No backup required: Texas senior care depends on luck and wits to cope with heat after power outages

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Some 120 miles from where Hurricane Beryl first made landfall in Texas on Monday, the power was out in north Houston, specifically at the Ella Springs Senior Living Community, an 80-resident assisted living and memory care facility.

That first day, following their emergency plan, the staff got to work, locating two small generators, fans and portable air conditioners to try to make one common area – the dining room – cooler for residents. Ella Springs had previously registered with CenterPoint Energy, the utility that manages power lines in the area, as a “critical load” customer, according to director Brenda Hobson.

That designation, Hobson thought, would mean that like hospitals, her center would be among the first – ahead of residential customers – to have power restored. Electricity needed for air conditioning is one concern, admittedly a large one. But when the power went off at Ella Springs, it also took down the emergency alert system for residents.

“They all have the pendant to call for help,” Hobson said of the devices residents use to alert staff in emergencies. ”With the power outage, that doesn’t work.” And that means constant checks on each resident. “It’s a lot of extra stress on the staff.”

About 25 of her residents who have varying stages of dementia live in a secure unit. When the electricity went out, the locks on doors leading outside deactivated, forcing staffers to stand guard to keep residents from wandering.

After four days of being put on hold and disconnected, Hobson came to the realization that the “priority” designation with the utility wasn’t one at all.

“At this point, we’ve never had an outage like this before,” said Hobson. She understands CenterPoint has a tough job but better communication with its health care customers should also be top of mind, she said. CenterPoint did not immediately respond to questions about their priority list protocols.

Ella Springs was among roughly 14 nursing homes and 30 assisted living facilities in Harris County without power by late Thursday, four days after Beryl struck Texas. Although power was restored by Friday morning, the experience has her wondering why she pre-registered if they weren’t going to get power any sooner than anyone else.

When a storm hits Texas, utilities, by law, are supposed to give nursing homes and assisted living centers (as well as hospice sites) the same “priority,” as hospitals when it comes to restoring power But how that happens and how fast is not specified by the state.

And there’s no requirement that the state’s 2,000 assisted living facilities and 1,187 nursing facilities have generators to power heating and cooling systems.

The only requirement is that they have alternative power sources to keep medication refrigerated and lifesaving equipment like oxygen machines up and running.

“That’s been something we, as advocates, have tried to get passed for years,” said Greg Shelley, the chief long-term care ombudsman in Harris County. Shelley’s team is part of a state network that handles residents’ concerns and complaints.

When a storm hits the Houston area, Shelley and his staff of eight hit the phones, either from their cars, their homes or their office, trying to reach about 400 elder care facilities across the 1,700 square-miles of sprawling Harris County.

If they can contact a nursing home or assisted living facility staffer Shelley’s team quickly asks about power. Is power on? Are you on a generator? Is it working? What do you need?

The long-term care ombudsman network is usually among the first to get updated numbers on problems after a storm, about the conditions inside care homes for elderly and disabled residents. They pass along the information to emergency responders and officials.

But for the most part, elder care facilities in Texas have no requirement to have generators to power heating and cooling systems despite the increase in stronger storm activity over the past 25 years.

And if a facility has a generator, the type can vary. Most move residents into a common area and use portable generators to power a few fans or portable air conditioning units inside that area, as Ella Springs did. As of Friday, some 80 facilities along the coast remained without regular power. It is not clear how many had generators or had moved residents to facilities where power was restored. Luckily, so far at least, there have been no deaths or serious injuries reported as a result of the outages at senior facilities.

What are the rules?

Since 1996, state law has required all new nursing homes to have an emergency generator that powers safety features such as emergency lighting and exit signs, fire alarm systems, nurse call systems, telephones and medication and life-saving equipment. The same is true of all assisted living facilities that serve 17 or more residents.

However, state law does not require nursing homes or assisted living facilities to have a generator to power air conditioning or heating systems.

Texas Health and Human Services also requires emergency preparedness plans for assisted living and nursing facilities. This plan can include communication, sheltering arrangements, resource management, and evacuation. But these plans offer facility operators a lot of latitude in how they are implemented.

“ALFs and NFs should know who to contact regarding power issues in the event of a power failure,” said agency spokesperson Tiffany Young.

Young said nursing and assisted living facilities that lose power during a natural disaster can also choose to evacuate to another facility or agreed-upon location. She also said a nursing home must have a plan for remaining in the facility during an emergency.

HHSC does not regulate independent senior living facilities. These entities do not hold a state license and are not required to report any information to the state health agency.

When Hurricane Beryl made its way toward southeast Texas the state’s health agency sent out alerts to long-term care providers, reminding them to use their emergency plans.

Failed Attempts

Various lawmakers have attempted to require backup generators at assisted living facilities and nursing homes. Still, each attempt failed to reach Gov. Greg Abbott’s desk.

State Rep. Ed Thompson, R-Pearland, filed a bill to require backup generators at assisted living facilities in 2021 after Winter Storm Uri caused the Texas power grid to collapse for several days. However, the bill stalled in committee after facing opposition from the industry, which raised concerns, mostly about cost.

The price tag to equip all the state’s assisted-living facilities with generators would be enormous.

“I understand the cost being a problem. But I am sad these senior citizens who are forced to live in these environments, but nobody seems to care,” Thompson told The Texas Tribune on Friday. “It’s kind of disappointing to see because Texas is better than this.”

The Texas Health and Human Services Commission estimated that in 2021, the cost of installing a new generator capable of supporting certain air temperatures could range from $20,000 for a new and smaller facility to $720,000 or more for an older and larger facility.

Thompson refiled the bill in the 2023 session alongside Rep. Shawn Nicole Thierry, D-Houston, and Rep. Elizabeth “Liz” Campos, D-San Antonio.

Yet, the bill once again stalled in committee. “I thought the second go around we had a chance,” Thompson said. “I was shocked. It was a bipartisan no vote.”

The cost and feasibility of the potential generator law are hurdles lawmakers have been unable to get past in Texas.

“Hurricane Beryl has shown us once again how vulnerable our senior residents are during extreme weather,” Thierry said. “Many of these elderly Texans are disabled or bedridden, and it’s heartbreaking and unacceptable to see them suffer needlessly.”

But in Florida, it has been a different story since Hurricane Irma, a Category 4 storm, hit in 2017.

As power outages gripped the state, a grisly discovery in the storm’s aftermath was made inside a Fort Lauderdale-area nursing home where 12 residents died from heat after a hurricane-related power outage cut off the air-conditioning system.

As a result, Gov. Rick Scott issued emergency rules that he later signed into laws requiring nursing homes and assisted living facilities to maintain a backup power source.

Virginia passed a similar law in 2019 requiring assisted living facilities to install and maintain adequately sized emergency generators or accept mobile generators.

Oregon’s Department of Human Services requires assisted living facilities with ventilator-assisted care to have a functional emergency backup generator.

Maryland’s health code requires assisted living facilities that serve 50 or more people to have an emergency electrical power generator on-site. It must be able to start immediately and reach full speed within 10 seconds.

Thierry said she believes a generator requirement bill must be brought before lawmakers again during the next legislative session.

“We are experiencing more frequent natural disasters and extreme weather-related events, so I feel like it’s clear that the bill I’ve been pushing for multiple sessions should be prioritized,” she said. “Ensuring that nursing homes and all assisted living centers in Texas have adequate and uniform standards for backup power is not only sensible, it's a matter of life and death.”

Thompson, who announced his retirement from the Texas House last year, said he is not optimistic about a bill’s chances.

“I don’t see much hope for the bill under the current environment,” Thompson said. “They are going to spend all their time talking about other things that don’t have an impact on people.”

Thompson’s advice to Texans is if a loved one is being put in a nursing home or assisted living facility, check to see if they have a backup generator. He said if they don’t, leave and find a place that does because this is the best way to initiate change.

How many Texas facilities have generators?

It took the crushing statewide power outage of the 2021’s winter storm to force Texas to take its most recent tally of how many of its senior facilities have generators on hand.

That 2022 survey yielded responses from 1,520 licensed assisted living facilities and 1,139 licensed nursing home facilities. About 47%, or 715, of the assisted living respondents reported having a generator on hand and 99%, or 1,132, of the nursing facilities that answered reported having one.

One caveat. There’s a lot of wiggle room in that survey. For one, it’s all self-reported information. None of it is independently verified, according to the Texas Department of Health and Human Services.

Also, having a generator and being able to cool an entire facility are two separate things. Facilities were only asked if their generator “is configured to providing cooling for at least part of the facility.” Not all senior facilities that said they had a generator could actually use one to cool an entire building.

In Harris County, providers like Hobson spent the better part of a week answering questions from frantic residents and families who worried about the power outage. Hobson said that a better communication process between utilities and hospitals, nursing homes and assisted living facilities could be where to start.

“If everyone learns from this we can hopefully make some progress before the next time,” she said. “We’re trying to answer our residents and their families and we just have to tell them ‘We don’t know.’ ”

On Friday, Hobson met with electricians, bracing for an estimate. She wants to know what it would cost for a larger, better power backup.

“It’s going to be extremely expensive,” she said. Could the government help, she wonders? “Any kind of help would be helpful.”

Disclosure: CenterPoint Energy and Texas Department of Health and Human Services have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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