Nursing homes told to power up

State mandates addition of emergency generators

Florida health-care regulators and the nursing home industry have long known senior facilities can be a dangerous place to be after a hurricane.

As far back as 2006, the nursing home industry had a hurricane summit that revealed two key points: That nursing homes are not on the state’s top priority list during power outages, and that most don’t have generators large enough to run full central air conditioning.

Yet 11 years later, with the deaths of 11 seniors at The Rehabilitation Center at Hollywood Hills, Hurricane Irma has revealed that these two issues remain unresolved — and continue to put some of the state’s most vulnerable at risk.

Now Gov. Rick Scott has given an executive order demanding immediate change, and that has state legislators, emergency management

officials, health-care regulators and nursing home owners scrambling to meet what some are calling an impossible deadline.

On Friday, they reconvened for another hurricane summit in Tallahassee to discuss the new order, which calls for nursing homes and assisted living facilities to install emergency power systems capable of cooling their buildings for 96 hours. The Nursing Center Emergency Preparedness Summit was hosted by the Florida Health Care Association and LeadingAge Florida, an organization representing primarily nonprofit nursing homes and retirement communities.

Scott’s order requires facilities to have generators and enough fuel to maintain a maximum 80 degrees indoor temperature, as well as run lights and medical equipment. Current state laws for nursing homes require temperatures stay between 71 and 81 degrees — but facilities now just need to have “alternate power,” not specifically generators, to make that happen.

Scott said nursing homes and assisted living facilities have 60 days from Sept. 16 to comply with his generator rule or potentially face penalties.

The head of the state’s nursing home regulatory agency told summit attendees that now is the time for Florida to take action.

“This is the opportunity to learn lessons from this storm and make this the No. 1 place in the country to grow old and retire,” said Justin Senior, secretary of the Florida Agency for Health Care Administration.

Care facilities must be equipped to ride out a storm in place, Senior said. As Irma’s widespread winds descended on the state, “evacuation plans fell through. There generally was no place to run, no place to hide.”

The hurricane summit in February 2006, also hosted by the Florida Health Care Association and including participants from five additional Gulf states, was convened due to twin tragedies in 2005: when 35 residents drowned in a flooded Louisiana nursing home that lost power during Hurricane Katrina, and more than 20 Texas nursing home evacuees died after the bus carrying them away from Hurricane Rita caught fire and exploded.

“These things are very horrifying and very public,” said Jeff Johnson, AARP’s Florida director. “Sometimes, these are the things that generate the actions we should be taking.”

But not much changed back then in regard to generators and power restoration.

A 2006 bill, filed a year after Hurricane Wilma, called for backup generator and resembles Scott’s current executive order. One version included $57 million in state subsidies to help nursing homes make improvements. It didn’t pass.

At the time, some legislators said the nursing home industry pushed back against the bill. Other experts said the state didn’t want to spend the money.

LuMarie Polivka-West, the former public policy director for the Florida Health Care Association who led the 2006 summit, said she started badgering Florida Power & Light Co. in 2002 to put nursing homes on the state’s “critical” tier one power restoration list. The list now includes hospitals, fire and police stations, communication facilities, water treatment plants, transportation providers and shelters.

While the power company agreed to give facilities informal priority, they lobbied against the critical status, she said.

“They said there were too many nursing homes to do it,” Polivka-West said. There are about 680 nursing homes in Florida.

FPL declined on Thursday to comment.

So will Hurricane Irma be the spark?

Already, state lawmakers are rushing to jump on the hurricane reform train, though some caution that thoughtful legislation needs to be crafted.

“We need to do this, and a lot of bills are being filed,” said Rep. Jason Brodeur, RSanford. “But we still don’t know enough about what happened. Let’s see how it unfolds.”

Meanwhile, experts in emergency power are worried about Scott’s deadline. They repeatedly said they doubted it could be met. Generators that can cool an average 120-bed nursing home are massive and complicated, they said, usually requiring one to two years to design, permit, install and test. They estimated the upgrade would cost an average nursing home $350,000.

“I’m not saying we shouldn’t have generators. But we either need to streamline the [installation] process or change it,” said Mike Acree, an electric power generation consultant at Ring Power Corp., based in St. Augustine.

Polivka-West, now a research associate volunteer with the Claude Pepper Center at Florida State University, said Florida’s leaders have learned some lessons from difficult storms over the past two decades.

“Originally, nursing homes weren’t even part of national or local emergency hurricane planning,” she said.

Florida’s four punishing hurricanes in 2004 resulted in nursing homes getting an informal “second tier” status that can move them up on the restoration schedule, she said.

“Prior to that, nursing homes were the same as beauty shops,” she said.

Nursing home industry representatives, with special training, now are stationed through a storm at the Florida State Emergency Operations Center in Tallahassee, said Deborah Franklin, the Florida Health Care Association’s senior director of quality affairs. That allows them to quickly inform state officials when facilities contact them about needing food, medical and power emergencies, she said.

Franklin said additional requirements and reviews of the nursing homes’ emergency management plans have been added, including more training, and mutual aid contracts for transportation and housing in the event of an evacuation.

When it comes to generators and power restoration, however, the story remains the same.

While Florida has accomplished a lot, PolivkaWest said, emergency power issues need to be fixed. With rising seas from climate change plus a growing senior population, Florida had better get prepared, she said, and that means facilities need to storm-harden their buildings, including adding enough emergency power to keep residents safe, regardless of the expense.

“It needs to be part of the cost of doing business, just like having appropriate staffing,” said Polivka-West.