Florida Operators Face Stiff Competition, Steep Costs to Meet Emergency Rules

As the Atlantic hurricane season kicks off, skilled nursing providers in Florida have been working to meet the requirements of the state’s new nursing home generator law.

There have been hurdles along the way. The law, first proposed in the wake of the deaths that followed Hurricane Irma at the Rehabilitation Center at Hollywood Hills, became law in March after legal tangles and opposition from provider groups.

Under the legislation, SNFs and assisted living facilities are required to have generators that can maintain a temperature of 81 degrees or lower for four days. The deadline for compliance was June 1, but SNFs could apply for an extension if needed.


Hurdles abound, however, according to both LeadingAge Florida — which primarily represents non-profit providers — and the Florida Health Care Association (FHCA), the state’s affiliate of the American Health Care Association (AHCA).

“This has been a journey for our members to make sure they are able to have the generators properly installed,” Kristen Knapp, director of communications for the FHCA, told SNN. “It’s about a 38-week process, start to finish, to install one of these generators.”

Resource crunch


Even getting to that installation process has been complicated. The Southeast has been dealing with the aftermath of several different storms, Steve Bahmer, president and CEO of LeadingAge Florida, said: Texas had Hurricane Harvey, Florida had Hurricane Irma, and Puerto Rico had Hurricane Maria.

As a result, there’s been a shortage of resources even without the compressed timeline that the state first devised. LeadingAge Florida expressed opposition to the initial order by Florida Gov. Rick Scott, which gave SNFs and assisted living facilities 60 days to install generators and stock enough fuel for 96 hours after a power outage, arguing the timeline was impossible for providers to meet.

“Ultimately what happened was we were able to be in touch with the governor’s office and sit down with them and talk with them about what our concerns were about the emergency rules, and how those rules might be resolved in a way that still achieves the goal but makes it possible for providers to comply,” Bahmer said.

The main concern was being able to meet emergency requirements safely within a given timeline, both Bahmer and Knapp said. The generators need to be customized, while construction and storing 96 hours of fuel on a campus requires navigating local zoning regulations. Nursing homes’ emergency plans also have to be approved by local officials, Knapp said.

And once plans are approved, providers have to find a generator company, electrical and structural engineers, and construction workers, Bahmer said. With more than 3,000 assisted living facilities and well over 600 nursing homes in Florida, the demand for all those services is sky-high.

“Figuring out how to pay for it has been a very real issue,” he said. “But our members’ concern was never really about the cost.”

Still, the costs are considerable. On average, the total compliance bill was in the range of $350,000, according to both Knapp and Bahmer. Some of LeadingAge’s members in the state with multiple locations, though, could be spending multiple millions of dollars to comply, Bahmer added.

Working toward compliance

When asked about how many of the FHCA’s member nursing homes are in compliance, Knapp had no specific numbers, but pointed out that the Florida Agency for Health Care Administration recently launched an interactive website that shows how many facilities are in compliance with the emergency power rules — broken down by region and county. According to that site, almost 60% of nursing homes in Florida have had their plans approved.

Bahmer said 46 of Leading Age Florida’s just over 100 nursing homes were approved for an extension, while officially 19 are listed as noncompliant.*

“In every case I know of, it was a paperwork situation where there was a form that needed to be submitted or [something similar],” he said, adding the number of genuinely non-compliant members is even smaller.

In addition, if a facility has applied for and received an extension, they are in compliance with the law, Bahmer emphasized.

“The fact is that if you need that extension and the state has granted it, you are compliant, still working to full completion of your plan,” he said.

Both Knapp and Bahmer stressed that nursing homes in the state want to keep their residents safe and were willing to shoulder the expense and trouble needed to do so. Knapp in particular noted that partnerships at the local level have been strengthened as a result of the emergency preparation work, such as power companies reaching out to FHCA to offer assistance to nursing homes that experience outages.

“We live in a state where we have hurricanes, so you have to be constantly focused and mindful of that,” Knapp said. “Because you can never be too safe.”

Written by Maggie Flynn

*This article has been updated to include the number of LeadingAge Florida’s nursing homes that received an extension. At the time of the interview, 19 of LeadingAge’s member homes were not compliant; all of its nursing homes have attained compliance since.

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