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Florida’s Efforts to Protect Nursing Home Residents From Hurricane Ian May Have Worked

No deaths among nursing homes have been reported yet, but ongoing monitoring will be critical

nursing home resident evacuated from hurricane ian flood waters

Orlando Sentinel / Contributor

En español

As the death toll for Hurricane Ian continues to climb, it’s clear that the Category 4 storm hit older Floridians particularly hard. Of the roughly 120 people known to have been killed, more than half are confirmed to have been age 60 or older. But none of the dead identified so far were nursing home residents, suggesting a potentially effective emergency response by facilities that have come under fire for their response to COVID-19, which killed many thousands within their walls.

“I haven’t heard stories that have indicated any sort of negligence on the part of facilities,” says Jeff Johnson, AARP Florida’s state director. “Instead, I’ve heard stories of the facilities really going above and beyond to try and secure their residents from harm. I say this deeply cautiously, because you never know what’s going to come to light, but at this point, it looks as though [nursing homes] managed to get through this one relatively well.”

It’s too early to assess Ian’s true toll on nursing home residents in Florida, one of the largest nursing home states in the U.S., with roughly 700 facilities and 70,000 residents, plus another 3,000 licensed assisted living facilities. Johnson notes that many residents died in the aftermath of Hurricane Irma in 2017, which officially killed 129 people but was blamed for roughly 400 excess deaths in nursing homes from power outages in the weeks that followed.


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“People could unfortunately pass from a variety of things triggered by this hurricane, but they won’t be labeled as hurricane deaths,” Johnson says. “And they may not become apparent for months or even years.”

For now, the death toll suggests that the nursing home population may have fared better than in some past natural disasters, including Irma. That’s likely thanks in part to a 2018 state law that requires long-term care facilities to have comprehensive county-approved emergency management plans and an alternate power source, such as an on-site generator, in the event of a power outage. Power companies also appear to have prioritized those facilities in restoring electricity after the storm.

Thousands evacuated

Before Hurricane Ian made landfall, around 40 Florida nursing homes — mainly in the state’s southwest — moved to evacuate roughly 3,400 residents, according to the Florida Health Care Association, which represents long-term care providers. Around 115 assisted living facilities statewide with approximately 4,600 residents did the same.

As the storm moved east, dumping water in unexpected parts of central Florida and the east coast, some additional long-term care facilities were also forced to evacuate. In Orlando, Orange County Fire Rescue evacuated some 300 residents from three long-term care facilities through rising floodwaters, ferrying residents to paratransit buses and ambulances with stretchers and wheelchairs.

Most displaced nursing home residents were transferred to sister facilities or other nursing homes with spare beds outside the storm’s path. Ahead of the storm, Florida’s Agency for Health Care Administration, which regulates nursing homes and assisted living facilities, activated a statewide reporting network that requires all health care providers to report available beds, evacuation status and other essential information daily. A partnership between the state government, hospitals and long-term care organizations used the data to place residents in suitable facilities.

“It’s all hands on deck,” said Agency for Health Care Administration Secretary Simone Marstiller in a recent briefing with long-term care organizations. “We need to continue to work as well together as we have been up to now.”

Most of the nursing homes that evacuated have returned to their buildings, after getting approval from their county emergency management offices. Around 10 nursing homes across the areas of Port Charlotte, Cape Coral, Winter Park, Daytona Beach and Englewood were out of service as of Oct. 10 due to storm damage or flooding in the area, according to the Florida Health Care Association. Those residents are in other health care facilities.

New generator rule

Around 80 nursing homes lost power due to the storm, the Florida Health Care Association says. But Florida law requires all nursing homes and assisted living facilities to have a backup power supply to keep temperatures at or below 81 degrees Fahrenheit for at least 96 hours in such situations. The law passed after Hurricane Irma knocked out power in Florida in 2017 and a dozen residents in a Hollywood Hills nursing home that lost air-conditioning died from exposure to extreme heat.

Florida’s Agency for Health Care Administration reported that 100 percent of facilities across the state self-reported compliance ahead of Ian — and the agency visited more than 300 facilities across the state to verify compliance. The generator law, which AARP fought for, “may have really helped us in this case,” says AARP’s Johnson. All of the roughly 80 long-term care facilities that lost power after Ian reported activating their generators.

Power had been restored to the majority of nursing homes that lost it by Oct. 4, six days after the storm’s landfall on Florida, according to the Florida Health Care Association. Spokesperson Kristen Knapp wrote in an email that Florida Power & Light, Duke Energy and other utilities “have done amazing to help prioritize our care centers for power.”

Nursing homes should be closely monitored in days ahead, says AARP’s Johnson. “Remember: The Irma disaster in Hollywood was days [after the storm],” he says. Power has generally been restored much quicker this time around, he notes, but “problems could still pop up.”

Florida’s Long-Term Care Ombudsman Program, which advocates for long-term care residents, had received six storm-related inquiries from assisted living residents by early this week, including reports of lack of staff and mold and water damage. “Historically, we see increases in complaints over time as residents return to evacuated facilities,” spokesperson Audra Peoples wrote in an email.

The stress or deterioration that a person can experience when changing living environments — known as transfer trauma and often affecting those with dementia — will likely be an issue that comes to light later on, says Johnson, particularly given the volume of evacuations performed.

Staffing shortages, a long-standing issue in U.S. nursing homes, may also worsen as workers are forced to deal with their own losses from the storm. But the state reports that it’s moved 400 additional nurses into southwest Florida. An Emergency Order allowing health care facilities to deploy out-of-state health care workers to the same roles in Florida during the emergency has also been activated.

For now, those who advocate for nursing home residents are optimistic. “The nursing home system seems to have found ways to be better prepared for storms like this,” Johnson says. “And it makes me wonder: How do we bring that attention and planning to those who are aging in place at home so we can ensure they are safe too? There’s an opportunity for us as a state to really lean into that.”

If you’re concerned about any long-term care residents impacted by Hurricane Ian, contact Florida’s Long-Term Care Ombudsman Program at 1-888-831-0404 or ltcopinformer@elderaffairs.org.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.