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Nursing Homes Facing Life-or-Death Decisions in Power Blackouts

As the Pacific Gas & Electric Company in California tries to reduce wildfire risk by cutting power during times of high risk, care facilities like nursing homes are up against factors that could prove deadly to at-risk patients.

California has thus far experienced a slow fire season and that’s good news to skilled nursing homes, those that care for people with dementia, medically fragile patients, who could be forced to evacuate or experience a blackout of power.

The Pacific Gas & Electric Company, along with Southern California Edison and San Diego Gas & Electric, have adopted plans to shut off electricity during times when the threat of wildfire is high. That could prove problematic for a number of nursing homes, which may have backup power for just six hours.

“These facilities are required to have a very minimal emergency preparedness standard within the building,” said Jason Belden, disaster preparedness manager for the California Association of Health Facilities. “They have a diesel generator, or a gas-powered generator, and it must power for at least six hours for emergency plugs, lighting and fire protection systems.”

But none of that pertains to the HVAC units or keeping medicine cool and food from spoiling, things that would be necessary if a facility were forced to shelter in place. Most of the facilities in California don’t have the physical capacity to stay “islanded” for multiple days, Beldon said.

As far as evacuating, there is a mortality factor related to evacuating patients in these facilities. Beldon cited studies from multiple disasters that showed 3 percent mortality within 30 days after evacuation and 5 to 10 percent within 90 days.

That means that in the first 30 days after an event, the normal mortality rate for that population would be “X” plus 3 percent with the evacuation. “We’re talking about reducing their lifespan rather than actually killing them,” Beldon said. “We’re straining them so bad that they can’t overcome that and can’t get better.”

He said those fatalities aren’t considered when calculating deaths that are a direct result of the disaster.  “We’re not really thinking of those a loss of life in a response to an event. Nobody is considering these things when we’re proactively cutting off the power.”

So, the choice to shelter in place or evacuate could be a perilous one, depending on the facility and the nature of the event. After Hurricane Irma passed through south Florida in September 2017, a nursing home with 150 patients lost power and tried to shelter in place. It was so hot that 12 of the patients died.

“You shelter in place until you can’t,” said Lindsay Anderson, research assistant professor at University of South Florida. On the other hand, sometimes these facilities are encouraged or even forced to evacuate by local authorities, and most aren’t equipped to do that and don’t get the necessary assistance to do it safely.

Many of the patients have dementia, many need specialized food or equipment, have medical regimens that need to be adhered to, and all that can go out the window in an evacuation. “They’re there for a reason and they need skilled care,” Anderson said.

As of January of this year, such facilities had to create plans for backup power, but some got waivers because of noise ordinances or other local restrictions. “There are places that have paid for these expensive generators and they still aren’t connected because of a problem with local approval,” said Kathryn Hyer, director of the Florida Policy Exchange Center on Aging at the University of South Florida. “It’s harder than you might think.”

Back in California, the Association of Health Facilities is urging those within these facilities to prepare for power shutdowns by to entering into memorandums of understanding with industrial contractors or people who can supply temporary cooling and temporary generators.

“If we get a big event, where we get multiple facilities contacted to shut off power, that may overwhelm a community or county’s ability to assist in keeping those folks sheltered in the buildings and we don’t want to move them if we don’t have to,” Beldon said.