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On Wednesday, eight residents of the Rehabilitation Center at Hollywood Hills perished after the home lost power and a portable cooling system malfunctioned in the wake of Irma. The Hollywood Police Department, along with healthcare and elder protection administrators, have begun investigations. All of the nursing home‘s 140 or so surviving residents were evacuated, and the state Agency for Health Care Administration froze new admissions.

On Thursday, Miami-Dade Mayor Carlos Gimenez said he would pursue local legislation requiring generators strong enough to operate air conditioners at government-subsidized senior housing if state lawmakers don’t act. He said the process of evacuating elderly residents with medical needs is too daunting after a severe hurricane sparks widespread evacuations and broad damage.

The Florida Health Care Association, the nursing home industry’s trade group, said Thursday afternoon that 56 of the state’s 683 nursing homes were still without commercial power. The state reported that 45 nursing homes were evacuated or closed, including 29 that moved residents after the storm.

The industry representatives raised concerns about the availability of generators, the shortage of staff — as many low-wage workers stayed home to evacuate their families instead of showing up for work, said Kristen Knapp, the health care association’s spokeswoman. And they worried about evacuation, as many homes had moved residents from South Florida to another area of the state that then became a mandatory evacuation zone.

The 2005 hurricane season was one of the worst in recent memory. It included Katrina, which later devastated New Orleans when its storm surge broke levees and flooded homes, and Wilma, a powerful Category 3 that tore through the Everglades and left a record-breaking 98 percent of South Florida without power. Wilma alone caused $20.6 billion in damage.

Nursing home administrators met at a summit at the University of South Florida in 2006 to discuss the lessons they’d learned, and to plot a strategy to avoid getting caught flat-footed in the future. A report from that summit said the industry needed to develop a power grid that prioritized nursing homes and other "critical care" facilities.

"Their argument was if it went to nursing homes, then [assisted living facilities] would come back and say ‘what about us?’ My conversations with them were always ‘if we do it for them, we have to do it for everybody’ — and then have no priority."

That left the issue of generators, and several lawmakers — especially some from the hurricane-magnet that is South Florida — badly wanted to pass a sweeping law that would require all nursing homes to equip themselves with generators powerful enough to keep residents cool and safe during a power outage.

State health care administrative rules require that nursing homes maintain a generator to sustain life-saving equipment, such as nursing call buttons, fire alarms, and breathing machines. The generators don’t have to power air conditioners, and many don’t, including Rehabilitation Center of Hollywood Hills.

Walter G. "Skip" Campbell, the mayor of Coral Springs, chaired the Senate’s Children, Families and Elder Affairs Committee at the time, and remembers the resistance lawmakers encountered from a long-term care industry that was — and is — accustomed to getting its way.

"Lots of people did not have electricity. A lot of people did not have fuel to get around. And a lot of people were experiencing Florida weather in such a way that we felt generators were necessary, in certain places like nursing homes," he added.

A group of mostly South Florida lawmakers cobbled together a bill that Gelber calls "the possible." The intent, an analysis said, was "to encourage nursing home facilities to have an emergency electrical power system to allow these facilities to remain fully operational during and after an emergency."

The details were far less ambitious. The bill created a two-year pilot program in five South Florida counties — Broward, Collier, Miami-Dade, Monroe and Palm Beach — in which nursing homes with mostly clean records could be partially reimbursed by the state if they installed generators and agreed to accept residents from other homes that had to evacuate. The reimbursement was to be "based on available funds," an analysis said, which means the project would be subject to fiscal realities and legislative whim.

Knapp added that state rules require every nursing home "to have access to alternate power sources" and "submit a detailed emergency preparedness plan to local emergency management officials that outlines the policies and procedures in place to ensure that residents continue to have their needs met before, during, and after a natural disaster."