Strategic Approach to Facilitating Evacuation by Health Assessment of Vulnerable Elderly in Nursing Home and Assisted Living Facilities (SAFE HAVEN II Study PROJECT SUMMARY/ABSTRACT Over 12,000 nursing home residents and over 12,000 assisted living residents were evacuated from Texas and Florida facilities during Hurricanes Harvey and Irma. Older adults are especially vulnerable to harm during disasters because of their medical comorbidities, such as dementia, and functional impairments. A fundamental question in disasters is whether to evacuate residents or shelter in place. Our prior examinations of nursing home (NH) resident outcomes after the Gulf hurricanes from 2005-08 showed that significant morbidity and mortality occurred in the months following the storms, and that those who were evacuated suffered greater morbidity and mortality compared to those who sheltered in place. However, the response to Hurricanes Harvey and Irma in August and September of 2017 suggest a continuation of the trend toward long-term care evacuations that we first observed in the response to the Gulf storms a decade ago. It demonstrates a need for additional evidence to inform policies created to protect vulnerable NH residents in disasters. A particular need exists to examine the effect of disasters on assisted living (AL) communities, for which little evidence exists concerning the effect of disasters on resident health and safety. The overall goal of this research proposal is to understand more about evacuation vs. sheltering in place during hurricane emergencies. It includes an examination of the impact of doing one or the other on NH and AL resident mortality and morbidity. Our proposal examines the effect of the hurricanes on NH residents (Aim1). It utilizes a novel methodology to identify AL residents developed by our team through a recent NIA R21 and to examine their outcomes (Aim 2). It examines the experiences of AL administrators to better understand the impact of evacuation and sheltering in place in those communities (Aim 3). It will be among the first studies to understand the impact of disasters on the growing AL population. This proposal represents a rapid response to the recent disasters to ensure that appropriate and timely data are collected while events are fresh, and to guide disaster planners and responders in efforts to protect increasingly vulnerable NH and AL residents from harm in future disasters.