COVID-19 Supplement to Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Homes II (SAFE HAVEN II)

PROJECT SUMMARY/Abstract: Much of the research concerning the effect of disasters on older adults has focused on weather events andother natural disasters. The COVID-19 emergency provides critical evidence of the need for an all-hazardsapproach that includes more robust planning for pandemics. Currently, nursing homes (NHs) and assistedliving communities (ALCs) face a mounting challenge from the COVID-19 virus. The reports of NH deathsraise the prospect that the 1.3 million NH residents will be among the most severely affected population. Therisk is also believed to be high for ALC residents, where acuity has increased in the past decade. Of criticalconcern is the care of residents with Alzheimer's disease and/or related dementias (ADRD), who make up 50%of NH residents and 41% of ALC residents. Residents living with ADRD are potentially at great risk of harmfrom COVID-19 because of difficulty they may have understanding safety precautions (e.g. social distancing)and the trauma of usual care disruptions. We propose to supplement our current research into the effects ofHurricanes Harvey (Texas) and Irma (Florida) by examining the effect of and response to the COVID-19emergency among NHs and ALCs in Florida, with a focus on residents with ADRD. The overall goal of ourcurrent research, SAFE HAVEN II, is to understand more about the effect of hurricanes on older adults inresidential care. It conceptualizes disaster planning within the all-hazards framework. The Centers forMedicare and Medicaid Services requires all US NHs to develop all-hazards disaster plans that includepreparedness for a pandemic. However, NH and ALC responses to the COVID-19 emergency suggest a greatneed for guidance concerning protecting residents and staff, maintaining staff, and managing stress caused bysocial distancing requirements and other disruptions. This supplement proposal builds on the parentapplication by employing the research infrastructure established for SAFE HAVEN II, including relationshipswith NHs and ALCs across Florida. Through this supplement, we propose a mixed methods approach tosurvey and interview NH and ALC administrators to better understand the impact of the COVID-19 emergencyon their ADRD residents compared to other residents without ADRD (Aim1), and to define the morbidity andmortality of NH and ALC residents and how this varies for residents with ADRD vs. those without (Aim 2). Aim1 results will be used to provide critical initial guidance on protecting residents from COVID-19 and additionallyto generate hypotheses concerning the effect of and response to the virus in long-term care. Quantitative datacollected and analyzed through Aim 2 will be used to test these hypotheses and confirm or refine guidancefrom the qualitative analysis. These results, combined with work from the parent project, have the potential tosubstantially strengthen the ability of NHs and ALCs to protect and care for their most vulnerable residents.Results will provide valuable guidance concerning residents with ADRD, potentially at greater risk of harm in apandemic due to exposure, disruptions, and isolation.