AJC Watchdog: Florida nursing home deaths could have happened here

12:00 a.m. Thursday, Sept. 28, 2017 Local
President Donald Trump receives a briefing from Gov. Rick Scott on Hurricane Irma relief efforts in Ft. Myers, Fla., Sept. 14, 2017. Eleven elderly people died from heat-related causes after their nursing home lost power. DOUG MILLS / THE NEW YORK TIMES

Eleven deaths in a Hollywood, Fla., nursing home are blamed on excessively high temperatures during the power outages caused by Hurricane Irma.

Following the tragedy, Gov. Rick Scott directed state officials to enact emergency regulations requiring the state’s nursing homes and assisted living facilities to have generators and 96-hours of fuel on hand to run the air conditioner during power outages. The changes come too late for a state that was warned about about the dangers a decade ago.

This scene could have easily been set in Georgia, with Gov. Nathan Deal scrambling to enact new safety requirements amid the shock and grief of dead parents and grandparents. Right now, Georgia’s regulations are no better than Florida’s were before the storm.

The Georgia Department of Community Health does not require emergency power generators to power HVAC units for nursing homes. Separate regulations for assisted living facilities mention generators as a method for maintaining temperatures in an emergency but do not specifically require them or say how long such facilities must be prepared to operate on alternate power.

Earlier this month the same storm knocked out electricity throughout the metro area, leaving some neighborhoods in the dark for days. Across the state, 1.5 million Georgia Power customers lost electricity. Following the storm, temperatures in metro Atlanta hovered near 90 degrees, just a degree or two cooler than in Miami.

As I mentioned, the idea that elderly people are particularly vulnerable during disasters isn’t new.

In 2007, following the deaths two years prior of 70 nursing home residents in Hurricane Katrina, the academic journal Behavioral Sciences and the Law published a survey of laws and regulations in the Gulf Coast states. The article notes that most of the states studied have no requirement that a generator be used to power heating and cooling despite the fact that “loss of air conditioning can result in heat stroke and death.”

Kathryn Hyer, director of the University of South Florida’s Policy Exchange Center on Aging, was one of the study’s authors and said it has taken years for recommendations contained in the article to work their way into public policy. Part of the struggle has been cost, she said.

Once the horror fades, Hyer said she expects the elder care industry in Florida to push back against Scott’s emergency measures. Generators big enough to run heating and air for large facilities are expensive and Hyer said she has seen estimates that the costs could run $3,000 per bed.

“Most facilities (in Florida) are about 100-120 beds. That’s a big number,” she said. The requirement that facilities also keep four days of fuel on hand likely will also be problematic, she said.

“That’s the hospital standard. That’s a lot of fuel,” she said.

Hyosub Shin/The Atlanta Journal-Constitution
About 1.5 million were without power in Georgia immediately after the remnants of Hurricane Irma passed through the state. State laws do not currently require backup power for nursing homes and assisted living facilities to power heating and air systems. HYOSUB SHIN / HSHIN@AJC.COM

But nearly a dozen preventable deaths, combined with potential criminal charges, almost-certain lawsuits and the still-unfolding political fallout from the south Florida tragedy have officials focused on safety rather than cost.

In Georgia, officials are waiting for new federal regulations to offer the protections they won’t pass themselves. Under the new regulations, Medicare-eligible facilities must provide “alternate sources of energy” to maintain safe temperatures for residents.

Those regulations go into effect in November and the Department of Community Health has proposed a state rule change requiring nursing homes to maintain the higher federal standard. A public comment hearing on the change to the state rules is scheduled for Oct. 17.

The new federal regulations are a step forward, but Georgia is free to do more, if it chooses.

The federal regulations do not go into detail about what kind of alternate power facilities should have — or how long they should be prepared to provide power in an outage. Three days? Four, like in Florida?

And the new federal regulations cover nursing homes, but not assisted living facilities, which will still be held to the existing vague standards.

A powerful player in this discussion is the Georgia Health Care Association, the industry group representing nursing home and assisted living facility owners in the state. According to the Institute on Money in State Politics, GHCA has contributed $1.8 million to Democratic and Republican candidates over the past two decades. The industry group is a powerful lobbying force at the Capitol every year and swings a big stick when it comes to how the industry is regulated.

Devon Bacon, spokeswoman for GHCA, said the organization is “supportive of any proposal designed to improve the security and care of nursing center residents, including a proposal to increase generator access.”

But she said any specific proposal needed careful attention “to ensure its implementation would not negatively impact the resources available to provide care on a daily basis.” You can read that as “depending on how much it costs,” but Bacon said cost isn’t the sole consideration.

Most nursing homes have alternate power arrangements — sometimes battery backup for emergency lighting, sometimes smaller generators for similar purposes. Bacon said the industry would need to evaluate what facilities already have and what it would take to upgrade them.

And what about assisted living facilities, which would not be affected by the new federal regulation? These types of retirement communities are different from nursing homes and “should be considered in a different context than skilled nursing centers,” Bacon said.

Earlier this month, Hyer testified before a Senate committee on the need for better disaster response and preparedness for older Americans and stressed that generators should be required for nursing homes and assisted living facilities.

In speaking to me, she said it is important that assisted living facilities be included in this discussion because it is a growing part of the equation “because people don’t want to be in nursing homes.” They also are important because these retirement communities are often located within neighborhoods, meaning it is hard for utilities to prioritize them for power restoration, she said.

“You can’t rely on emergency or priority restoration,” she said. “I think for assisted living, generators become very important.”

Jen Ryan, the governor’s spokeswoman, said the state is “actively working to strengthen disaster-preparedness plans as dictated by federal law.” In the meantime, Deal “will continue to monitor the process,” she said.

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