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An oxymoron of long-term care—Sheltering-in-place during an evacuation: A literature review of the best practices of evacuation and sheltering-in-place for long-term care facilities

Megan Baxter, MDEM


Background: Long-term care facilities (LTCFs) are defined as residential facilities that are home to elderly patrons who are no longer able to live independently. These facilities require comprehensive emergency planning to provide the best response to the threat of a disaster for their residents. However, LTCFs are often overlooked in disaster planning, leaving them to work independently to create suitable arrangements in the event of a disaster. This article examines the literature on evacuating and compares it to the literature on sheltering-in-place for LTCFs. Conclusions regarding best practices are also provided.

Methods: A literature review and Internet search were completed in July 2016. Information was entered onto a spreadsheet listing the key points of each article, which was reviewed for emerging themes.

Results: Out of the 399 acquired articles and grey literature found during the research portion of this article, 30 were deemed pertinent, 22 of which appear in this article. All included articles were peer reviewed. Themes emerging from these articles include the persistent absence of research into the best practices for LTCFs during emergencies and the difficulties of evacuating and sheltering-in-place with frail populations.

Conclusion: While there is no one right answer for all scenarios, sheltering-in-place appears to be the default safe option for those in LTCFs—with the assumption that the facility has taken steps toward preparation, such as purchasing generators and securing enough food, water, and medical supplies to sustain the residents, staff, and families of both for 7 days. Additionally, a LTCF needs to devise contingency plans for evacuation if necessary, to be fully prepared for a catastrophic event.


emergency preparedness, sheltering-in-place, shelter-in-place, evacuation, disaster, elderly, geriatric, long-term care center

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