The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report on April 30, 2026, finding that most nursing homes in the United States do not have adequate or reliable emergency power systems, raising significant concerns for resident safety during power outages.
The audit was conducted in response to recent emergencies that exposed serious risks. During Hurricane Ida, multiple nursing home residents in Louisiana died after being evacuated to an overcrowded warehouse with unsafe conditions following widespread power outages. Similarly, during Winter Storm Uri, 118 nursing homes in Texas lost power, forcing many facilities to evacuate residents.
To assess the reliability and adequacy of emergency power systems, the OIG reviewed a sample of 100 nursing homes participating in the Medicare and Medicaid programs. The audit identified deficiencies in 72 of those facilities, totaling 119 deficiencies overall. These issues were largely attributed to limited resources and frequent management and staff turnover.
The most common deficiencies included problems with generator maintenance and insufficient electrical circuit coverage. Specifically, 53 nursing homes had generator maintenance issues, while 38 had inadequate circuit coverage. In addition, 10 facilities were using generators that were 40 years old or older. Because some facilities had multiple issues, the total number of deficiencies exceeded the number of nursing homes cited.
Based on these findings, the OIG estimated that of the 15,115 nursing homes nationwide, approximately 10,983 (73 percent) have inadequate or unreliable emergency power systems. More specifically, an estimated 7,967 nursing homes (53 percent) have inadequate generator maintenance, 5,869 (39 percent) have insufficient circuit coverage, and 1,447 (10 percent) are operating generators that are at least 40 years old.
The report emphasizes that these deficiencies place residents, staff, and visitors at increased risk of injury or death during power failures, particularly during extreme weather events or other emergencies that disrupt electrical service.
The OIG had previously identified emergency power systems as an area of concern in its July 2023 Work Plan, noting that prior onsite inspections found some nursing homes operating generators that were more than 30 years old. At that time, the OIG announced plans to assess whether emergency power systems were capable of providing reliable and adequate power, including to critical systems such as HVAC, and whether they were being properly maintained. The findings in this latest report are consistent with those earlier concerns, highlighting ongoing issues with generator age, maintenance, and overall system reliability.
As a result of these findings, the OIG recommends that the Centers for Medicare & Medicaid Services (CMS) share the results of the report with nursing homes and reinforce the importance of maintaining adequate and reliable emergency power systems. CMS concurred with this recommendation.
Access the full report here.
Compliance Perspective
Issue
Reliable emergency power systems are critical to maintaining resident safety during power outages. Federal requirements mandate that nursing homes maintain emergency power systems capable of supporting essential functions, including life safety systems, temperature control, and critical equipment. The recent OIG findings highlight widespread deficiencies in generator maintenance, circuit coverage, and aging equipment, increasing the risk of adverse outcomes during emergencies.
Discussion Points
- Review policies and procedures related to emergency power systems, including generator maintenance, testing, and circuit coverage to ensure that all essential systems are supported during a power outage. Confirm that responsibilities for monitoring, servicing, and responding to generator failures are clearly defined. Ensure that your Emergency Preparedness Plan addresses power interruption scenarios, including contingency plans for system failure. Facilities may also benefit from periodic review of these policies with qualified consultants or external resources to identify gaps and align with current regulatory expectations.
- Train all relevant staff on emergency preparedness requirements, including their roles during a power outage and procedures for implementing backup systems. Ensure that maintenance staff are trained on generator requirements, including proper installation standards, routine testing, maintenance, and documentation in accordance with applicable codes and manufacturer guidelines. Conduct drills that simulate power failure scenarios to reinforce staff readiness and response. Med-Net Academy offers the course Emergency Preparedness Requirements for Nursing Homes, which reviews key program requirements, including emergency plans, risk assessments, policies and procedures, communication plans, and emergency generator requirements.
- Periodically audit generator performance, maintenance logs, and circuit coverage to ensure compliance with federal requirements and manufacturer recommendations. Verify that generators are capable of supporting all required systems and that routine testing is completed and documented. Conduct mock scenarios to evaluate system performance during outages, including failure of primary and backup systems. Engaging third-party reviewers to perform mock surveys or targeted assessments can provide additional insight into potential compliance risks and help assess the effectiveness of existing emergency power systems. Contact Med-Net Healthcare Consulting or info@mednetconcepts.com for more information.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*