Deaths after Irma put spotlight on nursing homes. Most still don't meet requirements.

ORLANDO, Fla. — As Hurricane Dorian surges toward Florida's east coast with the potential for destructive winds and high surf, hundreds of the state's elder care facilities still don't meet all of the requirements for emergency power plans under state law. Instead, many sites are still asking for more time to get their backup power and fuel in order, state data shows.

Mary Mayhew, secretary of the state's Agency for Health Care Administration, said facilities that fail to comply "will continue to be held accountable" and face sanctions. Between August 2018 and August 2019, almost 300 facilities have been fined for failing to follow the regulations, including part of a law signed last year by then-Gov. Rick Scott.

The state's more than 3,700 nursing homes and assisted living facilities are now required to have the capability to keep indoor temperatures from going above 81 degrees for at least 96 hours after a power outage. Doing so requires them to purchase generators.

The industry remains under heightened scrutiny two years after Hurricane Irma struck Florida and led to the deaths of a dozen residents at a nursing home north of Miami. The Rehabilitation Center at Hollywood Hills lost air conditioning and overheated in the days after the storm, and the calamity spurred legislation to tighten safety regulations, and this week led to manslaughter charges for four employees in a criminal investigation.

Ahead of Dorian, Mayhew said, the agency would conduct site visits and make calls to facilities in "the potential impact area." As of Friday afternoon, the hurricane was on track to become an extremely dangerous Category 4 storm over the next few days, and a wide swath from Miami to Jacksonville remained on high alert, with residents scrambling to fill up their cars' gas tanks and buy necessary supplies.

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This Thursday, Aug. 29, 2019 image provided by NASA shows a view of Hurricane Dorian from the International Space Station as it churned over the Atlantic Ocean north of Puerto Rico. Leaving mercifully little damage in its wake in Puerto Rico and the Virgin Islands, Hurricane Dorian swirled toward the U.S., with forecasters warning it will draw energy from the warm, open waters as it closes in. (NASA via AP)
Store shelves are empty of bottled water as residents buy supplies in preparation for Hurricane Dorian, in Doral, Fla., Thursday, July 29, 2019. The U.S. National Hurricane Center says Dorian could hit the Florida coast over the weekend as a major hurricane. (AP Photo/Marcus Lim)
Shoppers prepare ahead of Hurricane Dorian at The Home Depot on Thursday, Aug. 29, 2019, in Pembroke Pines, Fla. (AP Photo/Brynn Anderson)
Empty shelves are seen with a sign at Costco stating that the retailer is currently sold out of water ahead of Hurricane Dorian on Thursday, Aug. 29, 2019, in Davie, Fla. (AP Photo/Brynn Anderson)
National Hurricane Center Director Ken Graham, left, looks on as Florida Gov. Ron DeSantis speaks about Tropical Storm Dorian outside of the the National Hurricane Center, Thursday, Aug. 29, 2019, in Miami. (AP Photo/Lynne Sladky)
This GOES-16 satellite image taken Thursday, Aug. 29, 2019, at 14:20 UTC and provided by National Oceanic and Atmospheric Administration (NOAA), shows Hurricane Dorian, right, moving over open waters of the Atlantic Ocean. The U.S. National Hurricane Center said Dorian was expected to grow into a potentially devastating Category 3 hurricane before hitting the U.S. mainland late Sunday or early Monday somewhere between the Florida Keys and southern Georgia. (NOAA via AP)
Shoppers wait in long lines at Costco, Thursday, Aug. 29, 2019, in Davie, Fla., as they stock up on supplies ahead of Hurricane Dorian. (AP Photo/Brynn Anderson)
MIAMI BEACH, FLORIDA - AUGUST 30: People walk to their boat through a flooded parking lot at the Haulover Marine Center before the arrival of Hurricane Dorian on August 30, 2019 in Miami Beach, Florida. The high water was due to King tide which may cause additional problems as Hurricane Dorian arrives in the area as a possible Category 4 storm along the Florida coast. (Photo by Joe Raedle/Getty Images)
MIAMI BEACH, FLORIDA - AUGUST 30: Weston Rice drives through a flooded parking lot as he prepares to drop his jet ski into the water at the Haulover Marine Center before the arrival of Hurricane Dorian on August 30, 2019 in Miami Beach, Florida. The high water was due to King tide which may cause additional problems as Hurricane Dorian arrives in the area as a possible Category 4 storm along the Florida coast. (Photo by Joe Raedle/Getty Images)
A man stands on a store's roof as he works to prepare it for the arrival of Hurricane Dorian in Freeport on Grand Bahama, Bahamas, Sunday, Sept. 1, 2019. Hurricane Dorian intensified yet again Sunday as it closed in on the northern Bahamas, threatening to batter islands with Category 5-strength winds, pounding waves and torrential rain. (AP Photo/Ramon Espinosa)
This GOES-16 satellite image taken Sunday, Sept. 1, 2019, at 17:00 UTC and provided by National Oceanic and Atmospheric Administration (NOAA), shows Hurricane Dorian, right, churning over the Atlantic Ocean. Hurricane Dorian struck the northern Bahamas on Sunday as a catastrophic Category 5 storm, its 185 mph winds ripping off roofs and tearing down power lines as hundreds hunkered in schools, churches and other shelters. (NOAA via AP)
President Donald Trump, left, listens as Kenneth Graham, director of NOAA's National Hurricane Center, on screen, gives an update during a briefing about Hurricane Dorian at the Federal Emergency Management Agency (FEMA), Sunday, Sept. 1, 2019, in Washington, at right of Trump is Acting Administrator Pete Gaynor, Federal Emergency Management Agency, and acting White House chief of staff, Mick Mulvaney, Environmental Protection Agency (EPA) Administrator Andrew Wheeler, and Neil Jacobs, Assistant Secretary of Commerce for Environmental Observation and Prediction. (AP Photo/Jacquelyn Martin)
President Donald Trump speaks during a briefing about Hurricane Dorian at the Federal Emergency Management Agency (FEMA), Sunday, Sept. 1, 2019, in Washington, as Acting Homeland Security Secretary Kevin McAleenan, left, looks on. (AP Photo/Jacquelyn Martin)
People walk on a largely deserted beach of the Atlantic Ocean on the barrier island in Vero Beach, Fla., Sunday, Sept. 1, 2019. The barrier island is under a voluntary evacuation today and a mandatory evacuation tomorrow in preparation for the possibility of Hurricane Dorian making landfall. (AP Photo/Gerald Herbert)
RIVIERA BEACH, FLORIDA - SEPTEMBER 1: Workers place shutters over the windows of a Food Mart store as the owner prepares just in case Hurricane Dorian hits the area on September 1, 2019 in Riviera Beach, Florida. Dorian was projected to make landfall along the Florida coast but now projections have it making a sharp turn to the north as it closes in on Florida. (Photo by Joe Raedle/Getty Images)
Tree branches are seen in the road during the approach of Hurricane Dorian on September 1, 2019 in Nassau, Bahamas. - Hurricane Dorian strengthened into a catastrophic Category 5 storm Sunday, packing 160 mph (267 kph) winds as it was about to slam into the Abaco Islands in the Bahamas, US weather forecasters said."#Dorian is now a category 5 #hurricane with 160 mph sustained winds," the Miami-based National Hurricane Center said in a tweet. "The eyewall of this catastrophic hurricane is about to hit the Abaco Islands with devastating winds," it said.The slow moving storm was expected to linger over the Bahamas through Sunday and much of Monday, dumping up to 25 inches of rain in some areas and unleashing storm surges of 10 to 15-feet, forecasters said. (Photo by Lucy WORBOYS / AFP) (Photo credit should read LUCY WORBOYS/AFP/Getty Images)
Tree branches are seen in the road during the approach of Hurricane Dorian on September 1, 2019 in Nassau, Bahamas. - Hurricane Dorian strengthened into a catastrophic Category 5 storm Sunday, packing 160 mph (267 kph) winds as it was about to slam into the Abaco Islands in the Bahamas, US weather forecasters said."#Dorian is now a category 5 #hurricane with 160 mph sustained winds," the Miami-based National Hurricane Center said in a tweet. "The eyewall of this catastrophic hurricane is about to hit the Abaco Islands with devastating winds," it said.The slow moving storm was expected to linger over the Bahamas through Sunday and much of Monday, dumping up to 25 inches of rain in some areas and unleashing storm surges of 10 to 15-feet, forecasters said. (Photo by Lucy WORBOYS / AFP) (Photo credit should read LUCY WORBOYS/AFP/Getty Images)
The entrance to Wambasso Beach County Park is closed in Wambasso Beach, Florida on September 1, 2019, ahead of Hurricane Dorian. - Hurricane Dorian unleashed "catastrophic conditions" as it hit the northern Bahamas, lashing the low-lying island chain with devastating 180 mph (285 kph) winds, the most intense in its modern history. Florida residents, meanwhile, were bracing for a potentially dangerous brush with the storm as it slowly turns north after passing the Bahamas. (Photo by Adam DelGiudice / AFP) (Photo credit should read ADAM DELGIUDICE/AFP/Getty Images)
US President Donald Trump receives a briefing at the Federal Emergency Management Administration (FEMA) on Hurricane Dorian in Washington, DC, on September 1, 2019. (Photo by Nicholas Kamm / AFP) (Photo credit should read NICHOLAS KAMM/AFP/Getty Images)
US President Donald Trump receives a briefing at the Federal Emergency Management Administration (FEMA) on Hurricane Dorian in Washington, DC, on September 1, 2019. (Photo by Nicholas Kamm / AFP) (Photo credit should read NICHOLAS KAMM/AFP/Getty Images)
ATLANTIC OCEAN - SEPTEMBER 1: In this NOAA GOES-East satellite handout image, Hurricane Dorian, now a Cat. 5 storm, tracks towards the Florida coast taken at 13:20Z September 1, 2019 in the Atlantic Ocean. A hurricane warning is in effect for much of the northwestern Bahamas as it gets hit with 175 mph winds. According to the National Hurricane Center Dorian is predicted to hit the U.S. as a Category 4 storm. (Photo by NOAA via Getty Images)
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Almost 60 percent of nursing homes statewide — about 400 facilities — had been given more than a year to come into compliance, according to state data. Those facilities have not yet implemented their plans. The information is being made available through an online portal that also lists which facilities have had their plans implemented or have requested an extension.

When looking at both nursing homes and assisted living facilities, state officials say that 96 percent have either a permanent or a temporary generator, plans to get a temporary generator delivered, or a full evacuation plan in case of a power outage.

In addition, facilities that have asked for an extension are still required to have either a temporary generator, show how they will obtain one within 24 hours of a power outage, or have an evacuation plan.

Several facilities that have been fined over the past year and contacted by NBC News either declined to comment Friday or did not immediately respond.

At San Jean Facility Care in Orlando, which was fined an unspecified amount in April, a man who answered the phone said, "Everyone is busy getting ready for the storm. Everything is fine here."

At other sites that are working with the state to come into compliance, workers said they are well-prepared.

"We have a week's worth of medication and food," said Zoriah Clarke, a receptionist at Avanté at Orlando, which takes care of 98 people. "We have a backup generator and if their family members want to take them out for the storm, we're allowing them to."

Her supervisor was unavailable for comment about the facility's compliance efforts.

Coming into compliance can be a lengthy process, particularly for smaller assisted living facilities that only have a handful of beds. Local or state officials must approve installation work.

Generators are also expensive, and can cost upwards of $18,000, including fuel, said Bob Misko, an emergency management consultant who has devised more than 140 emergency plans for elder care facilities across 13 counties in Florida.

Misko said that the initial requirement that facilities have emergency power plans in place last year was a difficult rollout, but that "no one wants a repeat of Hollywood Hills."

Kristen Knapp, a spokeswoman for the Florida Health Care Association, which represents nursing homes from across the state, added that there has been a lack of supply and only so many people who can do such skilled work.

In the interim, facilities have held trainings and run drills so that people are prepared, Knapp said, and "facilities are working their plans now" by stockpiling supplies and keeping in touch with emergency officials.

At Renaissance Health and Rehabilitation in West Palm Beach, just west of the Palm Beach International Airport and President Donald Trump's Mar-a-Lago resort, staffers were closing up windows Friday and ensuring all their available generators were ready to go. The site is home to 120 residents.

Standby air conditioners were also on the ready, Sylvester Kenton, who works in maintenance at the facility, said. And "if that doesn't work," he said, "we evacuate."

Phil McCausland reported from Orlando, and Erik Ortiz from New York.

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