Why Don’t Nursing Homes Have Generators?

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Eight residents died in one Florida nursing home following Hurricane Irma. The cause of the deaths was excessive heat in the nursing home, that did not have a working generator to provide air conditioning. This tragedy has shone a light on nursing home emergency preparedness requirements. Many were astonished to learn that, in a tightly regulated industry, nursing homes are not required to have emergency generators with sufficient power to air condition the building. Especially in a hurricane prone region. Especially in a state where the average daily temperatures during hurricane season reach ninety degrees.


Federal Rules

Nursing homes are subject to both federal and state regulations. The federal government modified its emergency preparedness regulations last year, but they do not go into full effect until November 2017. Since different regions of the country are subject to varying degrees of threats from floods, tornadoes, blizzards, and hurricanes, the federal rules do not spell out every feature that a facility must have to be emergency ready.  The regulations try to strike a balance between protection and unnecessary cost by requiring each facility to identify its risks and to develop a plan to address its specific situation.  With regard to heating and cooling of a nursing home, the revised Emergency Preparation regulations require nursing homes to provide “alternate sources of energy to maintain temperatures to protect patient health and safety and for the safe and sanitary storage of [provisions].” The regulations stop short of mandating generators.

CMS further discusses its expectations in a FAQ (frequently asked questions) bulletin.  The discussion reiterates that the new regulations do not state how a nursing home is to meet the requirements, only that it must have an emergency plan that maps out how it will provide an alternate source of power.


Florida Rules

States are able to supplement the emergency preparedness requirements established by the federal government. Until this weekend, the state of Florida had no regulations mandating the use of generators to provide alternate power to nursing homes. On September 16, Governor Scott issued an emergency order, requiring all nursing homes and assisted living residences to install back up generators within 60 days. Those not in compliance will be subject to a $1,000 per day fine and possible loss of licensure. This emergency order cannot be extended indefinitely; the state legislature must enact a law to keep the emergency mandate in place.

Nursing home proponents are pointing out the difficulties in compliance. First, installing a generator requires developing an extensive plan and rewiring the facility to tie the identified equipment to the generator. The process also requires permitting and local inspection. It is unlikely that facilities can complete this process within 60 days.  Further, generators large enough to power air conditioning for an entire building are expensive. Governor Scott’s emergency order does not include any funding;  some facilities may not be able to afford an unanticipated capital investment of this magnitude.


Past Failed Efforts

Florida has been here before. In 2006, after Hurricane Wilma, the Florida Legislature considered enacting a law that would require nursing homes to install generators to cool their facilities.  The House passed the bill, but it died in the Senate over concerns about the cost of such a requirement. In light of the deaths last week, it may be politically impossible to vote against providing this protection.


And In Case You Were Wondering

Massachusetts does require its nursing homes to have back up generator power. See 105 CMR 150.017B(16).

Assisted living residences are not covered by federal regulations, and few states have addressed emergency power needs in assisted living. Massachusetts regulations do not require assisted living residences to install emergency generators.


White Oak Cottages has a gas-powered generator that provides full electrical backup to both cottages.


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