This Congressional report has been professionally converted for accurate flowing-text e-book format reproduction.

Every time a hurricane strikes the United States, hundreds of thousands, even millions, of people face a difficult decision: heed the warnings of local officials and evacuate the area, or ride out the storm by "sheltering in place." This decision can be a matter of life or death, especially for people living in low-lying areas vulnerable to flooding and storm surges.

For nursing homes and assisted living facilities entrusted to take care of frail residents with complex medical needs, the decision to evacuate or shelter-in-place takes on even greater weight. Administrators of these facilities are not only considering their own safety, but that of residents unable to fend for themselves, and the staff who care for them. Many nursing homes and assisted living facilities chose to shelter-in-place when hurricanes Harvey and Irma struck Texas and Florida, respectively, late in the summer of 2017. While most of these facilities weathered the storms without incident, the exceptions were glaring and tragic.

At one Florida nursing home, the county medical examiner ruled the deaths of 12 residents as homicides. Each resident died due to complications from heat exposure after the facility's air conditioning was knocked out for several days. The nursing home's administrators failed to recognize the threat posed by prolonged exposure to extreme heat and did not move residents elsewhere. In Texas, several facilities were inundated by water and were among those that conducted chaotic mid-storm evacuations that potentially put residents in harm's way. Texas state regulators have cited two of the nursing homes examined in this report with more than 50 violations of state and federal standards, which could result in termination from the Medicaid program. Instead of sheltering in safety, residents found themselves sheltering in danger.

This compilation includes a reproduction of the 2019 Worldwide Threat Assessment of the U.S. Intelligence Community.