OBJECTIVES To investigate the factors associated with whether assisted living communities (ALCs) in Florida evacuated or sheltered in place for Hurricane Irma in 2017, focusing on license type as a proxy for acuity of care. DESIGN Cross-sectional study using data collected by the state through its emergency reporting system and a post-hurricane survey. SETTING AND PARTICIPANTS Analyses included all 3112 ALCs in the emergency reporting system. A subset of 1880 that completed the survey provided supplementary data. METHODS χ2 tests were used to examine differences between ALC characteristics (license type, size, payment, profit status, rural location, geographical region, and being under an evacuation order) and whether they evacuated. Logistic regression was used to test associations between characteristics and evacuation status. RESULTS Of 3112 ALCs, 560 evacuated and 2552 sheltered in place. Bivariate analysis found significant associations between evacuation status and evacuation order, license type (mental health care), payment, and region. In the adjusted analysis, medium and larger ALCs were 43% (P < .001) and 53% (P < .001) less likely to evacuate than ALCs with fewer than 25 beds. Compared with ALCs in the Southeast, nearly every region was more likely to evacuate, with the highest likelihood in the Central West (odds ratio 1.76, 95% confidence interval 1.35‒2.30). ALCs under an evacuation order were 8 times more likely to evacuate (P < .001). We found no relationship between evacuation status and having a license to provide higher care. CONCLUSIONS AND IMPLICATIONS Prior research highlighting harm associated with evacuation has led to recommendations that long-term care facilities carefully consider resident impairment in evacuation decision-making. Evidence that small ALCs are more likely to evacuate and that having a higher-care license is not associated with evacuation likelihood shows research is needed to understand how ALCs weigh resident risks in decisions to evacuate or shelter in place.

中文翻译：

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飓风艾尔玛期间的辅助生活社区：疏散或就地避难的决定以及居民的敏锐度


目标 调查与 2017 年飓风“艾尔玛”发生时佛罗里达州的辅助生活社区 (ALC) 是否疏散或就地避难相关的因素，重点关注许可证类型作为护理敏锐度的代表。使用该州通过紧急报告系统和飓风后调查收集的数据设计横断面研究。设置和参与者 分析包括紧急报告系统中的所有 3112 个 ALC。完成调查的 1880 人中的一部分提供了补充数据。方法 使用 χ2 检验来检查 ALC 特征（许可证类型、规模、付款、利润状况、农村位置、地理区域和是否接受疏散命令）之间的差异以及他们是否疏散。使用逻辑回归来测试特征和疏散状态之间的关联。结果 3112 名 ALC 中，560 人被疏散，2552 人就地避难。双变量分析发现疏散状态与疏散命令、许可证类型（精神卫生保健）、付款和地区之间存在显着关联。在调整后的分析中，与床位少于 25 个的 ALC 相比，中型和大型 ALC 撤离的可能性分别低 43% (P < .001) 和 53% (P < .001)。与东南部的 ALC 相比，几乎每个地区都更有可能撤离，其中中西部地区的可能性最高（比值比 1.76，95% 置信区间 1.35-2.30）。收到疏散命令的 ALC 疏散的可能性是其他人的 8 倍 (P < .001)。我们发现疏散状态与拥有提供高级护理的许可证之间没有关系。结论和含义 先前的研究强调了与疏散相关的危害，并建议长期护理机构在疏散决策中仔细考虑居民的受损情况。 有证据表明，小型 ALC 更有可能疏散，并且拥有高级护理许可证与疏散可能性无关，这表明需要进行研究以了解 ALC 在决定疏散或就地避难时如何权衡居民风险。