Effect of Forced Transitions on the Most Functionally Impaired Nursing Home Residents


Address correspondence to Kali S. Thomas, PhD, Center for Gerontology and Healthcare Research, Brown University, Box G-S121(6), Providence, RI 02912. E-mail: Kali_Thomas@brown.edu



To examine the hospitalization rate and mortality associated with forced mass transfer of nursing home (NH) residents with the highest levels of functional impairment.


Retrospective cohort study.


One hundred nineteen Texas and Louisiana NHs identified as being at risk for evacuation for Hurricane Gustav.


Six thousand four hundred sixty-four long-stay residents residing in at-risk NHs for at least three consecutive months before landfall of Hurricane Gustav.


Using Medicare claims and instrumental variable analysis, the mortality (death at 30 and 90 days) and hospitalization rates (at 30 and 90 days) of the most functionally impaired long-stay residents who were evacuated for Hurricane Gustav were compared with those of the most functionally impaired residents who did not evacuate.


The effect of evacuation was associated with 8% more hospitalizations by 30 and 90 days for the most functionally impaired residents. Evacuation was not significantly related to mortality.


The most functionally impaired NH residents experience more hospitalizations but not mortality as a consequence of forced mass transfer. With the inevitability of NH evacuations for many different reasons, harm mitigation strategies focused on the most impaired residents are needed.