After a dozen residents at a Hollywood nursing home slowly sweltered to death after Hurricane Irma knocked out power and their air conditioning, Florida officials vowed to take steps to prevent it from happening again.

The Legislature followed up by passing rules requiring backup power for cooling for at least 96 hours at all of the state's 685 nursing homes and 3,101 assisted living facilities. The new rules went into effect Friday, the first day of hurricane season.

But only 48 nursing homes and 91 ALFs have reported they have installed equipment and had state site inspections as of May 25, according to the most recent data available by the Agency of Health Care Administration, which is in charge of tracking and enforcing the new rule.

Hundreds of facilities — 348 nursing homes and 343 assisted living facilities — have requested extensions to give them more time to install equipment and have it inspected to meet the requirements set by the rules.

But the 567 facilities whose requests for extensions have been approved, while technically in "compliance," have up to Jan. 1, 2019, to meet the actual requirements of the rule, meaning many facilities may not have the mandated backup power for cooling for this hurricane season.

So the nightmare scenario could happen again.

"It is AHCA's expectation that all assisted living facilities 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," said agency spokeswoman Mallory McManus in a statement. "If a facility has not documented compliance with the June 1 deadline the Agency will issue a notice of violation, which can lead to fines and other penalties."

The state, which has updated individual nursing home records online with their emergency generator status, intends to make aggregate reports available online starting next week. But it will still be conducting physical checks well into hurricane season, as many facilities await site inspection by the agency or by state fire marshals.

Though long-term care facilities' plans are being reviewed by both local emergency management agencies and the state, local offices are also behind, according to the agency's data. Local emergency management agencies have approved only 319 nursing homes' plans and 778 assisted living facilities' plans as of May 25.

Facilities had until the end of the day Friday to submit paperwork indicating they are obeying the rule.

The delays mean that as Florida enters another hurricane season, many of the state's long-term care facilities either don't have equipment installed and operational or haven't undergone a state inspection.

McManus said the agency is processing the remaining extension requests as quickly as possible and that it will begin conducting more site visits after June 1 to facilities that have implemented their plans but have not yet been inspected. The agency had said in April that an inspection by its Office of Plans and Construction would be required before a nursing home would be considered in compliance with the rule.

McManus declined to specify a timeline in which the Office of Plans and Construction intends to complete its site visits, saying they are "not scheduled and not announced."

Gov. Rick Scott first directed the state to issue emergency rules requiring generators in long-term care facilities in the weeks after the tragedy at the Rehabilitation Center at Hollywood Hills, where the dozen deaths are part of a homicide investigation into the nursing home. After months of legal disputes between the state and industry groups that pushed back on the requirements, lawmakers passed a set of compromise rules near the end of the legislative session in March. The rules — which required ratification by the Legislature because of the high cost incurred — require those facilities to submit a safety plan verifying they have installed a working generator or alternate power source that can supply electricity for 96 hours.

Though the changes were touted as one of the most visible reforms post-Irma, 254 nursing homes and 313 assisted living facilities have already been approved for extensions up to Dec. 31, long after this hurricane season will be over. Under the approved rules, extensions can be granted for reasons including construction or delays in delivery, zoning or regulatory approvals, provided the facility submits alternative cooling plans that can keep residents at safe temperatures for 96 hours.

Even if facilities have complied with the new emergency power rules, they could be waiting long into hurricane season for physical checks on their generators. According to data provided by the state, only 68 nursing homes so far have been surveyed and approved by the agency's Office of Plans and Construction. State fire marshals, who are also authorized under the rules to assist in inspections, have approved 96 assisted living facilities as of May 25.

The state's inspections are, in some cases, also the only physical checks on facilities: Many local emergency management divisions have said they do not intend to do physical checks. Charles Cyrille, division director for Miami-Dade's Office of Emergency Management, told the Herald in April that physical inspections were the state agency's responsibility, and Pinellas County's emergency management office said it was also reviewing the plans in lieu of doing physical inspections.

Broward County, which regulated the Hollywood Hills facility, said it is visiting the facilities to check on the generators, though it is not performing tests on the equipment.

Paper reviews, however, can miss details. Broward's emergency planning division signed off on Hollywood Hills' emergency plan last year, even though it missed critical details about air conditioning and copy-pasted its hurricane drill from the previous year.

Some nursing home emergency plans from Miami-Dade that were later reviewed by the Herald were also largely inadequate, even if they'd been approved by county officials: A quarter had entirely blank sections, and a third did not document a week's worth of rations as required by the state.
The state is tracking when facilities report implementing their emergency power plan, when local emergency management agencies approve the plans, and when fire marshals or the agency's office does site visits. The agency plans to issue notices of violation after Friday's deadline if no paperwork has been submitted, McManus said.