Debra Dobbs1,2, Julianne Skarha3, Lily Gordon3, Dylan J Jester1,2, Lindsay J Peterson1,2, David M Dosa3,4,5. 1. School of Aging Studies, University of South Florida, Tampa, Florida, USA. 2. Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida, USA. 3. School of Public Health, Brown University, Providence, Rhode Island, USA. 4. Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. 5. Providence VAMC, Center of Innovation for Long Term Services and Supports, Providence, Rhode Island, USA.
Abstract
Background: Nursing home (NH) residents are vulnerable to increased mortality after a natural disaster such as hurricanes but the specific vulnerability of NH residents on hospice and the impact on admission to hospice are unknown. Objectives: Exposure to Hurricane Irma (2017) was used to evaluate increased mortality among Florida NH residents by hospice status compared with the same time period in a nonhurricane year. Difference in hospice utilization rates poststorm for short- and long-stay NH residents was also examined. Setting/Subjects: Subject were all Florida NH residents of age 65 years and older utilizing fee-for-service Medicare claims data exposed to Hurricane Irma in 2017 compared with a control group of residents residing at the same NHs in 2015. Analysis: Mortality rates were calculated by hospice status, rates of hospice enrollment, and the corresponding odds ratios (ORs). Results: Hurricane exposure was associated with an increase in mortality 30 days poststorm (OR = 1.12, 95% confidence interval [CI]: 1.00-1.26) but not 90 days poststorm (OR = 1.02, 95% CI: 0.95-1.10) for residents on hospice. For the rate of hospice enrollment poststorm among residents previously not on hospice, there was an increase in odds of enrollment among long-stay residents in 30 days (OR = 1.15, 95% CI: 1.02-1.23) and 90 days (OR = 1.12, 95% CI: 1.05-1.20) but not short-stay residents within 30 (OR = 1.02, 95% CI: 0.91-1.15) and 90 days (OR = 1.07, 95% CI: 0.99-1.15). Conclusion: Mortality in NH residents on hospice care increased in the aftermath of Hurricane Irma. In addition, NH residents not on hospice were more likely to be referred to hospice in the 30 days after the storm.
Background: Nursing home (NH) residents are vulnerable to increased mortality after a natural disaster such as hurricanes but the specific vulnerability of NH residents on hospice and the impact on admission to hospice are unknown. Objectives: Exposure to Hurricane Irma (2017) was used to evaluate increased mortality among Florida NH residents by hospice status compared with the same time period in a nonhurricane year. Difference in hospice utilization rates poststorm for short- and long-stay NH residents was also examined. Setting/Subjects: Subject were all Florida NH residents of age 65 years and older utilizing fee-for-service Medicare claims data exposed to Hurricane Irma in 2017 compared with a control group of residents residing at the same NHs in 2015. Analysis: Mortality rates were calculated by hospice status, rates of hospice enrollment, and the corresponding odds ratios (ORs). Results: Hurricane exposure was associated with an increase in mortality 30 days poststorm (OR = 1.12, 95% confidence interval [CI]: 1.00-1.26) but not 90 days poststorm (OR = 1.02, 95% CI: 0.95-1.10) for residents on hospice. For the rate of hospice enrollment poststorm among residents previously not on hospice, there was an increase in odds of enrollment among long-stay residents in 30 days (OR = 1.15, 95% CI: 1.02-1.23) and 90 days (OR = 1.12, 95% CI: 1.05-1.20) but not short-stay residents within 30 (OR = 1.02, 95% CI: 0.91-1.15) and 90 days (OR = 1.07, 95% CI: 0.99-1.15). Conclusion: Mortality in NH residents on hospice care increased in the aftermath of Hurricane Irma. In addition, NH residents not on hospice were more likely to be referred to hospice in the 30 days after the storm.
Entities:
Keywords:
disasters; hospice utilization; hurricane; mortality; nursing homes
Authors: Aurora Pop-Vicas; Momotazur Rahman; Pedro L Gozalo; Stefan Gravenstein; Vincent Mor Journal: J Am Geriatr Soc Date: 2015-08-17 Impact factor: 5.562
Authors: David M Dosa; Kathryn Hyer; Lisa M Brown; Andrew W Artenstein; Lumarie Polivka-West; Vincent Mor Journal: J Am Med Dir Assoc Date: 2008-09-07 Impact factor: 4.669
Authors: Lisa M Brown; David M Dosa; Kali Thomas; Kathryn Hyer; Zhanlian Feng; Vincent Mor Journal: Am J Alzheimers Dis Other Demen Date: 2012-09 Impact factor: 2.035
Authors: Kathleen T Unroe; Greg A Sachs; M E Dennis; Susan E Hickman; Timothy E Stump; Wanzhu Tu; Christopher M Callahan Journal: J Gen Intern Med Date: 2014-11-06 Impact factor: 5.128
Authors: David Dosa; Zhanlian Feng; Kathy Hyer; Lisa M Brown; Kali Thomas; Vincent Mor Journal: Disaster Med Public Health Prep Date: 2010-09 Impact factor: 1.385
Authors: Nan Tracy Zheng; Dana B Mukamel; Bruce Friedman; Thomas V Caprio; Helena Temkin-Greener Journal: J Am Med Dir Assoc Date: 2014-10-07 Impact factor: 4.669
Authors: David M Dosa; Julianne Skarha; Lindsay J Peterson; Dylan J Jester; Nazmus Sakib; Jessica Ogarek; Kali S Thomas; Ross Andel; Kathryn Hyer Journal: JAMA Netw Open Date: 2020-10-01