Care fa­cil­ity’s emer­gency plan over­looked air con­di­tion­ing

The Buffalo News - - CONTINUED FROM THE COVER - By Carol Marbin Miller and El­iz­a­beth Koh

MI­AMI – When the Re­ha­bil­i­ta­tion Cen­ter at Hol­ly­wood Hills sub­mit­ted its emer­gency man­age­ment plan to county ad­min­is­tra­tors in July, it in­cluded de­tails on how the nurs­ing home would main­tain clean linen, dis­trib­ute canned food and en­sure that res­i­dents had ac­cess to hand san­i­tiz­ers.

It made no men­tion of how res­i­dents would be kept cool if the home lost power.

That was a tragic over­sight. On Wed­nes­day, health reg­u­la­tors said, eight res­i­dents of the re­ha­bil­i­ta­tion cen­ter suc­cumbed to car­diac and re­s­pi­ra­tory fail­ure af­ter a portable air cool­ing sys­tem mal­func­tioned.

The home’s fail­ure to fore­see the cat­a­strophic con­se­quences of an air con­di­tion­ing melt­down – and Broward County’s fail­ure to in­sist that the home do so – point to a se­ri­ous statewide prob­lem. Florida’s emer­gency plan­ning sys­tem for long-term care fa­cil­i­ties is the govern­ment equiv­a­lent of a take-home exam: Providers ad­min­is­ter the ex­er­cise them­selves, drill them­selves and are ex­pected to hon­estly re­port on their short­com­ings and cor­rect them.

In its emer­gency hur­ri­cane drill con­ducted in Oc­to­ber 2016, the home de­scribed its com­mu­ni­ca­tion and safety and se­cu­rity as good, though it noted that im­prove­ment was needed “to man­age re­sources and as­sets more or­ga­nized.” It said the same thing in a June 2017 hur­ri­cane drill.

Most long-term care fa­cil­i­ties “don’t have an emer­gency man­age­ment plan that is worth the pa­per it’s writ­ten on,” said the state’s first el­der af­fairs sec­re­tary, Bent­ley Lip­scomb. “Be­cause no­body re­quires them to. They are only re­quired to keep pa­tients barely alive.”

Nurs­ing homes are re­quired only to have backup gen­er­a­tors to power life-sav­ing equip­ment such as nurs­ing call but­tons and fire alarms. Many homes keep their gen­er­a­tors in stor­age and ne­glect to main­tain them, said Lip­scomb, who over­saw the Depart­ment of El­der Af­fairs from 1992 un­til 1998.

“They’ve got the gen­er­a­tor in the back some­where in a shed, or in the base­ment. No­body ever checks to see if it runs, or to see whether it can make elec­tric­ity for all the won­der­ful life-sav­ing ap­pli­ances,” said Lip­scomb, who headed Florida A ARP from 1999 through 2008, af­ter he left state govern­ment.

In Novem­ber 2016, the fed­eral Cen­ters for Medi­care and Med­i­caid Ser­vices im­posed an ad­min­is­tra­tive rule re­quir­ing all nurs­ing homes to have “al­ter­nate sources of en­ergy to main­tain tem­per­a­tures to pro­tect res­i­dent health and safety.” Nurs­ing homes, how­ever, are not re­quired to im­ple­ment the emer­gency pre­pared­ness rule un­til Novem­ber 2017 – mean­ing the Hol­ly­wood Hills home, and oth­ers, need not have been in com­pli­ance this hur­ri­cane sea­son.

No­tably, fed­eral reg­u­la­tors have said in guid­ance to nurs­ing homes that the rule does not re­quire them to in­stall gen­er­a­tors. “CMS does not spec­ify what type of al­ter­nate type of en­ergy source or emer­gency and standby power sys­tem a fa­cil­ity chooses,” the agency wrote.

Kris­ten Knapp, a spokes­woman for the Florida Health Care As­so­ci­a­tion, the nurs­ing home in­dus­try’s trade group, said those al­ter­na­tive en­ergy sources could in­clude equip­ment like spot cool­ers and fans.

Un­der state law and ad­min­is­tra­tive rules, nurs­ing homes are re­quired to sub­mit a “com­pre­hen­sive emer­gency man­age­ment plan” to their county govern­ment each year.

In Broward County, once the plan is filed with the emer­gency man­age­ment di­vi­sion, ad­min­is­tra­tors con­duct a “pa­per re­view” to en­sure that all por­tions of the plan meet re­quire­ments, said Miguel As­car­runz, the county’s di­rec­tor of emer­gency man­age­ment.

But the emer­gency man­age­ment di­vi­sion does not send in­spec­tors to ver­ify what fa­cil­i­ties re­port. Haz­ard drills, for ex­am­ple, are con­ducted on their own. The county re­views the self-as­sess­ments of their per­for­mance. Lo­cal fire agen­cies con­duct their own re­views of the emer­gency plan’s fire safety pro­ce­dures, As­car­runz said.

State health care reg­u­la­tors merely ver­ify that a plan has been sub­mit­ted.

The Hol­ly­wood Hills nurs­ing home, in what ap­peared to be self-con­ducted eval­u­a­tions of its haz­ard drills, gave it­self con­sis­tent rat­ings of “good” and “ex­cel­lent” in 2016 and 2017. The grades were among the few good marks the fa­cil­ity has re­ceived: Fed­eral health reg­u­la­tors gave the re­hab cen­ter a health in­spec­tion rat­ing of “much be­low av­er­age,” and an over­all rat­ing – in­clud­ing such things as staffing and fire safety – as “be­low av­er­age” this year.

Mean­while, Gov. Rick Scott an­nounced new rules Satur­day re­quir­ing nurs­ing homes and as­sisted-liv­ing fa­cil­i­ties in the state to have gen­er­a­tors ca­pa­ble of main­tain­ing com­fort­able tem­per­a­tures for at least 96 hours in the event of a power loss.

Un­der the new rules, all of the state’s as­sisted-liv­ing fa­cil­i­ties and nurs­ing homes will have 60 days to ob­tain what the gover­nor’s state­ment called “am­ple re­sources” that will “sus­tain op­er­a­tions and main­tain com­fort­able tem­per­a­tures” for at least four days af­ter a power fail­ure. Those re­sources, the state­ment said, in­clude a gen­er­a­tor and fuel.

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