March 25, 2019

Health Care at Home: The New Risks from a Growing Trend

By Marriele Mango

Resilient power is on the rise, and not just for big industry and market rate customers. Affordable housing developers have started to include solar PV and battery storage (solar+storage) in designs for new affordable housing complexes; and solar+storage for critical public facilities, like wastewater treatment plants and fire stations, are increasingly recognized by state and local governments as necessary investments. Despite this progress, one vulnerable population has remained basically untouched by the resilient power movement; individuals dependent on in-home medical equipment.

Natural disasters and extreme weather are becoming more commonplace. Power outages are leaving vulnerable populations, including those with electricity-dependent medical equipment, in the dark. As grid reliability and resiliency become more of a concern, some utilities are changing preparedness planning to include pre-emptive grid shutdowns. After Camp Fire in California, which resulted in the deaths of 85 people and forced thousands to seek emergency shelters, the utility servicing the affected territory, PG&E, is considering de-energizing power lines to reduce the risk of starting a fire. It’s easy and inexpensive, but it would also leave electricity-dependent residents endangered.

Outages can have widespread public health implications, but for those dependent on electricity for in-home medical equipment, even a short-term outage can be potentially fatal. As more people opt to receive medical care at home, access to resilient emergency backup power will need to be prioritized and made more accessible, especially to low-income households. There are over 2.5 million Medicare beneficiaries that require in-home electricity-dependent medical equipment. Health care trends suggest that this number will only continue to grow as seniors increasingly choose to receive health care at home (80 percent of Medicare beneficiaries are aged 65 or older), rather than in an institution such as a nursing home. With the senior population expected to double by 2060, more and more people will be reliant on electricity as part of in-home medical care regimen. Additional electricity-dependent populations, such as the privately insured and Medicaid beneficiaries, further add to this figure.

Health care complications, including outage related issues like medical device failure, accounted for almost one-third of the estimated 4,645 additional deaths in the three months following Hurricane Maria. The elderly are hit especially hard. The Centers for Disease Control and Prevention published mortality data after Hurricane Irma and found that more than 15 percent of deaths were attributed to an exacerbated existing medical condition caused by a power outage, and an additional 2 percent were associated to a disruption in medical services. The average age of all victims was 63. During the 2003 North American blackout, a single Manhattan emergency department reported 23 patients with issues related to medical device failure due to power loss. The average age of the patients was 67.

The reality is that, despite warnings and disaster preparedness programs, medically vulnerable households are only marginally more likely to evacuate. Of the 680 people that had to be evacuated to Houston after Hurricane Katrina, over 40 percent had chronic health conditions such as heart disease, hypertension, and diabetes. The seemingly dangerous choice to shelter in place during an emergency can be attributed to a variety of reasons, including immobility, economic limitations, dependency on heavy medical equipment, not having access to a car or an inability to drive, and/or a lack of a social network outside of their community.

When electricity-dependent individuals who rely on medical devices are forced to seek emergency assistance during a power outage, it’s typically at a hospital or medical clinic. After disasters, hospitals are inundated with people in search of power for critical medical equipment, such as oxygen concentrators. A 2003 blackout study published in the Critical Care Medicine journal found that respiratory device failure accounted for 65 emergency department visits and 37 hospitalizations over the two-day period. Residents evacuated to shelters face similar issues. Of the 1,400 people that checked-in to emergency shelters during 2008’s Hurricane Gustav, 20 to 40 percent relied on electricity-dependent medical equipment.

Those who can shelter at home through an outage typically rely on gas generators. Gas generators require refueling, emit pollutants, are prone to failure, and can lead to sickness or death when used improperly. Carbon monoxide poisoning killed nine people after Hurricane Sandy and thirteen people after Hurricane Ike. Gas generators can also be difficult to operate, especially if an individual is mobility impaired and home alone. Battery storage is a safe and reliable alternative that, when combined with solar PV, can provide a potentially unlimited power supply. Battery storage also requires minimal maintenance and can be installed to automatically switch on when the grid goes down. The benefits of resilient power over gas generators has never been more apparent than in Puerto Rico post Hurricane Maria.

After Hurricane Maria, a team from the University of Washington travelled to Puerto Rico to research the potential for solar+storage to support the critical medical needs of electricity-dependent households. Households that relied on a diesel generator reported that the generator was too noisy to be used at night, released toxic gases that worsened some medical conditions, and were expensive to fuel at $10 a day. Additionally, because diesel generators are not meant to provide continuous power, overworked generators resulted in breakdowns. After the solar+storage systems were installed, all fifteen households preferred solar+storage and nine of the fifteen reported improved health when compared to living with a diesel generator. Furthermore, while the upfront costs exceeded that of a diesel generator, solar+storage was found cost effective after repeated or extensive outages.

Residential solar+storage (or solely battery storage) programs remain limited primarily to regional pilot projects. Fewer provide program carve-outs for medically vulnerable households. Green Mountain Power (GMP), the largest utility in Vermont, is a great example of a utility recognizing resilient power as necessary for electricity-dependent households. GMP partnered with Tesla for a pilot that provides Powerwall battery systems to 2,000 customers. For a hundred low-income resident’s dependent on electricity for a medical device, the Powerwalls will be installed at no cost.

More can, and should, be done to prepare medically vulnerable households. As more people require electricity for critical health services, modernizations to back-up power technologies are inevitable. The growing residential battery storage market can transform how electricity-dependent residents prepare for and prevail through a storm. The entities responsible for the welfare of this vulnerable population, such as utilities, Medicare, and disaster management agencies, should recognize battery storage as critical to life support during a disaster and provide opportunities for electricity-dependent individuals to access resilient systems.

The following are recommendations to ensure resilient power is accessible to electricity-dependent households:

Utility administered residential battery storage programs. In addition to having access to a database of electricity-dependent residents, a utility can also reap the benefits associated with a virtual power plant. The Green Mountain Power pilot program is already affirming that resilient power can improve the quality of life for medically vulnerable households and provide cost effective savings through grid services. Expanding energy efficiency programs to include battery storage would establish a steady stream of funding for low income battery storage programs.

Expand Medicare coverage to include battery storage. If battery storage was included in the list of Medicare eligible durable medical equipment (DME), doctors would be able to prescribe battery storage. Medical device providers would then supply resilient power systems to home health care patients dependent on electricity for medical equipment.

Disaster relief funding as a tool for recovery and mitigation initiatives. Puerto Rico has created the new template for how cities and states can rebuild more resilient power systems after a natural disaster. Requiring disaster funds to include incentives and fiscal carve outs for the installation of resilient solar and battery storage systems, both for critical facilities and electricity-dependent residents, will contribute to a more reliable energy system and provide resilient power to the most vulnerable residents. 

Solar and storage carve-outs in emergency preparedness mandates. Twelve seniors died in Florida when their nursing home lost power and the lack of air conditioning resulted in extreme heat. In the wake of that tragedy, Florida now requires nursing homes and assisted living facilities to have back-up power, but only natural gas and diesel generators are referenced in the Emergency Power Plan Rules. States already imposing emergency power requirements should educate health service providers about the benefits of battery storage and provide incentives to encourage clean energy alternatives. 

Use big data and technology to better identify electricity-dependent households. For example, DME could incorporate devices that monitor equipment batter power and signal emergency responders using GPS once battery charge falls below a certain threshold. In addition, local and state governments, utilities, and Medicaid can improve data tracking of electricity-dependent individuals by exploring potential data-sharing with the HHS emPOWER map, which currently uses only Medicare claims to geolocate electricity-dependent individuals.

Prioritize multi-stakeholder dialogue. Utilities, medical equipment manufacturers, consumer-rights groups, Medicare, and homecare/home health associations are all deeply invested in protecting electricity-dependent individuals during an emergency. However, there has been little knowledge-sharing about resilient backup power options between these various sectors to date. Stronger relationships between the key players in the home healthcare space can create a system change and provide a platform for swift, coordinated, and effective emergency management that includes resilient solar+storage systems.

Energy Storage and Health is a joint research initiative of Clean Energy Group and Meridian Institute.

This blog post was also published in Renewable Energy World.