TALLAHASSEE, Fla. – Just weeks before another hurricane season, large numbers of Florida nursing homes and assisted living facilities in the storm-battered state continue to struggle to meet requirements that they have backup power generator to keep facilities cool.
State records show that 89 long-term care facilities have told Florida officials in the last month that they won’t have generators by June 1 -- which is when the six-month hurricane season kicks off. Some forecasters have predicted it could be a normal hurricane season resulting in as many as two to four major hurricanes.
The Agency for Health Care Administration has posted information that says 35 percent of the 684 nursing homes across the state have installed generators as required by rules that were put in place at the urging of former Gov. Rick Scott.
The remaining 444 nursing homes have submitted requests for “variances” from the rules, which required them to have generators on site and access to 96 hours of fuel by June 1, 2018.
The rules allowed the state to grant an extension to Jan. 1 for providers that couldn’t meet the initial deadline. Variances then gave providers another six months to meet the requirement, according to state officials.
But now, many nursing homes are seeking second variances.
Some of the other long-term care providers impacted by the generator mandate -- assisted living facilities -- also are struggling to meet the requirements. Nearly 75 percent of assisted living facilities, or 2,301 providers, have met the requirement to have generators on site.
The other 706 assisted living facilities that have requested additional time to get backup generators are responsible for more than 38 percent of the beds in assisted living facilities.
Scott issued a pair of emergency rules requiring nursing homes and assisted living facilities to have backup generators in the wake of the deaths of 12 residents of The Rehabilitation Center of Hollywood Hills. The residents died following Hurricane Irma, which knocked out the Broward County facility's air-conditioning system.
The emergency rules gave long-term care facilities two months to have generators installed on site and 96 hours of fuel to power the generators.
After legal wrangling between industry groups and the Scott administration, the two sides reached an accord in 2018 that required backup generators by Jan. 1 but included a process that nursing homes and assisted living facilities could follow to be considered in compliance.
State economists estimated that the mandate would cost nursing home operators $121.3 million over the first five years, about $66 million of which would be offset by taxpayers through Medicaid. The tab for assisted living facilities was estimated to be $243 million. Because assisted living facilities generally don’t house Medicaid-funded patients, those costs wouldn’t be offset by taxpayers.
Kristen Knapp, a spokeswoman for the Florida Health Care Association, told The News Service of Florida that it is taking up to two years for nursing homes to get generators and approval from state and local authorities that must sign off on design and construction plans. The Florida Health Care Association is the largest nursing home group in the state.
“Our members remain focused on the goal to keep the residents safe during disasters, but many of these challenges are beyond their control,” Knapp said in a statement. “Thus, the variances are needed to ensure providers experiencing these delays remain in compliance with the law.”
Doug Adkins owns two assisted living facilities in the Jacksonville area. Both facilities have generators on site and meet the backup power requirements.
Nevertheless, Adkins is frustrated by the situation and said the Legislature moved too quickly on rules that don’t make sense.
Adkins said people who live in assisted living facilities must be considered “ambulatory” or having the ability to move. He also noted that nursing homes are being reimbursed for the costs of generators but assisted living facilities are not. His concerns also include power companies that don’t make assisted living facilities a priority for power restoration.
“That’s just not what we do in America,” Adkins said. “In America, we work together to collaborate with one another and bring all parties to the table. That’s not what happened these rules.”
Sen. Oscar Braynon, D-Miami Gardens, said Wednesday that the Legislature can be quick to react to headlines and that it’s difficult to “get the people who are in control here to slow down and be deliberative about things.”
“What happens -- and I see this all the time -- is we knee-jerk react to things. And that was probably one of those cases,” he said.
Tallahassee health care consultant Skip Gregory told the News Service that more variance requests will be streaming into the state in the coming weeks as the initial six-month variances expire and generators still aren’t installed.
An engineer who headed the Office of Plans and Construction at the Agency for Health Care Administration for 22 years, Gregory said the rules had unrealistic deadlines but also were confusing for engineers who are working with the providers and for state and local planning officials who need to sign off on construction plans.
Gregory said that after a fire in 2003 killed eight nursing home residents in Nashville, the federal government responded by requiring the homes to have sprinkler systems. Gregory said the state fire marshal worked with the facilities.
“That had a great impact on saving lives,” Gregory said of sprinklers.
But Gregory isn’t sure that the generator rules will have as much of an impact.
“If they had done that (the rules) in a more reasonable way, I think we would have been better off than making impossible deadlines,” Gregory said. “I guess the politics of it was that the governor had to be strong and a leader. But I don’t think it worked very well in my opinion.”