ORLANDO, Fla. — When family members went to check on their loved ones at an assisted living facility called Grand Villa of Altamonte Springs last weekend, they were shocked to find their relatives’ rooms lacked power and air conditioning.
Under a 2018 Florida law, nursing homes and assisted living facilities are required to have an emergency plan and a backup power source to keep temperatures at or below 81 degrees Fahrenheit for at least 96 hours in the event of a power outage. The law was made after around 12 nursing home residents died of heat-related illnesses during a power outage caused by Hurricane Irma in a facility that lacked a generator.
The law requires only a portion of the facility — at least 20 square feet per resident — to be air-conditioned and maintained at this temperature, as long as the facility presents an emergency plan that shows residents can access the air-conditioned sections and that staff monitors residents for heat-related injuries.
“Even if they’re not legally obligated, this is not right,” said a Longwood man who came to check on his father-in-law.
This was just one of the recent clashes between families, assisted living facilities, nursing homes and the law.
Multiple people contacted the Sentinel to discuss their experiences during Hurricane Ian. They asked to stay anonymous because they didn’t want to face consequences from the facility. The Sentinel verified their identities through copies of bills from nursing homes or assisted living centers with their names and their relatives’ names on them.
Meanwhile, nursing homes and assisted living facilities maintain they followed federal and state safety requirements.
Every facility in Florida has a generator onsite, a generator status map shows.
Grand Villa, made up of multiple buildings, followed the law by providing power and AC to its memory care building and exceeded those obligations by powering part of the building that houses its activity spaces and dining rooms with an additional generator, said spokesperson Sandi Poreda in response to families’ complaints.
“Our staff members visited every resident’s apartment to let them know we had cooled space and invite them down,” Poreda said in an email. “While our elevators were out, we physically assisted any resident who needed help navigating the stairs. We also checked room temperatures.”
Poreda said most residents chose to stay in their rooms.
A family member of a different second-floor resident at Grand Villa said her mother is mobility-impaired and has dementia. Her call button wasn’t working, and neither was her cellphone, she said.
She took her mother home until power was restored Sunday evening.
“I just don’t think that was appropriate. And what about people who don’t have family members that are able to look after and advocate for them, and bring them to their homes?” she said.
Neither of the two families of Grand Villa residents felt their family members’ lives were threatened by heat. Still, they both said they had expected rooms to be air-conditioned.
“He was not dehydrated. He was not in pain. It was just a sad sight,” said the man who came to check on his father-in-law.
Amy Cameron O’Rourke — who worked for nine years as a nursing home administrator, 23 years leading a care management practice, and published a book on caring for aging loved ones — said she thinks Florida’s lack of a requirement to provide air conditioning in residents’ rooms is a “valid concern.”
“Thank God the temperature was okay during this hurricane,” O’Rourke said.
Flooding prompts evacuations, questions
Elsewhere in the state, nursing, retirement and assisted-living residents were unable to stay in their homes.
Ahead of the hurricane, 40 licensed nursing homes evacuated and transferred 3,508 residents; and 91 assisted living facilities evacuated 3,012 residents, Agency for Health Care Administration Secretary Simone Marstiller told reporters last Wednesday. The data was self-reported to the state in the Health Facility Reporting System.
AHCA did not respond to follow-up requests as to how many were evacuated in total or how many returned to their residences as of Friday.
In central Florida, the Good Samaritan Society of Kissimmee Village, a retirement community, was inundated with water from Shingle Creek. No injuries or deaths occurred.
The community has been hit hard by hurricanes before. Residents were also evacuated amid flooding in 2004 from Hurricane Charley and in 2017 from Hurricane Irma.
State Attorney General Ashley Moody toured the facility by airboat this week and said she will be reviewing state and local reports.
“There will be, moving forward, lots of assessments not just within the state level, not just determining whether there are civil investigations needed,” she said.
The Centers for Medicare and Medicaid Services requires facilities that accept Medicare and Medicaid, such as the Good Samaritan Society, to create emergency preparedness plans for natural and manmade disasters.
The Kissimmee community has been cited multiple times by CMS for failing to develop and maintain an Emergency Preparedness Program, including as recently as March. CMS’s website states this was corrected on April 22.
Other central Florida facilities flooded for the first time.
A total of 106 residents of Avante Orlando, an assisted living facility; and a total of about 200 from Life Care Center of Orlando, a nursing and rehabilitation home, and The Bridge at Orlando, an assisted living facility next door were evacuated through floodwaters on Thursday by Orange County Fire Rescue responders.
Life Care and The Bridge could not respond to questions in time for publication.
Kimberly Biegasiewicz, president and CEO of the Avante Group, said there was “no need” to evacuate prior to the storm and every safety requirement was followed. Government officials did not recommend evacuation beforehand.
“The facility has not had any historical flooding or leaks,” she wrote. “This was an unprecedented hurricane and storm event that significantly impacted Florida, and the City of Orlando as well, and the flooding occurred up and down Semoran Avenue, not just at Avante Orlando.”
The effects of evacuating a medically fragile resident can linger and result in hospitalizations or deaths later on, said University of South Florida Aging Studies Research Assistant Professor Lindsay Peterson.
Missed medications, falls that go unmonitored amid the chaos of moving, and stress can all contribute to hospitalizations and deaths of residents who are evacuated, she explained.
“Even the best evacuation, I think, is hard on some residents,” Peterson said.
Biegasiewicz notes Avante checked residents for physical and mental issues after the storm and is continuously monitoring evacuated residents’ physical and mental health.
Could policy have prevented this?
The big question Peterson wants lawmakers and long-term living facilities to ask in the aftermath of Ian is if there is any way to avoid an evacuation during future hurricanes.
Some but not all cases of flooding could have been avoided by updating buildings, but it would be a costly process, Peterson said.
“A lot of these are older buildings. And in order to possibly reinforce parts of the building, or redo the plumbing or ... change the elevation or something like that to prevent flooding, then that could be a lot of money,” she said. “And there’s nobody there saying: you’ve got to do this.”
A secondary question worth asking, she says, is when is it the government’s responsibility to mandate certain hurricane preparations?
Peterson pointed to the generator requirement, introduced after nursing home residents died. The AHCA also mandates certain life and safety regulations, Peterson said.
“They will get specific when they have something really specific to key into,” Peterson said. “But I imagine if they were to try to pass a law or create a regulation that they had to ensure that their roof could withstand a Category 3 wind or they had to repair all their plumbing problems ... That might be tougher to put across.”
In addition to the generator rule, the AHCA in Florida requires all residential health care facilities to create Comprehensive Emergency Management Plans for approval by county emergency management agencies.
Among other requirements, the plan must discuss the facility’s prior history of flooding and other hazards; present a plan for 24-hour staffing until an emergency is over; and present an evacuation and shelter plan.
Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a nonprofit advocacy organization, said the group has not been made aware of any deaths in nursing homes or long-term care facilities from the storm.
Florida is currently “ahead of the curve” compared with other states in terms of its mandates for emergency preparation, but improvements can still be made, she added.
For example, the fact that generators are not required to power full facilities, Smetanka said, is “not the best-case scenario at all.”
“I do think things are getting better, but you know, I think we still need to continue to refine our systems,” Smetanka said.
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