Barbara Baltazar was one of thousands of Houstonians who expected their elderly loved ones to have power through Hurricane Beryl. Her 76-year-old mom lives in Sharpview Residence and Rehabilitation Center in west Houston.
"I just absolutely with all my heart, I would have bet you money my mom would have had power because she was in a nursing home," Baltazar said.
But as the storm's high winds lashed the city last month, her mom's facility lost power for almost a week. The city's heat index climbed to 105 degrees. The facility, meanwhile, was relying on generators to power a string of fans and a slew of life-saving medical devices for its 85 residents, she said.
Hurricane Beryl is to blame for the deaths of at least 38 people in and around Harris County, according to numbers provided by medical examiners’ offices in five counties. Most of them, three in four of those who died, were seniors. About half of the seniors succumbed to hyperthermia, or overheating.
The death toll raised questions about whether state and city officials can keep elderly residents safe and comfortable during disasters. Elder care advocates say there are critical deficiencies, ignored or shot down for years, in our storm readiness rules for the most vulnerable Texans.
Nationwide, Texas ranks no. 3 for both the largest senior population and most seniors living in a nursing home.
That's all the more reason the state's oversight of senior care facilities has been in question — especially in Houston, which is currently facing an active hurricane season. The region is expected to get more frequent and stronger storms due in part to climate change.
Now, loved ones are demanding answers — and action.
Baltazar expressed her outrage to Houston City Council a week after the storm. Standing at the podium in city hall, frustration in her voice, the concerned daughter implored the city to do more to support elderly residents and nursing home staff.
"It is not okay to inflict this type of stress upon the elderly," she said.
What has Houston done...and not done?
Texas has more than 2,000 assisted living facilities and 1,200 nursing homes, according to Texas Health and Human Services. Nursing homes provide full-time medical care. Assisted living facilities help seniors with everyday tasks while allowing them more independence.
Since 1996, state rules have required new nursing homes to have generators that power things like lighting in certain areas, alarms, exit signs, phones and the nurse call system.
The rules for heating and cooling are a bit more complicated. The state health agency expects facilities to maintain "safe and comfortable temperatures" whether or not they are operating normally or experiencing an outage, HHS spokesperson Jennifer Ruffcorn told The Texas Newsroom.
If they can't, Ruffcorn said the facility has to either fix the temperature problems or have an evacuation plan.
Meanwhile, assisted living facilities aren't required to have generators at all, Ruffcorn confirmed. A 2022 state survey found that less than half of the responding assisted living facilities had one.
However, in the event of a power failure, these facilities should know who to contact as part of their emergency plan, Ruffcorn added. Large assisted living facilities with 17 or more residents, and any with fire alarm systems, also have to provide emergency power for safety features during outages.
When Winter Storm Uri froze over the state in 2021, power and heat were out for millions of Texans for days.
Uri's death toll was 246, according to a report issued by the state health agency. This information showed that, like Beryl, the majority were seniors. Most died because of hypothermia, or low body temperature. The storm threw in sharp relief the reality that extreme weather of any kind hits seniors harder.
Despite those numbers, Houston City Council didn't seriously look into strengthening its oversight over senior facilities in the aftermath of the freeze.
Houston Public Media revisited hours of city council meetings during and after Uri. There did not appear to be any mention of regulating senior facilities or requiring generators. Their focus at the time was COVID-19 and getting seniors vaccinated.
At-Large City Council Member Letitia Plummer said it wasn't at the forefront of the council's mind.
"We clearly had conversations but to be honest with you, nothing was really done," Plummer said. "No improvements were made. I don't think it really got the attention that it needed to get until Beryl happened."
Mayor John Whitmire said he will make it a top priority that the city protects seniors during outages. But he pointed out they need the cooperation of the state, which licenses and regulates these facilities, and noted state leaders have become less willing to cede power to local officials.
"It should be a statewide policy of making sure that senior citizen living centers have backup power," Whitmire told Houston Public Media on August 14. "We'll work with the Legislature but seniors and public safety and life quality issues is my highest priority."
Whitmire, a Democrat, took office in January. But for a half-century before that, he represented the city in the Texas Legislature.
When asked what Whitmire did for seniors during his tenure as a state leader, his spokesperson said the now-mayor "worked tirelessly to provide the support and resources that Texans need to prepare for and recover from a disaster." She did not point to any specific policies he championed and said Whitmire did not serve on the Senate Health and Human Services committee.
"Finding permanent solutions will require action at the state level, holding owners accountable and prioritizing generators," Mary Benton told Houston Public Media.
After the May derecho, Whitmire also said publicly he would investigate independent living facilities and residential complexes that don't provide medical care. He directed the Houston Housing and Community Development Department to lead the investigation, which said they are focusing on structural damage at 32 independent living communities in the city.
There was no mention of assessing backup power.
The city does have a storm resiliency plan that identifies which areas of Houston are most vulnerable to flooding, Plummer pointed out.
"It was completed during the [Mayor Sylvester] Turner administration, we just never did anything with it," she said. "We paid the money for consultants to complete it, but we really never implemented anything."
Whitmire's spokesperson said they're reviewing the plan for whether it's a "good fit for critical neighborhoods" and said, at this point, the plan is "conceptual" and "not funded."
The state's response to storms
Whitmire may want the state to take the lead on protecting the elderly during storms.
But elder care advocates say the state's emergency preparedness rules for senior facilities also fall short, and state lawmakers have declined to make Texas laws stronger.
Twice in the last five years, state Rep. Ed Thompson introduced bills that would have required nursing homes and assisted living facilities to have an emergency generator or other power source. One bill even included temperature mandates; it would have required nursing and assisted living facilities to keep temperatures between 68 and 81 degrees for at least 72 hours during a power outage.
Both bills failed to pass even the first legislative hurdle.
Thompson was surprised. He said he had bipartisan support, and worked with the Texas Assisted Living Association, or TALA, an industry group, to craft the bill.
"Everybody at the time ... was on board," Thompson, R-Pearland, told The Texas Newsroom. "Truthfully, I think what happened is, you know, we got played. We took people at their word and then they went behind our back and killed the bill."
Thompson said he thinks TALA's lobbyists persuaded a couple of committee members to change their minds.
The group did not confirm or deny Thompson's allegation.
TALA Vice President of Public Policy Carmen Tilton said the group opposed Thompson's first bill because it did not address the "true logistical challenges" of the issue. His next try was "significantly more flexible" and so they took a neutral position that "reflected both our appreciation for the good-faith effort as well as our lingering concerns."
The biggest problem after Hurricane Beryl, Tilton added, was poor communication from CenterPoint, the power provider.
"Assisted living communities are not shielded from power outages; no one is," she said. "But they, just like other health care facilities with priority restoration status, should have been brought back online much faster than they were."
A spokesperson for the Speaker of the Texas House Dade Phelan, who represents Beaumont, says he supports focusing on improving power restoration, including for elderly people.
"He looks forward to working with his House colleagues to build on these substantial resiliency efforts to safeguard the lives and health of vulnerable Texans statewide," Kimberly Carmichael told The Texas Newsroom.
Sen. Paul Bettencourt, an influential Republican from Houston, authored the Senate version of Thompson's bill in 2021.
Looking back, he said requiring assisted living facilities to have generators could be complicated and costly. He believes working on the state's power supply first could go a long way to eventually addressing these other problems.
"Quite frankly, the number one problem by a long shot is the lack of resiliency in the power grid," Bettencourt said.
"It's a better solution for us to get this grid where it's actually reliable," he added. "And then you can talk about how far to take what emergency services practices you need."
The next legislative session kicks off in January.
Senior advocates weigh in
The deaths of past legislation frustrated senior advocates, too.
"We have failed to see the Legislature prioritize the issue of generator requirements for nursing homes, as well as any requirements for a generator in an assisted living facility," said Patty Ducayet, the state's long-term care ombudsman.
Ducayet also wants the public to have better access to the emergency plans of nursing homes and assisted living facilities. Anyone can ask a facility for that information, but there's not a central location where it's housed, she said.
"I think we could improve internally at [the state health agency]," she said. "For example, what it knows about every facility, its generator power, what it powers, and what their plan would be if they lost power and they don't have a generator. We don't have comprehensive knowledge of that."
Mary Nichols founded Texas Caregivers for Compromise, an organization of people with parents who live — or have died — in long-term care facilities. She's concerned because seniors depend on power for much more than just keeping lights on. They need it to power their life-saving devices, maintain medications at the right temperature, and more.
"It's not just about ‘Oh gosh, Granny is in the dark, open a window and let her have daylight," Nichols said.
Even if Thompson's legislation had passed, some advocates said the bills didn't go far enough to protect seniors.
"Generators are pretty much already required at nursing homes, but that only fuels safety features. This has nothing to do with some of the other operations and temperature control," said Andrea Earl, the associate state director of advocacy and outreach for the Texas arm of AARP. "That's key to keeping these individuals safe, whether it be extreme heat or extreme cold."
Earl told The Texas Newsroom she would like Texas to study what Florida did after a dozen seniors died at a nursing home in the wake of Hurricane Irma. That's when that state began requiring nursing homes and assisted living facilities to have backup power and fuel to keep heating and A/C running during an outage.
"What AARP would like to see is something closer to that Florida model that really requires everybody to have a backup power source that can provide some temperature control, larger spaces that are temperature controlled, require the refrigerator to be managed and medication on-site to be safe and secure," Earl said.
In the absence of stronger state laws, a fix may lie at the local level.
City council member Plummer said she is working on a city ordinance that would require local senior facilities to have generators. Her proposal would give facilities a tax cut.
"Our seniors are so critically important to us, right?" Plummer said. "They're our parents, our grandparents, our great aunts, our great uncles. They're really important, and so we can't forget about them."