weeks later, we conducted interviews with administrators of 14 nursing homes that sheltered 458 evacuees in 4 states. Nine weeks after Katrina, we conducted site visits to 4 nursing homes and interviewed 4 administrators and 38 staff members. We used grounded theory analysis to identify major themes and thematic analysis to organize content. Results. Although most sheltering facilities were well prepared for emergency triage and treatment, we identified some major preparedness shortcomings. Nursing homes were not included in community planning or recognized as community health care resources. Supplies and medications were inadequate, and there was insufficient communication and information about evacuees provided by evacuating nursing homes to sheltering nursing homes. Residents and staff had notable mental health–related needs after 5 months, and maintaining adequate staffing was a challenge. Conclusions. Nursing homes should develop and practice procedures to shelter and provide long-term access to mental health services following a disaster. Nursing homes should be integrated into community disaster planning and be classified in an emergency priority category similar to hospitals. During and after disasters, the adequacy of response by public health agencies, medical providers, and public safety officials is influenced by the degree to which planning has addressed needs of special populations, such as vulnerable older people. 1 – 7 Previous research has found that nursing homes received notably less support than did hospitals from federal, state, and local response agencies during and after disasters. 1 , 2 Nearly 2 million Americans reside in about 18000 nursing homes. 8 In the coming decades, nursing homes will care for many more frail older people with increasingly complex health needs. 7 , 9 , 10 The disaster following Hurricane Katrina further demonstrated that our nation’s disaster management system does not respond adequately to the needs of frail older persons in nursing homes. About 70 nursing home residents died in 13 nursing homes during the immediate aftermath of Katrina. 11 In addition to hurricanes, nursing homes are vulnerable to earthquakes, tornados, chemical spills from train accidents, and widespread lasting power outages caused by ice storms. The public health system and nursing homes need to incorporate the special needs of older populations into disaster planning, training, and education. 1 – 7 , 9 , 12 – 14 We present experiences and perspectives of administrators and staff at nursing homes in the Gulf Coast region that sheltered evacuees from Hurricane Katrina’s path. Such facilities are often called “sheltering” nursing homes. From their experiences, we sought to identify needs for preparedness training in nursing homes that may shelter evacuees from disaster areas and related practice and policy needs of the public health system.
