A nursing home failed to repair its malfunctioning air conditioning system in a timely manner causing a resident to experience heat exhaustion, and nursing staff did not implement recognized protocol to help residents avoid heat exhaustion. F908, F921, F923 Maintain all mechanical, electrical, and patient care equipment in safe operating condition.
Healthcare Compliance Perspective – Heat Exhaustion:
The Compliance Officer will review the facility’s policies and procedures with the DON, the Administrator and the Maintenance Supervisor to ensure that a quality of care protocol is in place during times when heat and air conditioning systems may not be operational due to weather, power outages or mechanical failure. Staff should receive education and training about the vulnerability of the elderly to extreme temperature changes (hot or cold) and the need to provide a high standard of care whatever the circumstances to prevent submission of claims for substandard quality of care that might be considered worthless services or fraudulent billing under federal and state regulations. The maintenance staff will be educated on the importance of providing regular maintenance checks on the heating and air conditioning systems, and to notify the administrator immediately if a malfunction occurs. An audit will be conducted periodically to verify that all heating and air conditioning systems are operational and receiving regular maintenance checks, and that indoor temperatures are maintained between 71 and 81 degrees as required by F584 Safe Environment.
During the Memorial Day weekend last May, the temperatures outside an Indiana nursing and rehabilitation facility were reported to be between 86 and 95 degrees. Inside the facility the temperatures were reported to be between 81 and 86 degrees even with fans being used to cool the facility.
A maintenance supervisor at the facility was aware that the air conditioning units for one of the facility’s units were not working on May 25, the Friday of the Memorial Day weekend, but that fact was not communicated to the facility’s administrator until May 29, the day after the holiday weekend.
During the long weekend, one resident had to be taken to the emergency room due to heat exhaustion. This incident triggered an investigation by the State’s Department of Health and investigators toured the facility during the evening of May 29. During the inspection, the temperatures in 13 of the rooms occupied by the residents ranged between 81 and 86 degrees.
Although each room had a fan, the inspectors noted that there was no fresh water or any wet cloths in the rooms. Staff were interviewed and reported that in spite of the residents’ complaints about the heat, “there had been no monitoring for heat-related illnesses initiated.”
Several residents told the investigators that the temperature in the building had been uncomfortable for several weeks. It was also noted that some of the fans in the residents’ rooms belonged to the residents and were not provided by the facility.
The facility received a citation from the State for “failure to meet federal regulations of care, posing an immediate jeopardy to the care of its residents.” So far, there has been no notification of a fine being imposed.
