Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Short Communication Gerontology DOI: 10.1159/000302713 Hurricanes Katrina and Rita and the Department of Veterans Affairs: A Conceptual Model for Understanding the Evacuation of Nursing Homes Aram Dobalian   a, b Maria Claver   a, c Jacqueline J. Fickel   a   a  VAGLAHS HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, Calif., b  Department of Health Services, UCLA School of Public Health, Los Angeles, Calif., and c  Department of Family and Consumer Sciences, California State University, Long Beach, Calif., USA the utility of the conceptual model and to provide guidance about effective practices and procedures, this paper focuses on the responses of Veterans Health Administration (VHA) nursing homes to the 2 hurricanes. Results: Quarantelli’s conceptual framework, as modified by Perry and Mushkatel, is useful in guiding the development of central hypotheses related to the decision-making that occurred in VA nursing homes and other healthcare facilities following Hurricanes Katrina and Rita. However, we define evacuation somewhat differently to account for the fact that evacuation may, in some instances, be permanent. Thus, we propose modifying this framework to improve its applicability beyond preven- tive evacuation. Conclusions: We need to better understand how disaster plans can be adapted to meet the needs of frail elders and other residents in nursing homes. Moreover, we must address identified gaps in the scientific literature with respect to health outcomes by tracking outcomes over time. Information on health outcomes would allow administrators and others to more appropriately weigh the balance of risks and benefits associated with evacuation. Without this un- derstanding of the relationship between evacuation and health outcomes, it is not possible to develop effective re- sponse plans that are tailored to meet the needs of nursing home residents. Copyright © 2010 S. Karger AG, Basel Key Words Nursing homes  Emergency preparedness  Disasters  Disaster planning  Veterans Abstract Background: Hurricanes Katrina and Rita exposed signifi- cant flaws in US preparedness for catastrophic events and the nation’s capacity to respond to them. These flaws were especially evident in the affected disaster areas’ nursing homes, which house a particularly vulnerable population of frail older adults. Although evacuation of a healthcare facil- ity is a key preparedness activity, there is limited research on factors that lead to effective evacuation. Objective: Our re- view of the literature on evacuation is focused on develop- ing a conceptual framework to study future evacuations rather than as a comprehensive assessment of prior work. Methods: This paper summarizes what is known thus far about disaster response activities of nursing homes follow- ing natural and human-caused disasters, describes a con- ceptual model to guide future inquiry regarding this topic, and suggests future areas of research to further understand the decision-making process of nursing home facilitators re- garding evacuating nursing home residents. To demonstrate Received: August 5, 2009 Accepted: December 17, 2009 Published online: March 24, 2010 Aram Dobalian, PhD, JD VAGLAHS HSR&D Center of Excellence for the Study of Healthcare Provider Behavior 16111 Plummer St. (152), Sepulveda, CA 91343 (USA) Tel. +1 818 891 7711, ext. 7182, Fax +1 818 895 5838, E-Mail aram.dobalian  @  va.gov © 2010 S. Karger AG, Basel 0304–324X/10/0000–0000$26.00/0 Accessible online at: www.karger.com/ger