After seniors died last summer in a powerless, sweltering Hollywood Hills nursing home in the wake of Hurricane Irma, Gov. Rick Scott issued an emergency mandate that all such facilities — including assisted living facilities — be equipped with generators or have some plan in case the electricity is punched out in a weather event.
One state lawmaker said at the time that the lack of regulation of the elder care industry had, in essence, created “death warehouses” in places like The Rehabilitation Center at Hollywood Hills, where 12 residents ended up dying after suffocating in the heat for days.
But under a new rule championed by Scott and made permanent by lawmakers last session, it appears that many nursing homes and ALFs in Palm Beach County and throughout the state are struggling to comply, initial data shows.
All of Florida’s 685 nursing homes and 3,102 assisted living facilities were ordered to be in compliance by the June 1 start of hurricane season. But as of May 25, seven nursing homes and 82 ALFs in Palm Beach County had yet to report their emergency power plan to the Agency for Health Care Administration.
Statewide, the preliminary numbers were especially dismal for ALFs. A whopping 1,991 of ALFs throughout Florida — or 64 percent — did not report, according to AHCA’s preliminary data. That left a lot of facilities waiting for Friday, the day hurricane season started.
Nursing homes failing to report their power plans to AHCA were fewer in number: 135 statewide — just under 20 percent.
The agency was still getting documentation from facilities Friday, and the final tally will not be available until June 8. Facilities that fail to meet the deadline will be issued a notice of violation, which can lead to fines, suspensions, even revocation of their license.
The question remains whether this apparent lack of compliance represents an inability of small ALFs to pay for generators or a bureaucratic hiccup.
Debbie Lytle, owner of Amazing Grace Assisted Living Home in West Palm Beach, said she didn’t report to the state after Palm Beach County wouldn’t approve her plan despite the installation of natural gas generators at $15,000 apiece in each of her three, six-bed ALFs. She was told some of her documentation got lost.
“It’s extremely costly and we can’t absorb it, so those costs are being passed on to the senior citizens,” Lytle said. “And the state is doing nothing to help subsidize.”
Under the rule, all nursing homes and ALFs in the state must have reported by Friday that they have access to an emergency power source or made plans to move residents.
The great generator rush came in the wake of the tragedy at The Rehabilitation Center after Hurricane Irma knocked out power to a good portion of South Florida.
Florida state Sen. Gary Farmer, D-Fort Lauderdale, then said, in a statement that made national headlines: “Unfortunately, the regulatory systems here in Florida and elsewhere are such that we’re really just licensing death warehouses ― not nursing and care facilities.”
The Rehabilitation Center, meanwhile, is fighting to stay open, with its lawyer saying the patient deaths were “acts of God” due to Irma, despite the inconvenient fact that the nursing home sat across the street from a hospital ER.
Farmer’s concern seemed to be underscored in West Palm Beach when it was learned that residents of Savannah Court were found boiling on the home’s steamy second floor on Sept. 12 — one day before Hollywood Hills. A tipster had called 911 reporting “unbearable conditions.”
When police came back the next morning and asked why the residents hadn’t been taken to the cooler first floor, Executive Director Michael DeSalvo said: “You don’t know these people. They are all a bunch of whiny crybabies and have been before the storm.”
Lytle said The Rehabilitation Center was not reflective of the elder care industry’s response to Irma.
“You had one incident. It’s is unfortunate, but it shouldn’t penalize the rest of the facilities who did a phenomenal job to do whatever it took to keep all the residents safe,” said Lytle, who worked in nursing for 33 years. “At the end of the day, I care about the residents during the hurricane, and we had more employees on site than patients.”
Assisted living facilities and nursing homes are like chihuahuas and Great Danes — same animal but not exactly.
Nursing homes provide around-the-clock care and monitoring and are often large facilities. ALFs offer what is called custodial care, helping elderly residents get in out of bed, for instance. An ALF may be nestled in a neighborhood with five or six seniors.
But be it nursing home or ALF, the new generator requirement has been quite the muzzle.
The rule requires elder care facilities to have a power source that can keep a nursing home or assisted living facility at 81 degrees Fahrenheit or lower for at least four days. Nursing homes must keep 96 hours of fuel on site during emergency weather, while the fuel requirement varies between 48 and 72 hours for ALFs, according to size.
The state can grant an extension until Jan. 1, 2019, for facilities that would face delays in installing equipment or need zoning or other regulatory approval. Such extensions are approved only if the elder care center has ensured patient protections are in place to ensure safe temperatures during an emergency, which can mean trucking in a generator or moving residents to alternative housing.
In Palm Beach County, AHCA has received 22 requests for the extension from nursing homes, already approving 17 of them. The agency also received 39 requests for an extension from county ALFs and approved 16 of them.
Palm Beach County’s division of emergency management also assessed compliance, requiring a three-page form detailing its emergency power plan.
The Florida Health Care Association, which represents 82 percent of nursing homes in the state, said for large facilities the cost — up to $350,000 — and permitting process for these generators takes time.
“These are extremely large generators. It’s not a generator you can purchase at Home Depot,” said FHC spokeswoman Kristen Knapp.
Not an easy fix
Merely installing generators is not a panacea for the heat problem during power outrages following hurricanes, she added. Facilities must have staff on premises who know how to use those generators and have prepared by running disaster drills.
The Florida Senior Living Association, which represent ALFs, took Scott’s initial emergency order following the Hollywood Hills tragedy to court and then worked with lawmakers on the new rule during the last session.
“Our members are reporting that this is having a tremendous economic impact,” said Sandi Poreda, the organization’s spokeswoman. “It is definitely something that has dramatically affected the entire industry.”
Poreda said part of the delay in compliance may be that generator installation companies simply have not been able to get to all the facilities. She also says some cities, such as Pompano Beach, passed even stricter requirements, leaving nursing homes and ALFs confused.
AHCA is hoping that despite the lack of initial response the facilities who didn’t comply with the new requirements are still making arrangements in case a hurricane rumbles their way. The agency said it still needs to process hundreds of last-minute responses to meet Friday’s deadline not included in the preliminary report released on the eve of hurricane season.
“It is AHCA’s expectation that all ALFs and nursing homes are actively planning for hurricane season and complying with the new rules put in place to protect the vulnerable population they serve,” the agency said in a statement.
But there is one other issue. Somebody has to inspect all these new generators to make sure they are installed properly and not ticking time bombs.
“The issue becomes, ‘How do we know if these facilities are in compliance? How do we police that?” said state Rep. Emily Slosberg, D-Delray Beach. “I’m not sure how AHCA is enforcing the penalty.”
Slosberg will be co-hosting a roundtable on June 11 at South County Civic Center in Delray Beach on hurricane preparedness in Palm Beach County. She said there are other issues besides generators that need to be addressed, such as how nursing homes and ALFs inform families of the status of their loved one following an emergency.
“After Irma, I got a lot of calls from family members who couldn’t get hold of a loved one,” she said. “They just want to know if their loved ones are safe after the storm. It’s scary.”