To 75-year-old Karen Farino, evacuating out of her Charlotte Harbor nursing home was like a sleepover.
The nursing home, Solaris HealthCare, had to evacuate two years ago due to flood conditions caused by Hurricane Irma. Residents, ranging from middle age to 106 years old, were told to grab a pillowcase and fill it with what they would need for the next three days. For Farino, this was a change of clothes, her toothbrush and some toothpaste.
It took eight hours to evacuate the facility’s 173 residents, approximately 150 staff and their families. Four residents were transferred to a hospital due to their fragile conditions.
Residents slept on air mattresses blown up on the floors of the Florida Department of Health building in Port Charlotte. A parrot squawked, disturbing other family pets in close quarters. Drinking water was constantly passed around to prevent dehydration. They were served hot meals and ice cream they had stored for emergencies like this. Many rounds of Bingo were played.
But some weren’t so lucky.
Hurricane Irma also knocked out the air conditioning system in a Broward County nursing home — causing at least 12 deaths caused by heat exposure, the Florida House of Representatives’ hurricane response and preparedness committee reported in its 2018 report.
Legislators wanted to make sure what happened in Broward County never happened again. So, now nursing homes and assisted living facilities are required to have a plan in case their power goes out. But some local facilities still haven’t implemented their plans.
Twenty facilities between Arcadia, Charlotte County, Englewood, Venice and North Port do not have their emergency plans implemented, according to AHCA data.
There are also three facilities in this area which haven’t had their emergency plans approved.
These plans, which must be green-lighted by the county and state, address emergency environmental control when facilities have lost their primary electrical power source. This mainly involves the living facility having a generator to ensure the air temperature will stay at or below 81 degrees for a minimum of four days, or 96 hours.
But these plans aren’t just for hurricanes.
“These plans should be covering all disasters,” said Michael Milliken, the long-term care ombudsman for the Florida Department of Elder Affairs.
If a transformer goes out during the summer due to a car wreck, for example, facilities “have to be prepared for those kind of things,” Milliken said.
“Emergency power for assisted living facilities and nursing homes is critical to the health and safety of the residents of such facilities,” said Brian Gleason, a spokesperson for Charlotte County. “Electricity must be available via an emergency power plan to maintain safe temperatures and power life safety equipment.”
The ruling was made effective March 26, 2018, by the Florida Department of Elder Affairs. Assisted living facilities and nursing homes were required to implement their plans by June 1, 2018, and were allowed an extension up to Jan. 1, 2019.
Facilities are required annually to update their emergency power plan, along with their comprehensive emergency management plans.
To be considered compliant with AHCA’s measures, facilities either need to have their plan implemented or an extension approved.
Additional extensions can be granted if “unavoidable delays” caused the plan to be implemented past January.
Assisted living facilities are required to update AHCA on a quarterly basis, and nursing homes are required to update AHCA on a monthly basis, to ensure there are “no unnecessary delays,” according to AHCA.
There is not a limit of how many times facilities can request these extensions after the Jan. 1 deadline. “The Agency evaluates extension requests on a case-by-case basis to ensure appropriate timelines for compliance and safety measures are in place,” said AHCA spokesperson Patrick Manderfield.
If facilities don’t comply, the Agency for Health Care Administration (AHCA) can use “existing sanction authority,” which includes fines, license denial and revocations.
Why are these generators important?
When Julie Herrold heard that Hurricane Irma was headed for their Charlotte Harbor facility, “I had a pit in my stomach,” she said.
Herrold’s biggest fears as the director of nursing for Solaris HealthCare were injuries and deaths of residents.
“As you get older, physiologically your temperature regulation system isn’t functioning as well,” Herrold said. “Residents can’t adapt to extreme changes as well.”
Many of the residents at the nursing home also had “some degree of kidney disease.”
So, even before evacuation, the nursing home had stocked up on hydration stations, IV fluids and medical equipment. During the evacuation for Hurricane Irma, nurses monitored residents for heat exhaustion, disorientation and other symptoms to indicate problems.
AHCA and the Florida Department of Elder Affairs filed the emergency ruling with the Department of State in September 2017 to “ensure life-saving measures included in the emergency rules were permanently codified,” a statement from AHCA read.
Before the ruling, Solaris had three temporary generators to keep the fire control system, emergency lighting and electricity for medical equipment running. This next generator, which will complete the implementation of their emergency power plan, is solely for air conditioning.
As of Thursday, the center received its $250,000 generator a week and a half ago, according to administrator Stan Weyer. Before, the facility had to get county permits to set up a continuous line of fuel to the generator, figure out the engineering and just wait a while for the generator to be delivered.
For the next hurricane, “if we don’t have to evacuate, this (generator) will make it very comfortable,” Weyer said.
But these generators are also important for the return of residents, according to Kris Chana, the owner of Chelsea Place Senior Care in Port Charlotte.
Since Chelsea Place is located in a flood zone, residents will “always have to evacuate” in the midst of a hurricane. But when the water levels recede and residents have to return to a facility without power, that’s when the generators come in handy, Chana said.
Delays in Planning
There are seven facilities in Charlotte County, and 12 facilities in the Englewood, Venice and North Port area, that do not have their emergency power plans implemented, according to AHCA data.
But this doesn’t mean they don’t have a plan. If a facility hasn’t implemented its emergency power plan yet, it needs to get an extension approved by AHCA.
“While some facilities need more time to come into compliance with the rule, the majority have addressed their issues and have an approved plan in place to protect patients during a power outage,” Manderfield said. “Our Agency is committed to continue working with these facilities to ensure their plans are fully implemented.”
This extension requires the nursing home or assisted living facility to have an adequate plan in the meantime to protect patients during a power outage. This can include a temporary generator on-site, a plan to obtain a generator within 24 hours of a power outage or a full evacuation plan.
“It’s always important to have a game plan,” said Samantha Reyes, the executive director of Chelsea Place Senior Care in Port Charlotte. “We take pride in how organized we are in any given situation.”
Most facilities have these delays due to a lack of availability of equipment, installation scheduling and getting mechanical engineering and approvals.
“A lot of these facilities have to get custom generators,” said James Podlucky, an emergency management specialist for Sarasota County. “It takes time.”
AHCA requires monthly updates if an extension is filed to ensure the facility stays on track, which prevents the facilities from being fined for noncompliance.
Brookdale, an assisted living facility in Port Charlotte, recently had its plan implemented Feb. 28.
Prior to the ruling, though, “our plan included having both rented and owned generators arranged for deployment to communities, inclusive of qualified technicians to connect the generators, should a power outage occur,” said Heather Hunter, a spokesperson for the assisted living facility.
There have also been facilities which have failed to comply.
“This permanent rule is aimed at saving lives,” said Department of Elder Affairs spokesperson Jeffrey Bragg. “We will continue to enforce these rules and keep the public informed.”
But what kind of enforcement has there been?
AHCA has imposed fines against one Charlotte County assisted living facility, Parkside Assisted Living and Memory Cottage in Port Charlotte and four assisted living facilities in Sarasota County: Gocio Home, Spring Grove, Josefa’s Assisted Living Facility and Sea View Inn at Forest Lakes.
Since these fines, Parkside Assisted Living and Memory Cottage in Port Charlotte had its emergency power plan implemented in September 2018. Sea View Inn at Forest Lakes has since closed its doors.
No nursing homes in either county have been fined, Manderfield said.
“Our goal with the permanent rule is to safeguard Florida’s most vulnerable populations who reside in nursing homes,” said Justin Senior, an AHCA spokesperson.
Originally published in the Charlotte Sun on May 18, 2019.