DAL: DAL 13-11 SUBJECT: Advisory
Dear Administrator/Operator: The New York State Department of Health would like to remind you of our expectations regarding the protection of Adult Care Facility (ACF) residents from the complications of heat exposure. Many residents in ACFs have cardiopulmonary conditions which make them particularly susceptible to heat-related complications, and a large number of residents are on psychotropic medications which greatly diminish their ability to withstand warm temperatures. Each administrator/operator must provide a program that promotes the social, physical, and mental well being of the residents. To assist you in meeting this goal we are providing you with information and recommended procedures to prevent serious heat-related medical problems among your residents during the hot and humid weather.
x Alert staff to the signs, symptoms and consequences of heat exhaustion, heat stroke
x Alert staff to monitor residents for the signs and symptoms of heat illness (listed
below). Notify the physician of such observations and obtain medical services, if necessary.
x Make information available to both residents and staff on medications (sample list
enclosed) that may cause residents to become more susceptible to heat.
x Assure that facility policies and procedures for heat emergency situations are current,
complete, known to staff, and are carried out.
x Use air circulating and air cooling equipment (window fans, floor fans, mechanical
ventilation systems and air conditioners) to achieve and maintain air movement and air cooling within the facility, especially in resident rooms and resident use areas.
x Protect against temperature elevations within the facility by closing window blinds
and shades on sun-exposed walls, opening windows on shaded walls and turning off heat generating devices, such as lights.
x Assure, through active encouragement and assistance when necessary, that residents
maintain adequate fluid intake (e.g., water and fruit juices should be available). Alcohol should be avoided.
x Adjust menus as needed, incorporating items such as cold plates, salads, etc. Consult
x Encourage residents not to lie or sit in direct sunlight, e.g., if outside, encourage
x Encourage residents to wear appropriate clothing while indoors and outdoors.
x Monitor residents engaging in physical activities. Discourage strenuous physical
Additionally, statute and regulations for ACFs require each facility to maintain safe and comfortable temperature levels within the facility. If the outside temperature exceeds 85 degrees Fahrenheit, the guidelines below must be followed:
x One common room is required to be air-conditioned in facilities without central air-
conditioning. It is recommended this room be able to accommodate as many residents as possible. The Department expects that these facilities will turn on the air conditioning in the common room(s) and take air temperatures every hour in all common areas as well as in non air-conditioned rooms at several locations on each floor of the facility.
x The administrator/operator should observe and monitor the residents to make sure the
x If room air conditioners are typically used, the air conditioners must be turned on
regardless of a resident’s ability to pay.
x If your facility utilizes central air conditioning, there is no need to monitor hourly as
It is recommended that the administrator/operator follow the information and recommendations in this DAL to keep the building cool (i.e., maintaining air movement and protect against temperature elevations within the facility). The Department will hold the ACF operator fully accountable, including the imposition of fiscal penalties to the maximum extent permitted, if a comfortable environment is not maintained when the outside temperature exceeds 85 degrees Fahrenheit.
Thank you in advance for taking precautions to assure the health and safety of your residents during the summer. If you have any questions about requirements or guidelines, you may contact the Adult Home Hotline at 1-866-893-6772 and staff will assist you.
New York State Department of Health Symptoms of Exposure to Heat & Treatment Heat-Related Illness Signs & Symptoms Treatment
May lead to loss of consciousness slightly. Loosen or remove and/or circulatory failure. Skin is
15 minutes. Monitor the resident carefully. Heat exhaustion can quickly become heatstroke.
sweating; very high temperature (above 105 degrees); hard, rapid pulse; rapid, shallow breathing.
nausea; perspiration. Skin may be Lightly stretch the effected muscle hot and dry or cool and clammy
liquids with alcohol or caffeine in them as they can cause further dehydration, making the conditions worse.
RESIDENTS TAKING THE FOLLOWING MEDICATIONS MAY HAVE ADDED SENSITIVITY TO HEAT AND OTHER CONDITIONS Not all inclusive
Tetracyclines, sulfa drugs, quinolones (Cipro, Noroxin, etc.)
Atropine, Benadryl, Cogentin, Ditropan, Donnatol
ANTIDEPRESSANT DRUGS MOOD STABILIZER DRUGS Brand (mg/ml)
Depakote (dr) Depakote (ER) Depakote Sprinkles
Tegretol Tegretol XR Tegretol chew Carbatrol (er)
CONVENTIONAL ANTIPSYCHOTIC DRUGS Long Acting Antipsychotics Fluphenazine (Prolixin) decanoate Haloperidol (Haldol) decanoate Risperidone (Risperdal Consta) ATYPICAL ANTIPSYCHOTIC DRUGS
Risperdal, Risperdal Consta, Risperdal M-Tab
Zyprexa, Zyprexa Zydis, Zyprexa intramuscular
AGENTS FOR MANAGEMENT OF ANTIPSYCHOTIC MOTOR SIDE EFFECTS
Note: There is a potential for some drugs to interact with each other to increase a resident’s sensitivity to heat. For case-specific information, consult with the prescriber or pharmacist.
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x Encourage residents not to lie or sit in direct sunlight, e.g., if outside, encourage
x Encourage residents to wear appropriate clothing while indoors and outdoors.
x Monitor residents engaging in physical activities. Discourage strenuous physical
Additionally, statute and regulations for ACFs require each facility to maintain safe and comfortable temperature levels within the facility. If the outside temperature exceeds 85 degrees Fahrenheit, the guidelines below must be followed:
x One common room is required to be air-conditioned in facilities without central air-
conditioning. It is recommended this room be able to accommodate as many residents as possible. The Department expects that these facilities will turn on the air conditioning in the common room(s) and take air temperatures every hour in all common areas as well as in non air-conditioned rooms at several locations on each floor of the facility.
x The administrator/operator should observe and monitor the residents to make sure the
x If room air conditioners are typically used, the air conditioners must be turned on
regardless of a resident’s ability to pay.
x If your facility utilizes central air conditioning, there is no need to monitor hourly as
It is recommended that the administrator/operator follow the information and recommendations in this DAL to keep the building cool (i.e., maintaining air movement and protect against temperature elevations within the facility). The Department will hold the ACF operator fully accountable, including the imposition of fiscal penalties to the maximum extent permitted, if a comfortable environment is not maintained when the outside temperature exceeds 85 degrees Fahrenheit.
Thank you in advance for taking precautions to assure the health and safety of your residents during the summer. If you have any questions about requirements or guidelines, you may contact the Adult Home Hotline at 1-866-893-6772 and staff will assist you.
New York State Department of Health