Emergency Department Use Among Assisted Living Residents After Hurricane Irma

Abstract

Objectives: Nursing home residents are especially vulnerable to adverse outcomes after a hurricane. Prior research suggests that emergency department (ED) visits increase among community-residing older adults after natural disasters. However, little is known about the impact of hurricanes on the large population of older adults residing in assisted living (AL) settings, particularly the influence of storms on the rates and causes of ED visits. We examined whether rates of ED use for injuries and other medical reasons increased after Hurricane Irma in 2017 among AL residents in Florida.

Design: Retrospective cohort study.

Setting and participants: Samples of 30,358 Medicare fee-for-service beneficiaries in 2016 and 28,922 beneficiaries in 2017 who resided in Florida AL communities.

Measures: The number of injury-related and other medical visits per 1,000 person-days within 30 and 90 days of September 1 in 2016 and 2017. We adjusted for age, race, sex, and chronic conditions using linear regression with AL fixed effects. We compared the top 10 primary diagnoses resulting in an ED visit between 2016 and 2017.

Results: Adjusted rates of injury-related visits were 12.5% higher at 30 days but did not differ at 90 days. Other medical visits were 12% higher at 30 days in 2017 than in 2016 and 7.7% higher at 90 days. Heart failure was a leading cause of ED visits within 90 days of September 1 in 2017, unlike in 2016.

Conclusions and implications: Increased attention should be paid to AL communities in disaster preparedness and response efforts given the increased likelihood of ED visits following a hurricane.

Keywords: Disaster; emergency; injuries; long-term care.

Figure 1.. Adjusted rates of emergency department visits among assisted living residents age 65+ residing in Florida, by type of ED visit and year

Notes: Exposure date was September 1st in each year of each year (2016 and 2017) Data came from the 2016 & 2017 Medicare Master Beneficiary Summary File and Chronic Conditions, MedPAR file, and Medicare outpatient claims. Residents were enrolled in fee-for-service Medicare and resided in assisted living on September 1 of 2016 or 2017. All rates were standardized by the 1,000 person-days alive during each study window. Visits were classified as injuries by the New York University (NYU) algorithm based on ICD-10 codes. Rates adjusted for race, age, dual eligibility, the presence of chronic conditions, and AL fixed effects