Nursing homes slow to comply with emergency power rules
If you’re feeling reassured about Mom’s nursing home because of Florida’s new emergency power requirements, don’t be.
June 1 was the deadline for nursing homes and assisted living facilities to comply with the law mandating they have “alternative power sources.”
But as of that date, only 346 nursing homes and assisted living facilities out of a total 1,444 in South Florida, or 24 percent, had implemented backup power plans, according to data released Friday by Florida’s Agency for Health Care Administration in Tallahassee, which is carrying out rules ratified by the state Legislature.
More than 30 percent in South Florida were given extensions to implement their plans, as far out as Jan. 1, 2019. And 45 percent didn't respond at all.
Statewide, 775 facilities out of 3,781, or 20 percent, had implemented plans by the deadline. Forty percent were given extensions, and 39 percent didn't respond.
Emergency power rules were ordered in September by Gov. Rick Scott, who was out-
raged following the deaths of 12 residents at the nowclosed Rehabilitation Center at Hollywood Hills after Hurricane Irma. He immediately issued a 60-day emergency rule for nursing homes and assisted living facilities to obtain generators and a sufficient supply of fuel to cool facilities in the event of a power outage.
But trade groups for nursing homes and assisted living facilities said they couldn’t meet the new requirements for cooling and fuel in such a short time. Legislators ratified new rules that were a watereddown directive, providing more flexibility in meeting requirements. Scott signed it into law in March.
State Sen. Gary Farmer, who represents Hollywood, said he is “very concerned the state and the industry have not learned their lesson ... Candidly, the reason elderly residents are not receiving better care is the lack of strong enforcement by state and local authorities, and the lack of mandatory financial responsibility when bad homes acted negligently to cause injury or death.”
Farmer proposed legislation in 2017 that called for unannounced inspections to determine emergency plan compliance, but it didn’t get out of committee.
Last week, the Agency for Health Care Administration released data that showed few facilities were ready as of May 25. In response, elderly advocates said facility owners were valuing profits over people, while facilities pointed to delays in securing and getting permits for permanent generators.
In a letter to the Sun Sentinel, John Simmons, president of the Florida Health Care Association, which represents nursing homes and other long-term care providers, said judging the situation on early data was “ignoring the reality that deadlines are often met late in a process.”
By the June 1 deadline, the number of facilities in South Florida that were “compliant” increased, but mostly because a larger number of extensions were granted, according to the data released Friday.
The agency said Friday that 55 percent in South Florida and 61 percent in the state were compliant as of June 1, but that only means they filed a form detailing how they plan to keep temperatures below 81 degrees in the event of power loss.
Ultimately, it’s the owner or operator of a facility who is responsible for protection of residents, said Mike Milliken, the state’s long-term care ombudsman.
He said if he were a nursing facility owner, he would want the best equipment available to make residents comfortable in a hurricane or disaster where power is lost. “These people are vulnerable,” he said.
But a group representing the state’s largest assisted living facilities, which tend to have fewer frail residents than nursing homes, said there are good reasons why these don’t yet have generators installed that meet the state’s new four-day cooling and fuel requirements.
“They’re working very hard to get their equipment up and running,” said Gail Matillo, president of the Florida Senior Living Association. She said that if facilities can’t get permanent generators — which are often custom-made — installed, “they’re buying portable generators to get through the season.”
Susan Anderson, vice president of public policy for the association, said most assisted living facilities had generators before the deadline but that the units didn’t have the ability to power the heating, ventilation and air-conditioning system. “It’s a huge load to power HVAC,” she said.
In South Florida, such facilities often feature amenities that may include restaurants, a beauty shop, fun activities and transportation around town. Some are toprated nursing facilities owned or managed by the largest companies in America. They’ve spent millions of dollars on upgrades to make their facilities attractive to the elderly.
Consumers pay more than $3,000 a month for assisted living facilities, according to a 2017 survey by Genworth, which provides financial products for longterm care. For nursing homes, people have to pay out of pocket until Medicaid may finally cover the costs, according to Medicare.gov.
Yet some of these top-tier facilities don’t have alternative power sources that meet the state’s new requirements. For Bill Johnson, emergency operations director in Palm Beach County, the fact that all Florida nursing homes and assisted living facilities don’t already have generators boggles the mind.
“[Most] Publix stores in South Florida have generators. Lowe’s and Home Depot stores have generators … You would think a nursing facility would have a generator,” Johnson said. “You can’t legislate good behavior.”
Brian Lee, an elderly advocate for Texas-based nonprofit Families for Better Care, isn’t surprised at the lack of readiness.
Lee said he views Florida’s requirement for emergency power equipment and plans as analogous to fire sprinklers. “How often do you have a fire in nursing home? But you’re required to have those sprinkler systems, and they’re very expensive,” he said.
Generators, backup air conditioning and evacuation plans are a “safety precaution for the residents to keep them alive and give peace of mind to their families,” Lee said.
Installing a generator or arranging other emergency power is now a cost of doing business for nursing homes and assisted living, he said, and that cuts into facilities’ profit margins. Yet not meeting the emergency power requirements also could pose a danger to the industry’s health, he said.
“Florida had better be careful. The economic engine of Florida really is elderly people coming to their state. There are other states that people could move to if Florida doesn’t care for loved ones,” Lee said.
Broward’s assistant county administrator, Alphonso Jefferson Jr., said even when a county has signed off on a facility’s emergency plan, there’s little assurance a generator at a nursing home or assisted living facility has been tested for hurricane season.
The Agency for Health Care Administration said it is just beginning its inspections of facilities’ emergency power sources.
Milliken said it may take a legislative change to seek help from counties to verify that equipment is operational. He said verifying equipment and plans at 682 nursing homes and more than 3,000 assisted living facilities statewide is a “big job” that the Agency for Health Care Administration may not be staffed to handle.
Miami-based Catholic Health Services, which operates five nursing homes and assisted living facilities in Broward and MiamiDade counties, met the June 1 deadline — not just with an emergency plan, but with $1 million generators powering air conditioning at each building, according to George Saenz, facility plant operations director.
Last fall, the nonprofit Catholic Health Services was already considering a new generator for one building. But after Hurricane Irma, it expanded the project, he said.
When asking about a generator or emergency plan in a nursing home or assisted living facility, don’t accept the answer that the facility is “in compliance” with Florida law, Lee said. He recommends looking deeper into the facility’s state records and asking management questions.
John Knox Village in Pompano Beach, for example, is in state compliance because it received an extension until Aug. 15, according to state records.
John Knox had generators and fuel on-site, but they didn’t meet the state’s requirements. “We’re upgrading the capacity and amount of fuel that we need to cover 96 hours, including full air conditioning,” spokesman Rob Seitz said.
A longer extension, until Jan. 1, 2019, was approved by the state for the 120-bed Life Care Center at Inverrary in Lauderhill, managed by Life Care Centers of America, a $3 billion company based in Cleveland, Tenn.
“There are several factors beyond our control that have delayed the installation of our permanent generator,” said Leigh Atherton, director of public relations for Life Care Centers.
In the meantime, the center has secured emergency “spot coolers” that comply with “keeping 4,601 square feet of the facility under 81 degrees for 96 hours,” Atherton said.