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Florida’s Uncool Nursing Homes

Rick Scott
Fla. Gov. Rick Scott touring post-Hurricane Irma damage in Clay County.
Photo by Tim Donovan, courtesy Florida Fish and Wildlife.

In most places unlucky enough to be in the path of a major hurricane, the end of the storm is, sadly, not usually the end of its death toll.

While the immediate hazards of storm surge and high winds have moved on, fatalities often occur as a result of falling tree limbs and other debris, as well as contact with downed power lines and still-moving flood waters. And in hot climates, like that of my home state of Florida, power outages can leave vulnerable populations at the mercy of the weather.

As I recently recalled in this space, my Aunt Claire lived in Sunrise, Florida, when Hurricane Andrew hit in 1992. While her condo was in no danger from storm surge or freshwater flooding, I went to help her evacuate out of concern that a sustained power outage could leave her at risk from the heat. As the Centers for Disease Control and Prevention explains, older adults have a harder time adjusting to sudden changes of temperature, and are more likely to have a chronic health condition or take medication that affects their body’s ability to self-regulate at temperature extremes.

Andrew arrived in August; Hurricane Irma arrived in September. In South Florida, both months bring average high temperatures in the low to mid-90s, with the possibility of higher spikes. It’s a recipe for potential tragedy.

Eight residents of a Hollywood, Florida nursing home died shortly after Irma knocked out the transformer powering the facility’s air conditioning. The facility’s administrator issued a statement explaining that the nursing home had not lost power completely, and that its staff had attempted to use mobile cooling units and fans to care for the patients while they waited for Florida Power & Light to restore the transformer powering their A/C unit. (The facility reportedly had a backup generator for emergency life support functions, but not for cooling.) The staff’s effort was not enough.

After this incident, Gov. Rick Scott issued new emergency requirements mandating that nursing homes and assisted living facilities must have backup power and supplies sufficient for at least 96 hours after a loss of electricity. Facilities must be able to keep temperatures at or under 81 degrees Fahrenheit during this period. The new measures were to take effect Nov. 15 after a 60-day implementation period; after that date, operators faced a $1,000-per-day fine for noncompliance and the potential to lose their licenses.

“During emergencies, health care facilities must be fully prepared to ensure the health, safety and well-being of those in their care and there is absolutely no excuse not to protect life,” Scott said in a statement.

However, an administrative law judge blocked those rules last week, saying the 60-day period Scott allowed for compliance is impossible for most facilities to meet. The state has said it will appeal.

As the Wall Street Journal recently reported, Florida’s elder care industry is pushing back against Scott’s proposed requirements. Three industry groups initially filed petitions for review in a state appeals court, but a three-judge panel denied them. The groups submitted separate challenges to the Florida Division of Administrative Hearings, where they found success last week. Their argument is, generally, that the new rules aren’t badly intentioned but are unrealistic. Proponents of the measures counter that earlier legislative attempts to put similar requirements in place died under industry pressure.

Nursing homes depend heavily on public funding, from Medicaid to the direct assignment of many residents’ Social Security payments. At a bare minimum, the public has a right to expect that any place that concentrates older, more vulnerable adults and shelters them in place after a storm – a place that purports to offer life-support services – is prepared to prevent life-threatening conditions from creating multiple casualties.

That’s what happened in Hollywood, and Florida leaders are perfectly right to demand that such a thing never happen again. Yes, 60 days to implement may be unrealistic in some situations; as Bob Asztalos, chief lobbyist for the Florida Health Care Association, told Florida senators in a hearing, “You can’t just back up a generator to a nursing home and plug it in.”

But it isn’t unrealistic to get nursing homes to make best efforts, develop their plans, and submit such plans as part of their requests for waivers or abatement of penalties. Less time crying and more time planning would be a fair trade-off. More than 285 of the state’s nearly 4,000 elder care facilities have applied for 180-day waivers, though as of this writing, the state has yet to issue any.

The Florida rules are stricter than similar federal rules still set to take effect on Nov. 15, requiring nursing homes (though not assisted living facilities) to maintain alternative energy sources to keep patients cool in the event of power loss. These rules, too, arose from deaths in nursing homes, especially following Hurricane Katrina and Superstorm Sandy. It makes sense, however, for Florida’s rules to have a wider reach than their national counterparts. The problem is more pressing here than in, say, Maine.

As for asking for state subsidies for facilities’ private capital investment: How much equity in their businesses are they offering in exchange? Zero? Florida is full of banks, and the banks have ample funds to lend for sound businesses with solid and legally compliant business plans. If there are some homes that can’t measure up to that standard, maybe those are the ones that ought to be shut down or consolidated with stronger businesses that can.

Keeping residents safe from the heat, even in emergencies, doesn’t seem like too much to ask for a business that gets such a large share of its revenues from government sources in exchange for caring for a population that is at mortal risk from perfectly predictable events. Florida’s governor is right to demand that it be done ASAP.

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