Hurricanes Katrina and Rita and the Department of Veterans Affairs: a conceptual model for understanding the evacuation of nursing homes. 
Hurricanes Katrina and Rita exposed significant flaws in US preparedness for catastrophic events and the nation's capacity to respond to them.  These flaws were especially evident in the affected disaster areas' nursing homes, which house a particularly vulnerable population of frail older adults.  Although evacuation of a healthcare facility is a key preparedness activity, there is limited research on factors that lead to effective evacuation.  Our review of the literature on evacuation is focused on developing a conceptual framework to study future evacuations rather than as a comprehensive assessment of prior work.  This paper summarizes what is known thus far about disaster response activities of nursing homes following natural and human-caused disasters, describes a conceptual model to guide future inquiry regarding this topic, and suggests future areas of research to further understand the decision-making process of nursing home facilitators regarding evacuating nursing home residents.  To demonstrate the utility of the conceptual model and to provide guidance about effective practices and procedures, this paper focuses on the responses of Veterans Health Administration (VHA) nursing homes to the 2 hurricanes.  Quarantelli's conceptual framework, as modified by Perry and Mushkatel, is useful in guiding the development of central hypotheses related to the decision-making that occurred in VA nursing homes and other healthcare facilities following Hurricanes Katrina and Rita.  However, we define evacuation somewhat differently to account for the fact that evacuation may, in some instances, be permanent.  Thus, we propose modifying this framework to improve its applicability beyond preventive evacuation.  We need to better understand how disaster plans can be adapted to meet the needs of frail elders and other residents in nursing homes.  Moreover, we must address identified gaps in the scientific literature with respect to health outcomes by tracking outcomes over time.  Information on health outcomes would allow administrators and others to more appropriately weigh the balance of risks and benefits associated with evacuation.  Without this understanding of the relationship between evacuation and health outcomes, it is not possible to develop effective response plans that are tailored to meet the needs of nursing home residents.