Caregiver Neighborhood Vulnerability and Visitation Responses to an Environmental Shock in Nursing Homes.

Abstract

Objectives: To study the association between climate vulnerability in caregiver neighborhoods on nursing home (NH) visitation changes during and following Hurricane Ian (2022).

Design: Cross-sectional study.

Setting and participants: Caregiver neighborhoods defined through data-driven estimation of catchment areas among 480 Florida-based NHs certified by the Centers for Medicare and Medicaid Services.

Methods: The analysis outcome was the percent NH visitation change during Hurricane Ian compared with weekly average visitation over 8 weeks before. Caregiver neighborhoods were defined from recurrent visitations occurring every 2 weeks over 2 months prior. The Climate Vulnerability Index was used to evaluate the environmental, social, economic, and infrastructural factors shaping community adaptation to climate change. Associations between neighborhoods' domain vulnerabilities and percentages of visitation change in response to Hurricane Ian were analyzed separately using quantile regression models adjusted by NH quality rating and hurricane exposure.

Results: Visitations declined an average of 16.3% (SD = 36.3%) during and immediately following Hurricane Ian. Vulnerabilities in infrastructure, health, and environment exhibited a significant positive trend across visitation change quantiles, indicating that greater vulnerability was associated with larger reductions in visitations. For example, the 10th quantile (68.7% visitation loss, β = -2.296; 95% CI, -3.51 to -1.08]) and the 25th quantile (31.4% visitation loss, coef. = -0.771; 95% CI, -1.52 to -0.19]) were associated with infrastructure vulnerability. Health and environmental vulnerability showed similar significant effects at the lower quantiles of visitation change. Adjustments for covariates had minimal effects on these relationships.

Conclusions and implications: Hurricane Ian resulted in a significant loss in caregiver visitations to the NH. This loss is partly explained by climate vulnerability of neighborhoods in which caregivers reside. These findings are relevant to NH administrators, policymakers, and government officials involved in planning and mitigation strategies. Enhancing neighborhood infrastructure to support caregivers may promote continued care during extreme weather events.