Abstract
BackgroundLarge-scale natural disasters disproportionally affect both the medically complex and the older old, groups that are responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) programs impacted during the 2017 Fall Hurricane Season.MethodsConvergent mixed methods design, incorporating independently conducted qualitative and quantitative analyses. Phase One: 34 clinical staff were interviewed from the nine VA HBPC programs impacted by Hurricanes Harvey, Irma, and Maria to examine the experiences of their HBPC programs in response to the Hurricanes. Phase Two: Secondary quantitative data analysis used the VA’s Corporate Data Warehouse (CDW) to examine the electronic health records of patients for these same nine sites.ResultsThe emergency management activities of the HBPC programs emerged as two distinct phases: preparedness, and response and recovery. The early implementation of preparedness procedures, and coordinated post-Hurricane patient tracking, limited disruption in care and prevented significant hospitalizations among this population.ConclusionsIndividuals aged 75 or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals are able to receive care at home. HBPC programs, and similar programs under Medicare, connect the homebound, medically complex, older old to the greater healthcare community. Engaging with these programs both pre- and post-disasters is central to bolstering community resilience for these at-risk populations.
Highlights
Large-scale natural disasters disproportionally affect both the medically complex and the older old, groups that are responsible for most medical surge after a disaster
The size of the Home Based Primary Care (HBPC) programs ranged from a single, small Community Based Outpatient Clinic (CBOC), with a census of 45 to a large VAMCcentered program, with a census of more than 500, with an overall patient census of 3118 for all nine programs
The emergency management activities of the HBPC programs emerged as two distinct phases: preparedness, and response and recovery
Summary
Large-scale natural disasters disproportionally affect both the medically complex and the older old, groups that are responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) programs impacted during the 2017 Fall Hurricane Season. More than 2.5 million Medicare beneficiaries rely on electricity-dependent medical equipment, such as ventilators, to live independently in their homes [5]. There is an increasing frequency of large-scale natural disasters [6]. These disasters disproportionally affect both the medically complex [7] and the older old [8, 9]. It is incumbent on communities to mitigate the impact of disasters on community-dwelling, medically vulnerable older adults
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