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Nursing Homes Are Left in the Dark as More Utilities Cut Power to Prevent Wildfires

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Kate Ruder
Mon, 10 Jun 2024 09:00:00 +0000

When powerful wind gusts created threatening wildfire conditions one day near Boulder, Colorado, the state's largest utility cut power to 52,000 homes and businesses — including Frasier, an assisted living and skilled nursing facility.

It was the first time Xcel Energy preemptively switched off electricity in Colorado as a wildfire prevention tool, according to a company official. The practice, also known as public safety power shut-offs, has taken root in California and is spreading elsewhere as a way to keep downed and damaged power lines from sparking blazes and fueling the West's more frequent and intense wildfires.

In Boulder, Frasier staff and residents heard about the planned outage from reports. A Frasier official called the utility to confirm and was initially told the home's power would not be affected. The utility then called back to say the home's power would be cut, after all, said Tomas Mendez, Frasier's vice president of operations. The home had just 75 minutes before Xcel Energy shut off the lights on April 6.

Staff rushed to prepare the 20-acre campus home to nearly 500 residents. Generators kept running the oxygen machines, most refrigerators and freezers, hallway lights, and Wi-Fi for phones and computers. But the heating system and some lights stayed off as the overnight temperature dipped into the 30s.

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Power was restored to Frasier after 28 hours. During the shut-off, staff tended to nursing home and assisted living residents, many with dementia, Mendez said.

“These are the folks that depend on us for everything: meals, care, and medications,” he said.

Not knowing when power would be restored, even 24 hours into the crisis, was stressful and expensive, including the next-day cost of refilling fuel for two generators, Mendez said.

“We're lucky we didn't have any injuries or anything major, but it is likely these could happen when there are power outages — expected or unexpected. And that puts everyone at risk,” Mendez said.

As preemptive power cuts become more widespread, nursing homes are being forced to evaluate their preparedness. But it shouldn't be up to the facilities alone, according to industry officials and academics: Better communication between utilities and nursing homes, and including the facilities in regional disaster preparedness plans, is critical to keep residents safe.

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“We need to prioritize these folks so that when the power does go out, they get to the front of the line to restore their power accordingly,” said David Dosa, chief of geriatrics and professor of medicine at UMass Chan Medical School in Worcester, Massachusetts, of nursing home residents.

Restoring power to hospitals and nursing homes was a priority throughout the windstorm, wrote Xcel Energy spokesperson Tyler Bryant in an email. But, he acknowledged, public safety power shut-offs can improve, and the utility will work with community partners and the Colorado Public Utilities Commission to help facilities prepare for extended power outages in the future.

When the forecast called for wind gusts of up to 100 mph on April 6, Xcel Energy implemented a public safety power shut-off. Nearly 275,000 customers were without power from the windstorm.

Officials had adapted after the Marshall Fire killed two people and destroyed or damaged more than 1,000 homes in Boulder and the neighboring communities of Louisville and Superior two and a half years ago. Two fires converged to form that blaze, and electricity from an Xcel Energy power line that detached from its pole in hurricane-force winds “was the most probable cause” of one of them.

“A preemptive shutdown is scary because you don't really have an end in mind. They don't tell you the duration,” said Jenny Albertson, director of quality and regulatory affairs for the Colorado Health Care Association and Center for Assisted Living.

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More than half of nursing homes in the West are within 3.1 miles of an area with elevated wildfire risk, according to a study published last year. Yet, nursing homes with the greatest risk of fire danger in the Mountain West and Pacific Northwest had poorer compliance with federal emergency preparedness standards than their lower-risk counterparts.

Under federal guidelines, nursing homes must have disaster response plans that include emergency power or building evacuation. Those plans don't necessarily include contingencies for public safety power shut-offs, which have increased in the past five years but are still relatively new. And nursing homes in the West are rushing to catch up.

In California, a more stringent law to bring emergency power in nursing homes up to code is expected by the California Association of Health Facilities to cost over $1 billion. But the state has not allocated any funding for these facilities to comply, said Corey Egel, the association's director of public affairs. The association is asking state officials to delay implementation of the law for five years, to Jan. 1, 2029.

Most nursing homes operate on a razor's edge in terms of federal reimbursement, Dosa said, and it's incredibly expensive to retrofit an old building to keep up with new regulations.

Frasier's three buildings for its 300 residents in independent living apartments each have their own generators, in addition to two generators for assisted living and skilled nursing, but none is hooked up to emergency air conditioning or heat because those systems require too much energy.

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Keeping residents warm during a minus-10-degree night or cool during two 90-degree days in Boulder “are the kinds of things we need to think about as we consider a future with preemptive power outages,” Mendez said.

Federal audits of emergency preparedness at nursing homes in California and Colorado found facilities lacking. In Colorado, eight of 20 nursing homes had deficiencies related to emergency supplies and power, according to the report. These included three nursing homes without plans for alternate energy sources like generators and four nursing homes without documentation showing generators had been properly tested, maintained, and inspected.

For Debra Saliba, director of UCLA's Anna and Harry Borun Center for Gerontological Research, making sure nursing homes are part of emergency response plans could help them respond effectively to any kind of power outage. Her study of nursing homes after a magnitude 6.7 earthquake that shook the Los Angeles area in 1994 motivated LA County to integrate nursing homes into community disaster plans and drills.

Too often, nursing homes are forgotten during emergencies because they are not seen by government agencies or utilities as health care facilities, like hospitals or dialysis centers, Saliba added.

Albertson said she is working with hospitals and community emergency response coalitions in Colorado on disaster preparedness plans that include nursing homes. But understanding Xcel Energy's prioritization plan for power restoration would also help her prepare, she said.

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Bryant said Xcel Energy's prioritization plan for health facilities specifies not whether their electricity will be turned off during a public safety power shut-off — but how quickly it will be restored.

Julie Soltis, Frasier's director of communications, said the home had plenty of blankets, flashlights, and batteries during the outage. But Frasier plans to invest in headlamps for caregivers, and during a town hall meeting, independent living residents were encouraged to purchase their own backup power for mobile phones and other electronics, she said.

Soltis hopes her facility is spared during the next public safety power shut-off or at least given more time to respond.

“With weather and climate change, this is definitely not the last time this will happen,” she said.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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By: Kate Ruder
Title: Nursing Homes Are Left in the Dark as More Utilities Cut Power to Prevent Wildfires
Sourced From: kffhealthnews.org/news/article/nursing-homes-power-shut-offs-outages-wildfires-preparedness/
Published Date: Mon, 10 Jun 2024 09:00:00 +0000

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Union With Labor Dispute of Its Own Threatens to Cut Off Workers’ Health Benefits

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Phil Galewitz, KFF
Fri, 26 Jul 2024 09:00:00 +0000

The National Education Association, the nation's largest union, is threatening to cut off insurance to about 300 Washington, D.C.-based workers on Aug. 1 in an effort to end a bitter contract dispute.

It's a tactic some private employers have used as leverage against unionized workers that has drawn scrutiny from congressional Democrats and is prohibited for state employers in California. Experts on labor law say they've never seen a union make the move against its own workers.

“This is like a man-bites-dog situation where the union is now in a position as the employer,” said Paul Clark, a professor of labor and employment relations at Penn State University. “It's not a good look for a union.”

NEA workers with pressing health needs are worried but say they won't fold. Joye Mercer Barksdale, a writer on the NEA's government relations team, said she needs coverage for a medical procedure to address atrial fibrillation, a cardiac disorder. “This is insane for the NEA to use our health benefits as a bargaining chip,” she said.

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But Barksdale said the threat isn't enough to force her to agree to an unacceptable contract. “I am not ready to give in,” she said.

The NEA Staff Organization, the union representing workers at the NEA's headquarters, launched a strike on July 5 in Philadelphia, during the union's annual delegate assembly. It was its second walkout this summer as the two parties negotiate a new contract, navigating sticking points such as wages and remote work.

In response, the NEA ended the conference early. President Joe Biden was supposed to speak at the event but withdrew, refusing to cross the picket line. The NEA on July 24 endorsed Kamala Harris for president.

On July 8, the day after the conference had been scheduled to end, the NEA locked out workers. In a letter the day before, the NEA informed its unionized workers that they would not be paid, effective immediately, and their health benefits would expire at the end of July unless a new deal were reached.

“NEA cannot allow NEASO to act again in a way that will bring such lasting harm to our members and our organization,” Kim Anderson, the NEA's executive director, wrote in the letter, obtained by KFF Health News. “We are, and have always been, committed both to our union values and to the importance of conducting ourselves as a model employer.”

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Democrats in Congress, including Sens. Sherrod Brown of Ohio and Bob Casey of Pennsylvania, introduced legislation last year to protect striking workers from losing their health benefits, after several large companies, including General Motors, John Deere, RTX (formerly Raytheon Technologies), and the maker of Kellogg's cereals, threatened to or did cut off coverage during labor disputes.

“Workers shouldn't have to choose between their family's health and a fair contract,” Brown said in a statement to KFF Health .

The legislation was endorsed by large labor unions including the Service Employees International Union and United Steelworkers, according to a press release from Brown's office. The NEA wasn't among them.

“This tactic is immoral, and it should be illegal,” United Steelworkers' president at the time, Thomas Conway, said in the release.

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Officials at the NEA, which represents teachers and other administrators, declined an interview request. In a statement, the organization's president, Becky Pringle, said “we are making every effort to reach an agreement as quickly as possible” with its staff union.

“As union leaders who have been on strike, we recognize the significance and impact of these important decisions on a personal and family level. We truly value our employees and look forward to continued collaboration with NEASO to develop a new contract that benefits us all,” she said.

Kate Hilts, a digital strategist who works for the NEA, said she fears losing her coverage will leave her unable to afford treatment for a rare autoimmune disease that attacks her kidneys. Her next treatment was slated for August.

“I wake up every day and can't believe this is happening,” she said. “You would expect this from an employer that is antiworker or has a terrible labor record, but I am totally flabbergasted that a labor union would do this that bills itself as pro-worker, pro-family, pro-education, and pro-children.”

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The NEA staff union has filed multiple charges with the National Labor Relations Board this year, including allegations that the NEA withheld holiday overtime pay and failed to provide information on the outsourcing of millions of dollars in bargaining unit work.

California is one of the only states that protect striking workers from losing health coverage. The state legislature passed a law in 2021 that blocks the tactic from being used against public employees and another law in 2022 that allows any striking workers who lose their insurance to immediately get heavily discounted coverage through the state's Affordable Care Act marketplace.

If they remain locked out, the NEA workers would be eligible for coverage under COBRA, a federal program that allows people who are fired or laid off to maintain their employer-sponsored insurance for 18 months.

But the coverage can be a financial hardship, as individuals often must pay the entire cost of their insurance premiums, plus a 2% administrative fee.

Another option for workers would be coverage through the Affordable Care Act marketplace, though that also could be costly. And it may be unclear how soon that coverage would begin or whether insurers would cover their existing doctors.

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“I'm hoping the NEA will be so ashamed of what they are doing that, at the very least, they will not take away our health benefits,” Barksdale said.

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By: Phil Galewitz, KFF Health News
Title: Union With Labor Dispute of Its Own Threatens to Cut Off Workers' Health Benefits
Sourced From: kffhealthnews.org/news/article/nea-national-education-association-union-threatens-health-insurance-benefit-lockout/
Published Date: Fri, 26 Jul 2024 09:00:00 +0000

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The CDC’s Test for Bird Flu Works, but It Has Issues

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Arthur Allen and Amy Maxmen
Fri, 26 Jul 2024 09:00:00 +0000

The Centers for Disease Control and Prevention says a glitch in its bird flu test hasn't harmed the agency's outbreak response. But it has ignited scrutiny of its go-it-alone approach in testing for emerging pathogens.

The agency has quietly worked since April to resolve a nagging issue with the test it developed, even as the virus swept through dairy farms and chicken houses across the country and infected at least 13 farmworkers this year.

At a congressional hearing July 23, Rep. Brett Guthrie (R-Ky.) asked about the issue. “Boy, that rings of 2020,” he said, referring to when the nation was caught off guard by the covid-19 pandemic, in part because of dysfunctional tests made by the CDC. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, responded that the agency rapidly developed a workaround that makes its bird flu test reliable.

“The tests are 100% usable,” he later told KFF , adding that the FDA studied the tests and came to the same conclusion. The imperfect tests, which have a faulty element that sometimes requires testing a sample again, will be replaced soon. He added, “We have made sure that we're offering a high-quality product.”

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Still, some researchers were unnerved by the news coming four months after the government declared a worrisome bird flu outbreak among cattle. The CDC's test is the only one available for clinical use. Some researchers say its flaws, though manageable, underscore the risk of relying on a single entity for testing.

The problem came to light in April as the agency prepared to distribute its test to about 100 public health labs around the country. CDC officials detected the issue through a quality control system put in place after the covid test catastrophe of 2020.

Daskalakis said the CDC's original test design was fine, but a flaw emerged when a company contracted by the agency manufactured the tests in bulk. In these tests, one of two components that recognize proteins called H5 in the H5N1 bird flu virus was unreliable, eliminating an important safeguard. By targeting the same protein twice, tests have a built-in backup in case one part fails.

The agency developed a fix to ensure a reliable result: If only one of the two parts detected H5, the test was considered inconclusive and would be run again. With the FDA's blessing, the CDC distributed the tests — with workaround instructions — to public health labs.

Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, said the results of the tests have not been ambiguous, and there is no need to discard the tests.

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Still, the agency has asked a different manufacturer to remake the faulty component so that 1.2 million improved tests will be available soon, Daskalakis said. Some of the updated tests are already in stock at the CDC, but the FDA hasn't yet signed off on their use. Daskalakis declined to name the manufacturers.

Meanwhile, the outbreak has grown. Farmworkers continue to lack information about the virus and gear to protect them from it. Rural clinics may miss cases if they don't catch a person's connection to a farm and notify health officials rather than their usual diagnostic testing laboratories.

Those clinical labs remain unauthorized to test for the bird flu. Several of those labs have spent months working through analyses and red tape so that they can run the CDC's tests. As part of the licensing process, the CDC alerted them to the workaround with the current test, too.

But outside select circles, the news was largely overlooked. “I'm totally surprised by this,” Alex Greninger, assistant director of the University of Washington Clinical Virology Laboratory, told KFF this week. Greninger's lab is developing its own test and has been trying to obtain CDC test kits to evaluate.

“It's not a red alarm,” he said, but he's worried that as the CDC and the FDA spend months developing and evaluating an updated test, the only one available relies on a single component. If the genetic code underlying that fragment of the H5 protein mutates, the test could give false results.

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It's not uncommon for academic and commercial diagnostic labs to make mistakes and catch them during quality control checks, as the CDC did. Still, this isn't the agency's first mishap. In 2016, well before the covid debacle, CDC officials for months directed public health labs to use a Zika test that failed about a third of the time.

The CDC caught and worked to remediate the situation far more quickly and effectively in this case. Nonetheless, the mishap raises concern. Michael Mina, chief science officer of the telemedicine company eMed.com, said diagnostic companies may be better suited to the task.

“It's a reminder that CDC is not a robust manufacturer of tests” and lacks the resources that industry can marshal for their production, Mina said. “We do not ask CDC to make vaccines and pharmaceuticals, and we do not ask the Pentagon to manufacture missiles.”

The CDC has licensed its updated test design to at least seven clinical diagnostic labs. Such labs are the foundation of testing in the U.S. But none have FDA clearance to use them.

Diagnostic labs are developing their own tests, too. But that has been slow-going. One reason is the lack of guaranteed sales. Another is regulatory uncertainty. Recent FDA guidance could make it harder for nongovernmental laboratories to issue new tests in the early phase of pandemics, said Susan Van Meter, president of the American Clinical Laboratory Association, in a July 1 letter to the FDA.

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Transparency is also critical, scientists said. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, said as a public agency the CDC should make its protocol — its recipe for making the test — easily accessible online.

The World Health Organization does so for its bird flu tests, and with that information in hand, Pinsky's lab has developed an H5 bird flu test suited to the strain circulating this year in the U.S. The lab published its approach this month but doesn't have FDA authorization for its broad use.

The CDC's test recipe is available in a published patent, Daskalakis said.

“We have made sure that tests are out there, and that they work,” he added.

As the CDC came under fire at the July 23 congressional hearing, Daniel Jernigan, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, noted that testing is just one tool. The agency needs money for another promising area — looking for the virus in wastewater. Its current program uses supplemental funds, he said: “It is not in the current budget and will go away without additional funding.”

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——————————
By: Arthur Allen and Amy Maxmen
Title: The CDC's Test for Bird Flu Works, but It Has Issues
Sourced From: kffhealthnews.org/news/article/bird-flu-test-cdc-flaws/
Published Date: Fri, 26 Jul 2024 09:00:00 +0000

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KFF Health News’ ‘What the Health?’: Harris in the Spotlight

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Thu, 25 Jul 2024 18:45:00 +0000

The Host

Julie Rovner
KFF


@jrovner


Read Julie's stories.

Julie Rovner is chief Washington correspondent and host of KFF ' weekly health policy news , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

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As Vice President Kamala Harris appears poised to become the Democratic Party's presidential nominee, health policy in general and reproductive health issues in particular are likely to have a higher profile. Harris has long been the Biden administration's point person on abortion rights and reproductive health and was active on other health issues while serving as California's attorney general.

Meanwhile, Congress is back for a brief session between presidential conventions, but efforts in the GOP-led House to pass the annual spending bills, due by Oct. 1, have run into the usual roadblocks over abortion-related issues.

This week's panelists are Julie Rovner of KFF Health News, Stephanie Armour of KFF Health News, Rachel Cohrs Zhang of Stat, and Alice Miranda Ollstein of Politico.

Panelists

Stephanie Armour
KFF Health News


@StephArmour1

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Read Stephanie's stories.

Rachel Cohrs Zhang
Stat News


@rachelcohrs


Read Rachel's stories.

Alice Miranda Ollstein
Politico

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@AliceOllstein


Read Alice's stories.

Among the takeaways from this week's episode:

  • President Joe Biden's decision to drop out of the presidential race has turned attention to his likely successor on the Democratic ticket, Vice President Kamala Harris. At this late hour in the campaign, she is expected to adopt Biden's health policies, though many anticipate she'll take a firmer stance on restoring Roe v. Wade. And while abortion rights supporters are enthusiastic about Harris' candidacy, opponents are eager to frame her views as extreme.
  • As he transitions from incumbent candidate to outgoing president, Biden is working to frame his legacy, including on health policy. The president has expressed pride that his signature domestic achievement, the Inflation Reduction Act, took on the pharmaceutical industry, including by forcing the makers of the most expensive drugs into negotiations with Medicare. Yet, as with the Affordable Care Act's delayed implementation and results, most Americans have yet to see the IRA's potential effect on drug prices.
  • Lawmakers continue to be hung up on federal government spending, leaving appropriations work undone as they prepare to leave for summer recess. Fights over abortion are, once again, gumming up the works.
  • In abortion news, Iowa's six-week limit is scheduled to take effect next week, causing rippling problems of abortion access throughout the region. In Louisiana, which added the two drugs used in medication abortions to its list of controlled substances, doctors are having difficulty using the pills for other indications. And doctors who oppose abortion are pushing higher-risk procedures, like cesarean sections, in lieu of pregnancy termination when the mother's life is in danger — as states with strict bans, like Texas and Louisiana, are reporting a rise in the use of surgeries, including hysterectomies, to end pregnancies.
  • The Government Accountability Office reports that many states incorrectly removed hundreds of thousands of eligible people from the Medicaid rolls during the “unwinding” of the covid-19 public health emergency's coverage protections. The Biden administration has been reluctant to call out those states publicly in an attempt to keep the process as apolitical as possible.

Also this week, Rovner interviews Anthony Wright, the new executive director of the consumer health advocacy group Families USA. Wright spent the past two decades in California, working with, among others, now-Vice President Kamala Harris on various health issues.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: NPR's “A Study Finds That Dogs Can Smell Your Stress — And Make Decisions Accordingly,” by Rachel Treisman.  

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Alice Miranda Ollstein: Stat's “A Pricey Gilead HIV Drug Could Be Made for Dramatically Less Than the Company Charges,” by Ed Silverman, and Politico's “Federal HIV Program Set To Wind Down,” by Alice Miranda Ollstein and David Lim. 

Stephanie Armour: Vox's “Free Medical School Won't Solve the Doctor Shortage,” by Dylan Scott.  

Rachel Cohrs Zhang: Stat's “How UnitedHealth Harnesses Its Physician Empire To Squeeze Profits out of Patients,” by Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence. 

Also mentioned on this week's podcast:

Credits

Francis Ying
Audio producer

Emmarie Huetteman
Editor

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To hear all our click here.

And subscribe to KFF Health News' “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Title: KFF Health News' ‘What the Health?': Harris in the Spotlight
Sourced From: kffhealthnews.org/news/podcast/what-the-health-357-kamala-harris-campaign-health-policy-july-25-2024/
Published Date: Thu, 25 Jul 2024 18:45:00 +0000

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