Doctor: Nursing home deaths show the risks of being old in Florida

Posted at 6:29 PM, Sep 14, 2017
and last updated 2017-09-14 18:29:50-04

During the first 20 days of August 2003, almost 15,000 elderly French citizens died as a heat wave hovered over that country. Temperatures had risen only 7.2 degrees Fahrenheit over their usual seasonal averages.

This week eight residents of a single Florida nursing home with its power knocked out from Hurricane Irma died within hours of each other. Indeed, the elderly are often the first victims in extreme weather events.

It is time we reconsider the wisdom of caring for people who are the most sensitive to the changing climate in homes that are situated at the very epicenter of the change.

Florida possesses about 200,000 nursing and assisted living facility beds, befitting a state with the highest percentage of elderly residents in the nation. These homes are air conditioned, unlike what we saw in France in 2003 (a situation that’s since been corrected).

But air conditioning only works when you’ve got electrical power, the first public utility to falter in a hurricane like Irma.

No question, facility managers should have evacuated their residents as soon as it became apparentFlorida Power and Light wasn’t on the way to fix the damaged transformer supplying their AC system, something their own electrician couldn’t fix. No question, they should have had a backup generator ready to keep their AC running in such an event.

And any facility can only compensate so much for the fundamental flaws of Florida’s infrastructure, which includesa lot of vulnerable above-ground lines.

Florida Power and Light works with state and local officials to identify key facilities where it must keep the power running at all costs — places like Memorial Regional Hospital, down the street from the nursing facility where the eight died. Does FPL have the ability to prioritize power restoration to every facility providing care for vulnerable people across the 35 Florida counties it serves? Probably not.

The Rehabilitation Center at Hollywood Hills wasn’t on that list, and FPL’s press releases make clear: “We prioritize restoring power to critical facilities, such as hospitals, police and fire stations, communication facilities, water treatment plants, transportation providers and shelters.” Not mentioned: nursing homes.

As we age, our nervous systems falter. It’s one reason so many older people suffer serious injuries in falls; they’re not as quick to react to a loss of balance, and if they tumble, lack the automatic protective response of swinging arms out just in time. Those are often injuries that can lead to nursing home care.

Our autonomic nervous system, which also declines with age, is responsible for controlling things like the dilation and constriction of blood vessels feeding your skin. Dilating those blood vessels is an essential way we release the heat building up in our bodies. The problem holds true even if you’re outwardly as fit and lean as a younger person. Someone who’s 75 has anywhere from 25% to 50% less blood flow to their skin than someone who’s 30.

The older we are, the easier heat will overtake us. This is one of the effects of aging we can’t seem to avoid.

Why then do so many of us, as we age, choose to live in a place that’s hot?

Everyone knows Florida’s a great place in the winter, but with AC it’s a great place in the summer, too. That AC is critical to the entire South. I’m from Alabama, but the hottest summers of my life were the ones I spent living in Boston.

Friends and co-workers there couldn’t believe it, but Southerners like myself have come to expect, as a sign of civilization, an arctic blast when opening any door. You don’t get that in Massachusetts, even in the places that claim to be air conditioned. What makes Tuscaloosa, Alabama, habitable makes it possible to age in place in Hollywood, Florida, too.

Floridians alone can’t be blamed for their state’s current predicament of over-construction and environmental vulnerability. Florida is all of us: it’s populated mostly by people from out of state,and if you don’t live there now don’t tell me you haven’t thought about it.

The state is the nation’s playground, too, to the extent that 1.4 million Florida jobs depend on rolling out the welcome mat.

It’s no wonder so many Americans choose to stay.

Millions of Americans transition into the ranks of the elderly year after year; 81 million Americans will be over 65 in the year 2050.

Some 68% of Americans over 65 ultimately need physical help whether from their families or in assisted living or nursing facilities.

What percentage of Americans should we be encouraging into Florida nursing facilities for their later years? The state didn’t have the infrastructure to handle Irma in 2017. What’s going to fundamentally change that will make it withstand coming storms? Are we really going to rebuild it that much better, enough so that every facility providing care, not just major hospitals, can withstand Category 4 and 5 winds?

Florida’s elder care is everybody’s problem. Between Medicare and Medicaid, federal funds cover the majority of the nation’s nursing home costs, including those in the Sunshine State.

Should we be paying the same rates for such care in areas of the country that are the most vulnerable to climate change, and thus, imperiling the safety of their residents? It’s time we consider, as a national priority, gradually shifting federal long-term care funds toward areas of the country (even areas of Florida) where we have the infrastructure we need and the ability to maintain it.

Related links:

At least 8 dead after Florida nursing home left with no A/C from Irma

Full Coverage: Hurricane Irma