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Stay, or go?

That was the question facing the hundreds of Florida nursing homes and assisted living facilities in Hurricane Ian's path this week. Moving elderly residents can cause "transfer trauma," with the stress of relocation sometimes leading to deterioration. But staying put during a powerful hurricane comes with obvious risks to health and safety.

With Ian still wreaking havoc on the Southeast, and now blamed for 21 deaths in Florida, NPR reached out to two dozen Florida nursing homes in Charlotte, Collier and Lee Counties, where the storm struck first. Most could not be reached or declined to comment, but some shared updates.

"In 42 years, we've never evacuated," says an employee at Calusa Harbour in Fort Myers, Florida. The employee asked NPR not to use their name because they are not authorized to speak to the media.

But for Hurricane Ian, which hit Florida on the cusp of Category 5 winds, that changed. Calusa Harbour moved their assisted living residents to an affiliated facility an hour to the south.

More than 40 nursing homes made the same choice and evacuated around 3,400 residents before the storm set in, according to the Florida Health Care Association, a trade organization. Most are located in the southwestern part of the state, and transferred residents to affiliated facilities outside the storm's path. At least another 115 assisted living facilities also evacuated residents.

Others chose to ride it out.

"We stayed and we endured through it," says Tameka Miller, who works at the Port Charlotte Rehabilitation Center, in Charlotte County. Staff embedded with residents, and some family members also came to ride out the storm with loved ones.

"We had a little mishaps but everything is ok. We are running off a generator and we are running normally," says Miller.

Flooding in unexpected places led to rescues

As Ian dumped more than a foot of water on parts of the state, five more nursing homes with hundreds of residents reported being forced to leave as floodwaters rose, some well outside the evacuation zone, according to the FHCA.

In central Florida and the eastern coast, "the water rose so quickly because they took on so much rain that they had to leave," says spokesperson Kristen Knapp.

In one such area, Orange County Fire Rescue reported evacuating the Avante at Orlando and The Bridge and Life Care of Orlando facilities.

Videos show rescue workers ferrying residents in wheelchairs and gurneys to waiting buses.

The person who answered the phone at Avante at Orlando declined to comment, and gave a number to a corporate office mailbox that was full.

The Bridge At Orlando also did not pick up. A person who answered the phone at the Life Care Center at Orlando says 122 people were moved to an affiliated facility in Altamonte Springs.

"We are grateful for the compassion and professionalism displayed by our staff during and after the hurricane, as they've focused on ensuring our residents stay calm and comfortable," said Life Care Centers of America CEO Joe Jicha in a statement.

As of Friday, around 21 nursing homes are without power, according to Knapp, who says that could be an undercount because of power outages.

Florida law requires all assisted living and nursing homes to have backup power and four days worth of generator fuel on hand, after more than a dozen people died in a South Florida facility following Hurricane Irma due to lack of air-conditioning. Knapp says utility companies had been checking on and prioritizing these buildings for reconnection.

Christina Webb, front desk staff at Coral Trace Health Care in Cape Coral, says her facility also rode out the storm. Power has been out for about two days but generators are working fine.

"The only thing we had was some damage from trees falling, but people are out there picking them up now," says Webb.

Several counties in Florida remain almost entirely without power, and a spokesperson from Florida Power & Light told Reuters some areas will remain in the dark for a "prolonged period" because damage to the electricity system was too great.

"[We're] just taking it day-by-day right now," says Webb.