Nursing homes raise thorny questions about disaster preparedness, not least because the usual prescription — asking people to remove themselves from the path of the storm — doesn’t really work in this context. As a result, deadly outcomes like those suffered at Dean’s operations are fairly common during major storms, though they tend to get limited coverage beyond regional news reports.

When nursing home residents shelter in place, all sorts of problems can arise. Their facilities can flood — as the St. Rita’s nursing home near New Orleans did during Hurricane Katrina, leaving 35 residents to drown in their wheelchairs and beds. Infrastructure can also break down. On balance, this poses an even larger threat than the direct effects of storms, according to research by David Dosa, a geriatrician and Brown University professor who has studied the effects of weather events on populations in long-term care. Power loss and the subsequent failure of air conditioners in particular can cause residents to die of heat exposure. This is exactly what happened to a dozen residents of a Florida nursing home during Hurricane Irma in 2017.

However, this doesn’t mean that evacuation is always a safer option. For those who are elderly and have chronic conditions, moving from a stable environment to a more makeshift one is risky. Vulnerable residents can die from heart failure, falling, or from illnesses like COPD being made worse by air pollution or shifts in temperature. Some health effects may not become apparent until days or weeks after the storm — and in those cases, they usually aren’t counted in statistics detailing storm-related deaths.

Careful preparation can mitigate the amount of harm — and climate change is making those preparations even more urgent. Empirical evidence suggests that the warming atmosphere is driving up the frequency of Category 4 and 5 hurricanes, though smaller hurricanes are happening less often. Multiple studies have also suggested that climate change is causing storms to undergo rapid intensification that can increase their unpredictability and severity, and that it’s adding to the amount of rainfall that accompanies them.

Read the full article about nursing homes at risk of disasters by Nick Tabor at Grist.