This piece was first published in The Assembly
By Carli Brosseau
The Assembly
For at least a decade, no list of top places to retire seemed complete without Asheville, hailed for its temperate weather, proximity to natural wonders, and vibrant artistic scene.
The retirement-aged population in the mountain city boomed. People 65 years and older accounted for 96 percent of the 3,400-person increase in Buncombe County’s population from 2020 to 2022, the Asheville Watchdog reported. Across Western North Carolina, the share of older people is now about five points higher than the statewide average, data compiled by the state demographer’s office show.
So, when Hurricane Helene brought “biblical devastation” and widespread power outages to the area, it found a population particularly predisposed to suffer. Researchers have repeatedly found that older people are at heightened risk of death during and in the aftermath of tropical cyclones. An analysis of more than 500 such storms released this week suggests that Helene could result in thousands of deaths over the next several years, with about half expected among older people.
Days after Helene hit, thousands of people in western North Carolina were living in elder-care homes that were still disconnected from commercial power and municipal water service, officials have said. Residents of at least four facilities have had to be evacuated since the storm. The state has less stringent emergency preparedness rules for such facilities than other states frequently hit by extreme weather, and in recent years both the federal government and advocates for older people and those with disabilities have identified holes in North Carolina’s enforcement of safety standards.
The vast majority of older people in the mountains live at home, but roughly 17,000 people are in facilities that provide extra care. There are 91 nursing homes and 121 assisted-living facilities in the area heavily impacted by the storm, Kody Kinsley, secretary of N.C. Department of Health and Human Services, said during a news conference Tuesday.
Helene: Resources By County by Anna MacDonald
While state law and federal regulations mandate that nursing homes be prepared to provide backup power, assisted-living facilities, which typically house people with less acute medical problems, face no such requirement in North Carolina.
State Rep. Julia C. Howard Credit: NC General Assembly
In 2019, after a power outage left residents of an assisted-living facility in the Blue Ridge foothills without power in frigid temperatures for 12 and a half hours, state Rep. Julia Howard, a senior member of the House Republican majority, sought to change that. Under her plan, facilities would have to have generators to power not just lights and temperature-control systems, but also “other essential services” such as dispensing medications.
The bill Howard proposed, H.B. 410, died in the Senate even after being watered down to require only that the issue receive further study. The opposition, which was bipartisan, centered on cost. An industry lobbyist told lawmakers the requirement would cost adult-care homes about $84 million, NC Health News reported.
Florida has required its assisted-living facilities to comply with a similar measure since 2018. Maryland now does too, for facilities with 50 or more residents, and other states, including Texas, have been evaluating the issue as extreme weather events escalate.
The Assembly could not determine what share of assisted-living facilities in the area devastated by Helene have installed generators or signed contracts to have them brought in before storms. Many facilities have taken those steps voluntarily, said Jeff Horton, executive director of the N.C. Senior Living Association, and Frances Messer, president and CEO of the N.C. Assisted Living Association. Facilities get merit points during their state inspections if they have made provisions for backup power, Messer said.
In some parts of western North Carolina, voluntary compliance has been high. Every facility with more than six residents in Alexander, Burke, Caldwell, and Catawba counties had a generator installed or was able to get one quickly, said Tina Miller, the director of the Area Agency on Aging in those counties. Similar information was not immediately available from those agencies in other mountain counties, the state long-term care ombudsman, or a DHHS spokesperson.
There are, however, some elder-care facilities that lack backup power, Horton said. They tend to be dependent on public funding for resident room and board payments and Medicaid to pay for personal care, he said.
“What we usually see is providers whose revenue is primarily private pay (upwards of $8,000/month in many cases), can charge much higher rates than public funding pays and are able to afford generators,” Horton wrote in an email.
Some facilities heavily reliant on public pay have concluded that they can afford neither the electrical hookups required for a contract generator nor the lease-to-own arrangements floated by major utility companies, he said. The cost ranges from about $50,000 for just the hookups to $200,000 or more for a full installation, depending on the facility’s size, according to Horton. Maintenance costs come on top of that.
Before Helene arrived, state officials were in the process of revising the emergency preparedness rules for assisted-living facilities. The proposed rules, which are open for public comment until Nov. 15, would require assisted-living facilities to spell out in their emergency plans how they would respond to weather events such as hurricanes, utility outages, and interruptions in communications such as phone or internet. A 2020 investigation by The News & Observer found that assisted-living facilities in eastern North Carolina had often shirked the state’s disaster-planning requirements and local emergency managers felt powerless to hold them to account.
Kay Paksoy Castillo, the executive director of Friends of Residents in Long Term Care, said the group supports the stronger standards.
There is uneven emergency preparedness among nursing homes, too, even though they are required to have backup power. A 2020 audit by the U.S. Department of Health and Human Services’s inspector general found that North Carolina had not ensured that its nursing homes met federal standards. It sampled 20 high-risk nursing homes and identified 124 instances of noncompliance with emergency preparedness requirements, including emergency power. Four nursing homes did not properly perform generator weekly maintenance checks, monthly performance tests, or annual fuel quality tests, according to the report.
Kinsley and other emergency managers have stressed this week that all elder-care facilities impacted by Helene had been contacted and were receiving help, including emergency water.
Patients from four facilities have been evacuated, and DHHS was working with three other facilities to move patients as medically necessary, a department spokeswoman said Tuesday.
The department didn’t give details. But some information has been trickling out in social media posts and local news accounts.
With the Reddies River in North Wilkesboro rising last Thursday, about 50 people were transferred from Rose Glen Manor to another facility in Mount Airy, the Journal Patriot reported. One wing of the building was less than 100 feet from the water.
On Tuesday, volunteer pilots evacuated about 100 older people—many with dementia—from Burnsville, near Mount Mitchell, the Charlotte Observer reported. They came from Yancey House, Mitchell House, and other nearby facilities, according to the report.
Navion Senior Solutions, which operates senior-living homes across the Southeast, has posted frequent updates to Facebook about its communities in the region, noting when facilities had their power restored. By Wednesday evening, all but two of its facilities had commercial power. The exceptions were Carolina Reserve of Hendersonville and Carolina Reserve of Laurel Park, also in Hendersonville. Both were running on generators.
Messer, of the N.C. Assisted Living Association, said the biggest challenge now facing facilities is staffing. “The N.C. National Guard and N.C. Emergency Management Services are assisting with the delivery of food, medicines, and supplies as many roads have been decimated,” she said.
Carli Brosseau is a reporter at The Assembly. She joined us from The News & Observer, where she was an investigative reporter. Her work has been honored by the Online News Association and Investigative Reporters and Editors, and published by ProPublica and The New York Times.
The post Helene left some N.C. elder-care homes without power appeared first on North Carolina Health News.
