DOH NEWS

DEPARTMENT OF HEALTH Antonia C. Novello, M.D., M.P.H., Dr.P.H. Commissioner Contact: John F. Signor, (518) 474-7354

OFFICE OF MENTAL HEALTH James L. Stone Commissioner Contact: Roger Klingman, (518) 474-6540

ALBANY, July 16, 2002 - State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H. today announced that three Suffolk County adult care facilities (ACFs) have been cited for violations for their failure to maintain acceptable temperatures within the homes. State inspectors found in unannounced inspections conducted at the homes in the first week of July that temperatures in common areas and resident bedrooms exceeded 90 degrees Fahrenheit - above the 85 degree required temperature level. The homes cited for violations were Inver Adult Home, Montauk Manor and Holiday Manor.

"We are conducting this aggressive round of visits to ensure that adult homes have temperature control policies in place and are following them to protect the health and safety of residents," Commissioner Novello said. "The Department is committed to holding adult home operators accountable for the conditions in their homes. Those homes found in violation of temperature control regulations will be cited and required to take immediate actions to correct the violations, accommodate the needs of residents and cool the home to an acceptable temperature."

The State Health Department (the Department) has referred the three homes for enforcement action because they failed to comply with the heat-related directive issued by Commissioner Novello in a June 28, 2002 letter to all ACF operators statewide.

The June 28 letter contained detailed information regarding steps that ACF operators must follow to ensure the comfort, health and safety of residents, medications that may cause residents to become more susceptible to heat, rebate options available from NYSERDA in the purchasing of air conditioners, and, the signs and symptoms of heat illness (the steps to be taken by ACF operators are listed below). The Commissioner's June 28 directive also required adult homes that have air conditioning to turn those systems on to ensure comfortable temperatures for residents.

In addition to Commissioner Novello's June 28 letter, to further ensure the safety of residents, the Department has directed all adult homes identified with temperature control violations to provide fans in every resident bedroom and, where necessary, install air-conditioning to cool common areas of the home. ACF operators who fail to comply with State temperature control regulations may face enforcement action for endangering the welfare and safety of residents.

Today's actions are part of the State's ongoing surveillance of ACFs to ensure compliance with temperature control regulations. In addition to the focus surveys now being conducted, State Health Department inspectors routinely conduct a review of the temperatures in adult care facilities and determine whether the operators are taking necessary precautions to ensure that residents at risk for heat-related illnesses are appropriately cared for and provided plenty of fluids to prevent dehydration and other health-related complications. The homes must provide all residents with access to common areas of the home where temperatures have been cooled to comfortable levels.

The Department, the Commission on Quality Care for the Mentally Disabled (CQC) and the Office of Mental Health (OMH) are also working with the New York State Energy Research and Development Authority (NYSERDA) to provide ACFs with assistance to quickly purchase air-conditioners.

James L. Stone, Commissioner of the Office of Mental Health said, "Individuals on psychotropic medications often have adverse reactions to high temperatures, and are vulnerable to other heat-related illnesses. It's important for adult homes to provide appropriate care to adult home residents susceptible to heat-related illness during the hot summer months to further protect their health and well-being."

Gary O'Brien, Chairman of the Commission on Quality Care for the Mentally Disabled said, "The Commission is pleased with the Department of Health's action to ensure comfortable temperatures for residents within adult homes given the recent extreme heat conditions. Under Governor Pataki's leadership, New York is doing more than ever to protect adult home residents, who represent some of our state's most vulnerable citizens."

The New York State Energy Research and Development Authority (NYSERDA) is working with the Department of Health, CQC and OMH to help adult home operators ensure the health and safety of residents by providing incentives for the expedited purchase of Energy Star air conditioners, and also providing low- interest loans where needed for larger purchases.

"NYSERDA is pleased to be working with the Department of Health to help ensure the safety and comfort of the State's adult home population," said NYSERDA President William M. Flynn. " Working together, we are ensuring the well-being of residents."

Steps to be taken by Adult Care Facilities

High heat and elevated temperatures can have a significant impact on residents in adult care facilities, including the elderly and those taking various medications. The New York State Department of Health requires that every adult care facility:

• Identify all facility residents at risk of heat-related illness or problems;
• Have a formal heat policy and ensure that staff is aware of an understands such policy;
• Activate the heat policy when the outside temperature reaches 80 degrees;
• Have cooled areas within the facility where residents can be safely accommodated; and,
• Monitor residents and conditions within the facility.

In fulfilling these requirements, there are four key steps that must be taken by all facilities:

• Adult care facilities must identify all residents at risk of heat illness, including those that use medications which may cause added sensitivity to heat, that engage in physical activity, or are obese or have other conditions that increase sensitivity to heat.
• Adult care facilities must monitor temperatures within the facility. Temperatures should be taken:
• Inside the facility every hour when the outside temperature is 80 degrees
• The temperature should be taken in non-air conditioned rooms at several locations on each floor, and should be taken within the room closest to where sunlight enters. The temperature readings should be recorded in a log that includes the time, room location of the reading, and the name of the recorder.
• In common areas, both air-conditioned and non-air conditioned, the temperature should be taken every hour when the outside temperature is above 80 degrees. The temperature readings should be recorded in a log that includes the time, room location of the reading and the name of the recorder.
• In adult care facilities without individual air conditioned rooms, the facility must identify common areas that are cooler than 85 degrees so that residents can be located there in accordance with the facility heat policy. Common areas must be of sufficient size to safely accommodate the residents in the facility.
• If the resident exhibits any sign or symptom of heat illness, the facility must call 911 or a physician immediately and follow appropriate procedures, including: moving the resident to a cooler location; if the resident is conscious, offering cool fluids; and removing clothing to cool the resident.

High Heat Condition Checklist

The following checklist identifies a number of steps that facilities should follow during periods of high heat and elevated temperatures. At a minimum, all of these steps should be included in a facility's heat policy. The policy should take effect when the outside temperature reaches 80 degrees.

• Monitor residents for signs and symptoms of heat illness.
• Notify the physician of observations and obtain medical treatment when needed.
• Utilize ventilation, air circulation and air conditioning.
• Close windows and blinds/shades on sun-exposed walls, open windows on shaded walls, turn off heat generating devices.
• Assure adequate availability and ensure those residents drink fluids, i.e., water and fruit juices.
• Adjust menus, incorporating cold plates and other light foods.
• Encourage residents to stay out of the sun.
• Monitor residents engaged in physical activities.
• Move residents to cooler rooms.
• Make sure residents dress appropriately.
• Review the policies and procedures for heat emergency situations with staff periodically.
• Implement your emergency procedures if temporary relocation becomes necessary.

7/16/02-76 OPA