This is an exploratory study of nursing home preparedness in South Carolina intended to: (1) examine nursing home administrators' perceptions of disaster preparedness in their facility in the absence of an immediate emergency or disaster, and changes in their views about preparedness following a large disaster; (2) study whether administrators' knowledge of shortcomings in preparedness leads them to change their views about planning; and (3) suggest ways to enhance preparedness.

A descriptive survey based on interviews with public officials responsible for nursing home safety was developed and mailed to all 192 licensed nursing homes in South Carolina in July 2005, and an extensive literature review was performed. As responses to the baseline survey were received, Hurricane Katrina devastated the Gulf Coast.Two weeks after Katrina, a brief, post-Katrina survey was mailed, asking administrators if Katrina had influenced their preparedness plans. Quantitative responses were analyzed using descriptive statistics. Three researchers coded the qualitative data and conducted a thematic analysis.

One hundred twelve baseline surveys and 50 post-Katrina surveys were completed (response rates 58.3% and 26%, respectively). A large number of respondents reported a high level of satisfaction with the overall ability of their facilities to protect residents during an emergency or disaster. However, many were less satisfied with their preparedness in specific, important areas, including: (1) providing shelter to evacuees from other nursing homes; (2) transportation; and (3) staffing. In the post-Katrina survey, 54% of respondents were re-evaluating their disaster plans; only 36% felt well-prepared. Those re-evaluating their plans specifically mentioned evacuation, transportation, supplies, staffing, and communication.

Transportation, communication, supplies, staffing, and the ability to provide shelter to evacuees are important domains to consider when evaluating nursing home preparedness. Administrators believe their nursing homes need to improve in all of these areas. Recommendations include developing improved transportation arrangements, redundant communication systems, and stronger linkages with local emergency preparedness systems.

To identify the vulnerabilities of elderly to disasters, and to develop strategies to address these vulnerabilities.

A relevant literature search of journal articles, government training materials, news reports, and materials from senior organizations was conducted.

The vulnerability of the elderly to disasters is related to their impaired physical mobility, diminished sensory awareness, chronic health conditions, and social and economic limitations that prevent adequate preparation for disasters, and hinder their adaptability during disasters. Frail elderly, those with serious physical, cognitive, economic, and psycho-social problems, are at especially high risk.

This segment of the population is growing rapidly. Therefore, it is important that emergency management recognize the frail elderly as a special needs population, and develop targeted strategies that meet their needs. Several management strategies are presented and recommendations for further action are proposed.