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Coronavirus in a hurricane: Can Florida nursing homes social distance if the power goes off?

Nearly 100 of the state's long-term care facilities have temporary generators, which may require moving residents into a single large space.
Officials for the state Agency for Health Care Administration saidthat all but one of Florida's long-term care facilities have a required back-up generator in case they lose power. The rule was initiated in 2017, after several residents of The Rehabilitation Center at Hollywood Hills, pictured here, died after power was lost to an air-conditioning system during Hurricane Irma. [South Florida Sun-Sentinel]
Officials for the state Agency for Health Care Administration saidthat all but one of Florida's long-term care facilities have a required back-up generator in case they lose power. The rule was initiated in 2017, after several residents of The Rehabilitation Center at Hollywood Hills, pictured here, died after power was lost to an air-conditioning system during Hurricane Irma. [South Florida Sun-Sentinel]
Published Aug. 10, 2020

Residents of Florida’s long-term care facilities, already under siege from the deadly coronavirus, now face another threat: the height of the hurricane season, when storms bear down on the peninsula, threatening to knock out electrical power.

The state Agency for Health Care Administration reports that all of Florida’s 693 nursing homes and all but one of its 3,112 assisted-living facilities now have generators — mandated two years ago — to keep frail elders cool during a prolonged power outage. But the state allows homes to use less-powerful temporary generators, which may require moving residents into a single large space — increasing their risk of transmitting the virus.

Then Gov. Rick Scott first mandated the backup generators in September 2017, after a dozen residents overheated and died at the Rehabilitation Center at Hollywood Hills following Hurricane Irma. The emergency power rule, later codified in state law, requires every nursing home and assisted-living facility to have an alternative power source onsite with enough fuel to keep residents cool and safe for at least 96 hours, according to Patrick Manderfield, deputy communications director for the state healthcare agency.

The law required facilities to have generators in place by June 1, 2018, but the state granted extensions to dozens of homes each year. In May, the Miami Herald reported that 95 facilities still didn’t have generators.

Then came word of the nearly full compliance.

“Florida’s long-term care community has undertaken a significant commitment of resources to ensure every facility has acquired a sufficient alternate power source,” Manderfield wrote in an email June 29.

One state legislator sounded surprised at the announcement. And the incoming state senate president said he’ll call for a compliance audit.

But Manderfeld also said this about the temporary generators: “Some of the temporary generators would cool a portion of the facility, rather than the entire facility,” adding that “facilities do not report which specific areas of the facility a temporary generator will cool.” And the state’s requirements for how much space per resident must be cooled fall short of standards set this year in some local hurricane shelters to allow for social distancing.

Senior advocates remain concerned that while facilities may have met the state’s minimum standard, temporary generators may not be enough this year to keep residents safe.

“During this pandemic, it’s dangerous to residents that you have people that are congregating in one large space in close quarters,” said Brian Lee, national executive director of Families for Better Care, a nonprofit that advocates for better services at long-term care facilities. “So that is a real issue that should be of concern to the residents and their families and the caregivers in the buildings.”

• • •

The state healthcare agency maintains a website that lists every nursing home and assisted-living facility and indicates whether it has a “fully implemented permanent generator,” a “temporary generator onsite” or a “temporary generator to be delivered.”

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On Wednesday, the site indicated that 611 of the state’s nursing homes had permanent generators, and 82 had temporary generators. Additionally, 3,096 of the state’s assisted-living facilities had permanent generators, 15 had temporary generators and one had a temporary generator to be delivered.

Locally, of Hillsborough County’s 296 facilities, two nursing homes had temporary generators. Of Pinellas County’s 241 facilities, 10 nursing homes had temporary generators and a St. Petersburg assisted-living facility was the one reporting it had a temporary generator to be delivered. Of Pasco County’s 67 facilities, one nursing home had a temporary generator.

“The emergency power rule requires nursing homes and assisted-living facilities to maintain a safe indoor air temperature in resident-occupied areas not to exceed 81 degrees,” according to Manderfield, “and the required temperature must be maintained in an area determined by the nursing home or assisted-living facility to maintain all residents safely.”

Of the 100 facilities listed with temporary generators when Manderfield wrote, “at least 31 may be able to cool resident rooms, though it’s possible more facilities cooling a partial facility would also include the resident rooms,” he said.

Nursing homes must be able to cool at least 30 square feet per resident, he said, and assisted-living facilities at least 20 square feet per resident.

Since May 1, the agency has conducted 1,185 onsite generator reviews, according to Manderfield.

“Staff examined the generators and observed them being tested, as well as inspected for adequate fuel supply,” he wrote in an email.

The agency has levied 395 fines, totaling more than $169,000, against facilities for non-compliance over the past several years, he wrote, and seven facility licenses were revoked or their renewals denied due in part to non-compliance.

Manderfield shared a letter the agency sent to nursing homes and assisted-living facilities on May 29, reminding them of the generator requirement and the need for a refueling arrangement.

The letter also asked this, in reference to this year’s concerns over the coronavirus — albeit with no requirement for them to respond: “Can you maintain isolation and distancing requirements with your emergency power plans?”

That’s the main concern of Brian Lee, the advocate.

Lee agreed that temporary generators are an adequate interpretation of the law, but said, ”a better solution is that there are hardened generators in place that are able to keep the residents safe through a storm or disaster.”

Temporary generators have failures, Lee said, but more importantly this year is that temporary generators often are big enough to cool only one large area in a facility, forcing staff to move all residents into a common room like a dining room or conservatory.

The state’s requirement to provide 20 or 30 square feet of cooled air per resident, in fact, falls short of how some counties are planning for space this year in hurricane shelters. The Tampa Bay Times reported in June, for instance, that Pinellas County shelters are providing 60 square feet per person or family to allow for social distancing.

Lee also remains skeptical of the state’s declaration that all long-term care facilities have generators, permanent or temporary.

“I just think they’re relying on the word of the facilities,” he said. “And if that’s the case, I really find it hard to believe. I can be hopeful that they have the generators in place, but expect the worst that they probably all don’t.”

Manderfield didn’t respond to a question from the Times asking whether the facilities self-reported their generator status or agency staffers had verified them all.

• • •

State Rep. MaryLynn Magar, R-Tequesta, is chairwoman of the Healthcare Appropriations Committee for the 2020-2021 session and helped write the law requiring generators. She attributes the three-year timeline to get generators in all of Florida’s facilities to financing, permitting and logistical delays.

“It’s a very big expense,” she said. “Sometimes larger ones, even the smaller ones, were back-ordered. You know, after we get a storm, everybody wants one, and it’s hard to come by.”

Sometimes, county permitting is slow, Magar said, and sometimes installation is slow.

“I think most of them wanted to do it and stepped up to the plate,” she said. “I’m so pleased that you called, and I looked up these numbers and saw virtually total compliance.”

“I think the temporary generators are better than not having anything.”

Incoming state Senate President Wilton Simpson, R-Trilby, said that what happens during the next couple of months “will probably be a telltale sign” of how prepared the facilities are.

Simpson said he plans to ask the Senate Committee on Health Policy to audit the facilities’ compliance on the generator requirement.

It’s not that he doesn’t believe the data, he said, but that the Legislature should verify the readiness of these facilities.

“We have to get this done,” Simpson said.

Adding the coronavirus to an always tough hurricane season has been concerning AARP, as well, said Jeff Johnson, state director for AARP Florida.

“It has been such a fight to get to the point where virtually every facility at least claims to have backed-up power and cooling capacity,” Johnson said. “In healthy times, that would be a sensible strategy.”

But he adds this: “If we haven’t been able to adapt to the changing reality of a hurricane that comes in the midst of an infectious disease pandemic, then we are going to put very vulnerable people in harm’s way yet again.”

• • •

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