As Hurricane Irma made its destructive way up the Florida peninsula, some of the state's most fragile and vulnerable residents are staying put to ride out the winds, rain and flooding.
And experts say it's often the right thing to do.
At Miami Jewish Health Center, 700 people are sheltering in place, including nursing home residents, staff, and even some family members.gi
"I have two sons who live close, by but I'm safer here than I would be with them," said Mildred Lemke, 89, who is looking forward to playing blackjack and bingo as she hunkers down with fellow residents. "They have their own problems.
One of the most startling images from Harvey's destruction in Texas last month showed hapless nursing home residents wallowing in waist-deep floodwater. And memories endure of the 35 elderly nursing home residents who drowned at St. Rita's Nursing Home in St. Bernard Parish, just outside of New Orleans, during Hurricane Katrina in 2005.
The owners of the nursing home were acquitted of negligent homicide and cruelty charges.
Equally vivid, however, are memories of the flawed evacuation from Hurricane Rita just weeks later. More than 100 people died in the traffic jams, including 24 nursing home residents killed when their bus caught fire.
"Any time an older individual is exposed to a natural disaster like a hurricane, they end up having adverse events, whether that is mortality, death, or hospitalizations."
That's a worst-case scenario but research shows evacuating frail, elderly people can often do more harm than good.
Dr. David Dosa, a geriatrician and associate professor of medicine and health services research at Brown University, crunched the numbers and showed mortality rates nearly doubled after an evacuation and hospitalization rates quadrupled.
"Any time an older individual is exposed to a natural disaster like a hurricane, they end up having adverse events, whether that is mortality, death, or hospitalizations," Dosa said.
Dosa looked at the cases of more than 36,000 nursing home residents living in areas hit by four major hurricanes: Katrina and Rita in 2005, and Gustav and Ike in 2008.
"The research that we conducted in Louisiana and Texas after four of the hurricanes in 2005 and 2008 showed that there was an increased mortality among those that evacuated compared to those that sheltered in place," said Dosa, who published his findings in the Journal of the American Medical Directors Association.
"Our first studies involved interviewing nursing home administrators following hurricanes Katrina and hurricane Rita in 2005, and the interviews with those administrators told us that the act of evacuation in and of itself was dangerous," Dosa told NBC News.
Obviously, if a facility is in danger of flooding or wind damage, it's better to opt for physical safety. But if a building can withstand a storm's battering, it can be better to sit tight, Dosa said.
"All in all, we feel that it is safer if it is at all possible, to shelter in place," he said.
Mass evacuations are not done slowly or with care, and sick, frail or elderly people can be bruised and weakened by having to move quickly onto a bus, for instance. Large shelters often offer few comforts and no medical care.
"There's a wonderful study that showed that people who evacuate under optimal circumstances have increased hip fractures, for example, after moving from one hospital to a nursing home, and that's under optimal circumstances," Dosa said.
"It's quite clear to us that anybody with cognitive impairment or memory impairment such as Alzheimer's disease is at greater risk in a natural disaster such as a hurricane, they do worse in these circumstances."
Brian Kiedrowski, chief medical officer at Miami Jewish Health Center, agrees.
"The more you move people around, there's what we call transfer trauma," he said.
"As you start moving people around you're going to exacerbate medical and behavioral issues."
Dementia patients may suffer psychological trauma.
"New people, new faces all are tough on Alzheimer's patients, so if we can keep the semblance of the routine and order going, that is going to help," Kiedrowski said.
"We've got teams and dedicated people who are going take care of them," he added. "If we can maintain them in their environment, that would be the choice."
Negotiating airports or even a long car ride would have been difficult for Miami Jewish nursing home resident, Sarina Abramowitz, 76, who has multiple sclerosis.
"This is a very safe building," she said.
"We have a giant generator so if we lose power we'll get it right back. And we have all the food and all the water and everything."
Even better - her son, Miami resident Jay Abramowitz, and her grandchildren are riding out the storm alongside her.
"New people, new faces all are tough on Alzheimer's patients, so if we can keep the semblance of the routine and order going, that is going to help."
"I think it's great they had a lot of hotel rooms for the family and it's just like home," Abramowitz said.
Jay Abramowitz said the arrangement took a load off his mind.
"When we were given the evacuation orders, first thing on our minds is how do we get Mom out of south Florida," said Jay, an insurance executive.
They were tickled at the offer to stay on site with her.
"We're here with my kids, my wife, my mom, our dogs, our parrot -- they've welcomed us all and we brought all the comforts of home with us," he said.
"They've given us everything else and just being together is the biggest comfort."