People died in nursing home blackouts. 73% still aren't prepared.
Summary
An HHS inspector general audit -- launched after fatal power outages at nursing homes during Hurricane Irma, Winter Storm Uri, and Hurricane Ida -- found that an estimated 73% of the nation's 15,115 Medicare- and Medicaid-participating nursing homes have inadequate or unreliable emergency power systems. Auditors visited 100 nursing homes in person; 72 failed. Some were still running generators built in the 1970s.
72 of 100, checked in person
didn't just extrapolate from paperwork. Auditors visited 95 of 100⧉ sampled nursing homes in person between May and July 2024, reviewing generator maintenance logs, testing records, and physical equipment. 72 of the 100 had at least one deficiency -- 119 in total -- spanning three categories: maintenance record-keeping, circuit coverage, and generator age.
View data as table
| Inadequate generator maintenance | 7,967 |
|---|---|
| Inadequate generator circuit coverage | 5,869 |
| Generators 40+ years old | 1,447 |
Missing logs, empty tanks
The single biggest failure mode was paperwork that should have been routine: 42 of 71 maintenance deficiencies⧉ were incomplete records -- missing the monthly load tests or weekly inspections federal rules require. Eighteen more nursing homes had generators without enough fuel to run for the industry-recommended 3 days. Nine couldn't document whether their generators met the 10-second switchover requirement to essential systems during a real outage.
View data as table
| Incomplete maintenance records | 42 |
|---|---|
| Insufficient fuel for 3 days | 18 |
| Transfer time not tracked | 9 |
| Unsafe generator location | 2 |
Generators older than the residents' grandchildren
Ten sampled nursing homes ran generators 40 years old or older⧉ -- 6 of them 50-plus. Auditors photographed working units manufactured in 1972 and 1980. sets no age limit on nursing home generators; industry guidance puts a diesel unit's realistic lifespan at 30 to 40 years. Nursing home officials blamed the maintenance gaps on frequent management and staff turnover, and blamed the circuit-coverage and generator-age problems on a lack of resources.
The fix: a reminder email
's sole recommendation⧉ was that share the audit's findings with nursing homes and 'emphasize the importance' of adequate emergency power -- not new inspections, fines, or funding for generator replacement. agreed, pointing to a 2023 memo on backup microgrid systems as its existing guidance. That's on top of an inspection system that already exists: 's own comments note that state survey agencies already conduct on-site life-safety compliance surveys of nursing homes at least every 15.9 months and investigate substantial noncompliance complaints as they arise -- 's recommendation doesn't expand that system, just adds a reminder on top of it.
The takeaway
- 73% is a statistical estimate built on a real 72%. 's national projection tracks almost exactly with what its 100-home, in-person sample found -- this isn't a soft extrapolation.
- The failure mode is mostly avoidable. 42 of 71 maintenance deficiencies were incomplete paperwork -- missed load tests and inspections nursing homes are already required to perform.
- 's fix adds nothing to existing oversight. 's response is limited to a reminder; the report doesn't call for new inspections, funding, or deadlines beyond the on-site life-safety surveys states already conduct roughly every 16 months.
Two of the 71 maintenance-deficiency categories rest on standards softer than a rule: 's 3-day minimum fuel supply is an industry best-practice recommendation, not a federal requirement, and sets no maximum generator age at all -- 's 40-year unreliability threshold is its own judgment call based on industry standards, applied to 18 and 10 of the sampled homes respectively. Federal rules also permit evacuation as a legal alternative to maintaining onsite power during an emergency (though notes evacuation isn't always feasible in a widespread disaster), and the 2 sampled nursing homes with no generator at all weren't cited as noncompliant because they had no rooms requiring electric life-support equipment. 's audit measured compliance with these standards; it did not verify whether any nursing home's power failure during an actual emergency was directly caused by one of these deficiencies. The 15,115-nursing-home population and 100-home sample reflect participation as of September 30, 2023; 's fieldwork ran through February 2026.
Sources(1) ▾
- HHS Office of Inspector General, Most Nursing Homes Throughout the United States Do Not Have Adequate or Reliable Emergency Power Systems (2026-04-28) — National audit (Report No. A-02-23-01022) of emergency power system compliance at a stratified random sample of 100 Medicare/Medicaid-participating nursing homes, with statistically extrapolated national estimates. Fetched directly from oig.hhs.gov and converted with pdftotext -layout; read in full. oig.hhs.gov · original document
Comments
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This audit exists because people already died from this exact failure. During Hurricane Irma in 2017⧉, 12 Florida nursing home residents died from extreme heat after their facility lost power with no way to cool the building. During Hurricane Ida in 2021, 7 Louisiana residents died in unsafe conditions after evacuation to an overcrowded warehouse. In between, Winter Storm Uri knocked out power at 118 Texas nursing homes. Those disasters are why 's inspector general set out to check whether nursing homes nationally were prepared for the next one -- the audit doesn't claim the facilities it later sampled are the same ones involved in those specific incidents. What it found: an estimated 73% -- 10,983 of the country's 15,115 Medicare- and Medicaid-participating nursing homes -- have inadequate or unreliable emergency power systems, a category describes as an 'increased risk of injury or death during a power failure,' not a prediction of how many would repeat those specific outcomes.