Preventative Shutoffs are Resulting in a Medical Crisis: Resilient Power Can Help

This month millions of people lost power in California. The blackouts were not due to a natural disaster, but rather the result of utilities, primarily Pacific Gas and Electric (PG&E), intentionally suspending power to hundreds of thousands of customer accounts in across California. Deemed “Public Safety Power Shutoffs,” utilities are cutting power when environmental factors, such as high winds and dry conditions, make for high wildfire risk.

California isn’t alone; states like Oregon and Nevada have passed similar preventative shutoff measures. While utilities justify the shutoffs as necessary to avoiding a larger disaster―the Camp Fires in California that killed 88 people were caused by faulty PG&E equipment―the message is clear: utilities are no longer required to provide reliable service. For medically vulnerable residents dependent on electricity for critical medical equipment or air conditioning, these power outages can be as fatal as the disaster they’re meant to prevent.

PG&E has over 32,000 customers registered as requiring electricity for medical conditions. While the utility is required to notify these customers prior to planned outages, and some did have 48 hours’ notice, others only knew they had lost power because their medical equipment ceased to function. PG&E admitted that they failed to notify 23,000 customers subject to power shutoffs.

Ben Faus was awoken when his sleep apnea breathing machine failed in the middle of the night; “All of a sudden, I was like, ‘I can’t breathe’.” When Deanne Mediati lost power, she was sleeping connected to her oxygen concentrator. Her husband woke her up to alert her she had stopped breathing. Deanne never received an alert from the utility that a shutoff was impending, despite being on the medical registry.

For others, outages came sooner than expected. Julie Miller and her home aide thought they had until the morning before the outage began. When they were alerted that the power would actually be out a night earlier than expected, they did the best they could with limited time and resources. Julie ended up having to spend the night in her wheelchair because her mattress relied on electricity to remain inflated. “It was uncomfortable. I didn’t know what was going to happen. It was really a mess, actually. Psychologically, it was a mess. When you’re used to something and things get turned around … it is pretty stressful.”

Not only single family households are impacted; outages are just as dire for medically vulnerable individuals living in multi-family housing. Monteverde Senior Apartment residents living on upper floors had to either wait until the power returned and the elevator was back in service, or attempt the stairs, a potentially dangerous effort for seniors to undertake.

Now more than ever before, people are opting to receive their medical care at home. Although in-home medical technology has evolved enough to spur a rapid rise in home health care, as opposed to institutional care settings like a hospital or nursing home, most medical equipment comes with no more than a limited battery reserve and is simply not built to withstand hours or days without power.

Home oxygen equipment, one of the most common home medical devices, is used by over one million Medicare beneficiaries, over 94 percent of which use an oxygen concentrator that requires electricity to operate. When the outage hit Tom Watson, who relies on an oxygen generator and a nebulizer to deliver medication, he was forced to miss drug treatments and eventually had a difficult time breathing due to a lack of adequate oxygen supply.

When medically vulnerable, electricity-dependent customers reached out to PG&E, they received little support beyond outage alerts. Julie Miller tried to obtain a generator from the utility only to be told that the utility wasn’t in the position to provide such services. (PG&E has since proposed a $5 million program that would provide portable battery backup power systems to up to 500 people with disabilities.)

For those who can afford to buy a backup power system outright, portable diesel, natural gas, or propane generators are the most readily available option on the market, despite being difficult and expensive to fuel during times of high demand (like an outage). Additionally, gas generators can be expensive to maintain and emit toxic gases that contribute to climate change and poor air quality. Tom Watson wasn’t feeling well enough to leave his home to purchase a generator and ended up ordering one online. Rebecca Fortelka, who relies on electricity for a power wheelchair, air cleaning systems, and refrigeration for prescription drugs, bought a diesel generator after 48 hours without power. The generator cost $10,000 and between $1,000 to $2,000 per day to fuel.

Although diesel and other fossil-fueled generators are the prominent backup power options, there is an alternative emerging resilient power technology gaining market share: solar photovoltaics (PV) paired with battery storage (solar+storage). Solar+storage systems can automatically isolate from the grid in the event of an outage to power an entire residence or select critical loads, like outlets for medical devices and refrigeration.

Unlike gas generators, solar+storage can provide year-round economic benefits, such as electric bill savings, and don’t require expensive refueling or produce harmful toxic emissions. Some battery systems can even get an alert from the utility in the event there will be a shutoff and fully charge in preparation. As long as the sun is available to recharge the batteries, solar+storage systems can continue operating even during prolonged multi-day outages.

During the recent PG&E blackout, residents and facilities with solar+storage systems became prime examples of how resilient power can mitigate the impacts of outages on the surrounding community and businesses. In Humboldt County, the Blue Lake Rancheria Microgrid (BLR) provided critical services through the power shutoff. Owned by Blue Lake Rancheria, a federally recognized Native American tribe in northwestern California, the microgrid serves tribal government offices, EV charging, a hotel and casino. While the power was out in surrounding neighborhoods, the hotel hosted eight people with medical needs reliant on electricity. The Humboldt County Department of Health and Human Services, “credited Rancheria with saving their lives, due to their critical needs for power.”

In addition to supporting medically vulnerable patients, the BLR provided critical support to residents, community organizations, and government agencies. Local residents were able to access a safe space with lighting, charging stations, and internet. The microgrid also charged electric vehicles, powered a mobile office for the local paper, and helped to support municipal water and sewage systems. While diesel generators currently power a convenience store and gas station at Blue Lake Rancheria, there are already plans underway to replace the generators with a second solar+storage microgrid. The gas station serves as a critical resource for residents, emergency response vehicles, and government agencies to access fuel.

Residential solar+ storage systems also provided support to households through the outage. Derek Krause, a firefighter in Oakland, didn’t realize his neighborhood had lost power because his solar+storage system seamlessly transitioned from the grid to battery reserves. “Having taught the public about self-sustainability during emergencies, it was important to me [to install a solar+storage system].”

Obstacles to solar+storage adoption are primarily the cost, system costs remain too expensive for most, and lack of awareness, the majority of residents don’t know what solar+storage is and that it’s a viable energy security option. These hurdles are even more difficult to overcome for low-income households facing additional burdens and financing barriers. Critical facilities in low-income areas also face hurdles in securing the financing necessary to invest in solar+storage.

California has an incentive program, Self-Generation Incentive Program (SGIP), to reduce the costs associated with purchasing and installing a battery storage system. Built within SGIP is an Equity Budget and a new Equity Resilience Budget, which provides additional incentives for residents, non-profits, small businesses, education institutions, and governments in disadvantaged and low-income communities, as well as medically vulnerable households in areas of high wildfire risk.

The Equity Budget and Equity Resilience Budget incentives are significant. At $850 per kilowatt-hour and $1,000 per kilowatt-hour respectively, the incentives should cover most, in some case all, of the installed cost of a battery system. However, most people don’t know the incentive exists and are unsure how to access it, who to call, or which installers to trust.

The SGIP is a potential pathway to solar+storage for the most vulnerable Californians, but a lack of education and outreach has so far resulted in an ineffective, underutilized program. Gina Biter-Mundt, a disability rights advocate living in Napa that relies on electricity to power her motorized wheelchair and bed lift, has both a backup generator and a battery storage system. “…I’m one of the fortunate people where I’ve already thought about this stuff. There are some very vulnerable people out in the community who probably don’t have the financial means to be able to just purchase a generator…I’m concerned for those people that really are dependent on power, especially for oxygen to be able to breathe.”

For medically vulnerable households, California has a plethora of partners they could work with to get the word out on resilient backup power. Home health care agencies, Medi-Cal (the state’s Medicaid health care program), county health departments, advocacy organizations, and community groups are all invested in the wellbeing of medically vulnerable individuals and, in many instances, know where they live and how to effectively communicate supportive programs like SGIP.

SGIP incentives could make a huge difference in delivering energy security to those who need it most, especially in low-income communities. However, those incentives alone won’t be enough to reach all 32,000 electricity-dependent households in PG&E’s service territory, much less the rest of the state and the likely tens of thousands of additional uncounted residents that rely on electricity for their well-being.

Other opportunities, beyond building SGIP program awareness, to improve the affordability and accessibility of resilient power for medically vulnerable, low-income households are outlined in a report by Clean Energy Group, “Home Health Care in the Dark.” Recommendations include:

• Expand state Medicaid programs to include battery storage: Some state Medicaid programs currently allow for beneficiaries to apply for a diesel generator through flexible budget authority or home modification programs. Battery storage should be an eligible for this funding as well.
• Certify battery storage as Durable Medical Equipment (DME): A DME status would allow doctors to effectively prescribe a patient resilient power system that meets their specific medical needs. Medicaid, Medicare, or a private insurance provider would then cover some or all of the costs associated with renting or purchasing the unit.
• Develop utility programs: Utilities are in a unique position to offer battery storage; they already have access to a list of electricity-dependent customers through registry programs and can reap economic benefits from distributed battery storage through grid services, such as offsetting peak demand. Utility battery storage subsidies can reduce out-of-pocket costs for medically vulnerable households not eligible for the SGIP Equity or Equity Resilience incentives, or who have a remaining system balance post SGIP incentive.
• Create technical assistance budgets for critical facilities: Critical facilities, including community centers, public schools, and nursing homes, also need to be prepared to serve the community in the event of an outage. These facilities, especially in low-income communities, require additional support to get resilient power projects off-the-ground. A technical assistance fund could cover the costs associated with a solar+storage feasibility assessment and provide a crucial first step to resilient power for community service providers.

State public health programs and policies should reflect the growing needs of a population increasingly at-risk of a medical crisis in the event of an outage. Battery storage incentives through SGIP are a great start, but public health officials and utilities will also need to create pathways to overcome the health and income disparities currently hindering these vulnerable residents from accessing resilient power, either for their own home or in their community. Ultimately, if the new reality is that people reliant on electricity for their medical needs are going to be expected to fend for themselves in the event of a power outage, then the state and its utilities should be doing everything in their power to provide them with the tools they need to do so.