When the Legislature passed rules this year requiring emergency power in long-term care facilities, Hurricane Michael was exactly the kind of disaster lawmakers had in mind.
The potential Category 3 storm, which is predicted to hit the Panhandle Wednesday, is one of the most powerful storms the region has seen in decades. Gov. Rick Scott declared a state of emergency from the Panhandle down to the Big Bend region, and mandatory evacuations have been ordered where Michael is expected to come ashore. Officials have warned of storm surge, flooding and widespread power outages that could last days.
But those generator rules — which were conceived in the wake of the Hollywood nursing home disaster last year that killed a dozen people — are still not done being implemented by many facilities across the state, particularly hundreds in the region where Michael's impact is likely to be felt hardest.
A review of data maintained by the Agency for Health Care Administration shows that, in 33 counties encompassing the western half of the state south to Hernando County and east to Putnam County, more than half of the 412 assisted-living facilities and nursing homes have yet to implement their emergency power plans. Nearly all of those facilities have been granted extensions, many through the end of the year, citing regulatory delays and equipment and contractor shortages.
But with Michael set to bring high wind and torrential rain, those facilities are turning to temporary generators, portable coolers and sometimes evacuations to keep residents safe — just as they have in years past before the rules were approved.
In a statement, AHCA said facilities must prove they are able to keep residents safe in other ways to be given a reprieve from meeting the new requirements.
"Before [an extension] is approved by AHCA, the facility must provide a detailed explanation of how they will ensure patient protection during the extension timeframe," the agency said in a statement. "Extension details include how patient temperatures will remain safe during loss of power, such as how the facility will be cooled and evacuation plans if needed."
Scott first ordered requiring backup generators for air-conditioning in September 2017, days after a dozen residents overheated and died at the Rehabilitation Center at Hollywood Hills following Hurricane Irma. That now-shuttered nursing home, which remains under investigation and whose license is still being litigated, lost power to its air-conditioning, which caused the facility to reach sweltering temperatures before it was evacuated by officials.
But after months of legal disputes between the state and industry groups that pushed back on the requirements, lawmakers passed a set of compromise rules mandating facilities submit a safety plan verifying they have installed an alternate power source that can supply electricity for 96 hours. The rules also set requirements for how much backup fuel must be present on site.
Those rules have only seen partial implementation across the state. In the Panhandle and Big Bend regions, more than half have been exempted from meeting the rule by June 1 according to the agency's data, and are still implementing the requirements.
Of the 283 assisted-living facilities in those counties, 135 — almost half — have yet to finish installing or setting up the generators they need to comply with the mandate. Ninety-four out of 129 nursing homes in those counties also have yet to do the same.
Kristen Knapp, communications director for the Florida Health Care Association, a long-term care industry group, said many of those facilities have struggled with requirements for permitting and zoning generators, as well as delays in delivery and shortages of contractors who can install them. In the meantime, those facilities have established other ways to keep residents cool and safe, she added.
"There's so much more to the emergency preparedness than the generators," she said. "Making sure you have the right staff, the right management, leadership, making sure you're doing rounds, checking temperatures, keeping them hydrated, all of that is critical."
Knapp noted that many of the association's members, which comprise more than 80 percent of nursing homes statewide, have been working with AHCA to prepare for the impending storm. The state agency held calls open to all hospitals and residential care facilities Monday to discuss resources and support, she said, and activated an online reporting system so facilities can communicate what they need and have available.
In places that are expecting Michael to knock out power, some facilities are staking their hopes in additional resources procured right before the storm arrives.
Jeanna Hittinger, an administrator at the Heritage Healthcare Center in Tallahassee, said that her facility was reviewing several portions of their emergency management plan ahead of Wednesday's storm: "people that need dialysis early, batteries for our BiPAP [respiratory] machines. We're going through all of our disaster supplies."
They are also having a second "full-service" generator delivered Monday to supplement its current generator, which only cools certain portions of the building. The facility is still waiting on the permanent generator that will satisfy the emergency power plan they filed to comply with the new rule from earlier this year.
Heritage was approved for an extension on its emergency power plan, according to AHCA data, and has yet to finish implementing it.
"This right here will help us get through, 'till the other one can get installed," she said.