After resisting a mandate for more than a decade to install backup generators to keep frail elders cool during a power outage, Florida’s nursing home industry all but agreed Friday to do it now — and work to persuade Gov. Rick Scott to find money to pay for what they say will be a $240 million pricetag and ease his 60-day timeline
“Installing generators is extremely complex and takes time to get it done right,” said J. Emmett Reed, executive director of the Florida Health Care Association, as he opened the one-day “Emergency Preparedness Summit” in Tallahassee.
But Justin Senior, secretary of the Agency for Health Care Administration, which regulates nursing homes and assisted-living facilities, told the group that his agency will “aggressively” implement a rule to require them to obtain back-up generators by Nov. 15 and offered no help for financing it.
“We feel very strongly that the cost of not complying with this role is greater than the cost of compliance,” Senior told reporters later. “The cost of not complying is the potential for lost lives.”
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Three days after eight elderly people died at The Rehabilitation Center of Hollywood Hills after power to their air conditioning system failed, Gov. Rick Scott ordered AHCA and the Department of Health to issue the emergency rule.
The rule requires the facilities to obtain a generator and the appropriate amount of fuel “to sustain operations and maintain comfortable temperatures for at least 96 hours following a power outage,” the essence of legislation the industry vigorously opposed 12 years ago if there was no taxpayer financing to pay for it. Current state law requires that nursing homes have power generation in an emergency for limited needs, like oxygen tanks and nursing station lights, and the rule greatly expands that mandate.
“It got everyone’s attention,” said Reed, whose group represents 550 for-profit nursing homes and called the summit to help the industry find out how to comply.
More than 300 people attended the summit at Florida State University on Friday, Reed said, and he estimates another 700 people watched it stream online.
“I believe the governor’s heart is in the right place and my hope is he may consider the timeframe,” Reed said, noting that all but 20 of the nearly 683 nursing homes in Florida already have backup generators but most will need to expand their capacity to accommodate air conditioning.
Senior offered no hint that the deadline will be softened, but suggested that verifying whether all nursing homes and more than 3,100 assisted living facilities are in compliance will take his agency some time.
“We are going to get every single facility in the state in compliance with the emergency rule in the coming months and we will get the Legislature to get this rule codified in the upcoming legislative session,” Senior told reporters.
But in a private conference call with industry representatives late Thursday, he clarified that contrary to what many homes had previously thought, they do not have to purchase enough back-up generation and fuel to cool and power their entire facility. Instead, they must have enough power to cool “some place where residents can reside during the course of the emergency” for four days after the storm, Senior said Friday.
The Florida Health Care Association, and LeadingAge Florida, which represents not-for-profit nursing homes and independent living communities, lined up engineering, electricity and construction experts, architects, regulators and and lawmakers to offer advice on how to comply. By the end of the day Friday, they had a consensus.
“It can be done. There are several ways of doing it but there needs to be more time,” said Deborah Franklin, FHCA Senior Director of Quality Affairs, after the panel of construction and engineering experts concluded.
To install an emergency generator to power the entire nursing home is a 38-week process, including constructing a separate room for it and the backup diesel fuel tank, said Jason Wiseman of Core Construction, who has installed generator systems in hospitals and nursing homes.
“I would just say, let’s get a grip for what we’re doing,” said Skip Gregory of Health Facility Consulting, an architect who spent 17 years as the head of the AHCA division that inspected hospitals and nursing homes.
Melinda Skirvin, director of regional operations for Five-Star Senior Living, which owns 20 nursing homes and assisted living facilities of between 84 and 470 residents, said that although she has generators already in most of her homes she will need to add supplemental systems at a cost of between $15 million to $17 million.
“We’re not trying to put dollars ahead of residents. We want to move ahead in this direction anyway but my concern is the timeframe — it’s impossible,” she told the Herald/Times. “People think our profit margin is really big, but it’s not. It’s really small.”
When it comes to paying for it, the legislators in attendance weren’t offering the industry much help.
“There’s no free money lying around, and with Irma it’s already spent and it’s going to get worse,” said Rep. Jason Brodeur, R-Seminole, the chair of the budget committee that oversees the health care budget. Economists have predicted the state will face a shortfall of at least $1 billion in the 2018-19 budget year.
Sen. Rene Garcia, R-Hialeah, told the group that he agreed the 60-day deadline “is too short of a timeframe to try to get this done,” but he warned there will be no way out of the mandate. “We are going to move forward with some form of legislation having to do with generators and alternative power.”
Senior said the administration decided to require all facilities to have back-up generation, regardless of whether they are in a mandatory evacuation zone or not, because many senior homes that thought they were prepared for Irma found that as the storm shifted their “evacuation plans generally fell through.”
“There was no place to hide. No place to go,” he said.