US nursing homes aren't safe amid climate crisis, report finds. And it's getting worse.
Amid a devastating power outage and plummeting temperatures in 2021, workers at a nursing home in La Marque, Texas, kept elderly residents warm with blankets and socks used as mittens.
In Houston, a woman in a wheelchair wondered if she’d need to throw herself through a window to survive as able-bodied residents of the assisted-living facility left because the elevators weren’t powered.
In Austin, workers served coffee and tea as the home desperately tried to secure a backup power generator.
A report from two Senate committees obtained by USA TODAY examines how dire the situation became for Texas nursing home and assisted-living facility residents when a February 2021 snow and ice storm led to widespread power outages.
More than 100 nursing homes lost power and over 300 had no drinking water. Dozens of homes evacuated more than than 1,400 residents. And two people at assisted-living facilities were among the 246 deaths from the storm, though experts said the death toll was likely higher because frail or disabled residents might have struggled to recover from such disruption.
"Old people, nursing homes and these types of disasters don't jibe," said David Dosa, a geriatrician and an assistant professor of medicine at the Warren Alpert Medical School of Brown University. "Anytime you have one of these events, you have downstream morbidity and mortality that is probably significantly higher than is reported."
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The report comes as the Biden administration pursues nursing home reforms such as minimum staffing levels and improved oversight of infection control.
The administration vowed to wage the most ambitious effort to address nursing home quality, safety and staffing in decades. Last February, it said nursing home reforms would also examine emergency preparedness, but the administration has not released a detailed plan.
Report calls for greater urgency amid climate crisis
While focusing on how Texas long-term care facilities fared during the winter freeze, the report from the Senate Finance Committee and Senate Special Committee on Aging also highlights the risks confronting medically vulnerable adults and disabled residents during climate change-driven extreme heat or cold, floods, tornadoes or wildfires.
In all, the report cited 89 weather or climate-related events from 2017 to 2022 that caused outages and damages, jeopardizing the health and safety of long-term care residents.
Senate Finance Committee Chairman Ron Wyden said emergency preparedness is pivotal because homes that care for vulnerable residents will face greater challenges as the climate crisis leads to an increase in severe weather events.
“This report is a case study of just one in an increasing number of circumstances where elderly or infirm Americans are subjected to difficult conditions due to severe weather," said Wyden, an Oregon Democrat. "Whether it’s a winter storm, hurricane or wildfire, more must be done to ensure long-term care facilities are adequately prepared to handle these events and care for their residents.”
Winter storm of 2021: Texas families chronicle tragedy of preventable deaths
Report finds nursing homes lack generators
The report also highlighted regulatory loopholes that allow potential problems to go unchecked.
The Centers for Medicare and Medicaid Services requires nursing homes maintain “safe and comfortable” temperatures of 71 to 81 degrees. But the federal agency doesn't require homes to maintain generators or other emergency power supplies. CMS also doesn't regulate assisted living facilities.
Residents of 168 long-term care facilities in Texas hunkered down in homes that lacked a backup generator that also reported challenges such as no power, water, burst pipes and no transportation, the report said.
Temperatures at homes dropped to the 50s during the outage, and the Texas Ombudsman reported one resident of an Austin facility "died as a result of exposure to cold temperatures inside the building."
Recommendations: What can be done to protect nursing home residents?
In 2018, the committees recommended tougher regulations and oversight after safety failures led to preventable tragedies at nursing homes in Texas and Florida during and after Hurricanes Harvey and Irma.
While the report acknowledged some progress since 2018, too many gaps remain, leaving residents vulnerable. U.S. Sen. Bob Casey said the report serves as a "warning sign."
“As we experience more frequent and catastrophic climate disasters, long-term care facilities must be better prepared to protect residents living there,” said Casey, a Pennsylvania Democrat.
While the federal government require nursing homes to have an emergency plan and update it each year, audits of homes in eight states in recent years by the Office of Inspector General found two-thirds of facilities didn't have adequate plans. Some nursing homes couldn't locate emergency plans, failed to conduct training exercises or did not maintain emergency supplies such as diesel fuel for generators.
Citing a USA TODAY investigation, the report said many of those issues could be traced to inadequate enforcement from understaffed inspection agencies and from the nursing homes themselves being understaffed or having high turnover.
The new report issued more recommendations to protect long-term care residents:
►CMS should make a "top priority" to maintain emergency power capacity to heat or cool homes during a power outage. However, the report stopped short of specifying the type of emergency power supply the home must carry. Options could include generators, micro-grids or batteries that store power from solar cells.
►CMS should update its nursing home temperature standard with a heat index that includes humidity readings.
►Require homes that serve elderly residents to prepare for extreme heat or cold.
►State and local health agencies should coordinate with local utilities to prioritize restoring power to vulnerable long-term-care homes in the event of an outage.
States pursue laws after tragedies
In 2006, Maryland mandated generators for long-term care facilities after Hurricane Isabel in 2003 knocked out power to more than 1.2 million residents. Florida also required generators after Hurricane Irma triggered an outage that led to sweltering temperatures and a dozen deaths at the Rehabilitation Center at Hollywood Hills.
Following the statewide outages, Texas state Rep. Ed Thompson introduced a bill that would mandate generators at assisted living facilities carry generators. The legislation stalled last session amid opposition from industry groups, but Thompson is trying again this year.
Thompson told the Austin American-Statesman, part of the USA TODAY Network, he witnessed how a summer thunderstorm knocked out power to a facility, jeopardizing residents who needed oxygen or refrigerated medications.
MORE: Winter storm blackouts plagued Texas in 2011, too. But recommendations went unenforced.
'AN ELECTRICAL ISLAND': Texas dodged federal regulation for years by having its own power grid
Nursing homes say more regulation isn't needed
The American Health Care Association and National Center for Assisted Living, an industry group, said utilities and government agencies should work together to quickly restore power and water during emergencies.
“Instead of more regulations, we should focus on prioritizing nursing homes and assisted living communities in emergency situations given our vulnerable population," AHCA and NCAL said in a statement. The agency that oversees Medicare "already has extensive emergency preparedness regulations for nursing homes, and states have additional requirements for nursing homes as well as assisted living communities."
Purchasing generators might just be a pricey fix when day-to-day operations and staffing demand immediate investments, said Dosa, the Brown University professor who studies how long-term care facilities fare during emergencies.
Federal, state and local emergency planners and utilities share responsibility in coordinating efforts to protect older adults and disabled in homes during an emergency, he said.
He cited the example of 19 deaths at Lafon nursing home in New Orleans after Hurricane Katrina. Emergency management crews were in the parking lot of the facility as people died, he said.
"People died in that facility literally right under their nose," Dosa said. "These are just very vulnerable people who, unfortunately, get subjected to this kind of climate change event and don't do well."
Ken Alltucker is on Twitter at @kalltucker, or can be emailed at alltuck@usatoday.com
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This article originally appeared on USA TODAY: Climate change threatens vulnerable US nursing home residents: report
