As temperatures soared to historic highs over the weekend and Monday, Providence Mount St. Vincent’s five-story brick building baked under the sun.

With no central air conditioning, the nearly 100-year-old building and its 300 senior residents relied on portable AC units, fans and larger-scale cooling units borrowed from hospitals. Residents gathered in the long-term care facility’s café, the primary air-conditioned spot on the West Seattle campus. Employees, already wearing face masks and shields to prevent COVID-19, wore ice-soaked cloths around their necks as they provided cold drinks and compresses to others.

The heat wave was unprecedented, marking the hottest days ever recorded in Seattle, where fewer than half of all homes have air conditioning. For the state’s approximately 4,000 long-term care facilities — which must comply with varying state regulations for cooling — the 100-degree-plus heat posed a greater threat for its older adult populations, who are more susceptible to heat-related illnesses. The extreme temperatures also underscored, advocates say, the need for air conditioning at the sites in the future, when experts say more heat waves should be expected as a result of climate change.

“Every summer we are seeing and receiving increased complaints or concerns about buildings being overly warm due to temps outside, poor air ventilation and circulation in the building and/or lack of opened windows or shade management,” said Patricia Hunter, who heads Washington state’s ombudsman program for long-term care, which advocates for residents. “Often times, one will just see large fans in the hallways and corridors blowing warm air around. (But) planning and addressing the issues takes more than fans.”

Older adults are more prone to heat-related illnesses and death than other groups, according to the federal Centers for Disease Control and Prevention. Seniors don’t adjust as well to sudden temperature changes and are more likely to have medical conditions or take prescription medication that affect how a body responds to heat, controls temperature and sweats. Of the more than a dozen known deaths in the Puget Sound region attributed to the recent extreme heat, more than half were among people in their 70s, 80s and 90s.

It’s unclear whether any lived at a long-term care facility, as medical examiners’ offices don’t release addresses. But Hunter said she received complaints from family members of residents about the conditions at various buildings. A friend told her that the friend’s mother, who lives in a nursing home, was lethargic and warm, and the windows in her room were wide open, with the heat of the day pouring in.

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“Needless to say, my friend was not happy about the situation and immediately got to work to cool her mother down,” Hunter said.

Air conditioning regulations vary depending on the type of long-term care facility, and the state does not track how many facilities have air conditioning.

Nursing homes built after 2000 are required to have air conditioning, according to the state Department of Social and Health Services. But many buildings were constructed before 2000, said Deb Murphy, president of LeadingAge Washington, which represents nonprofit nursing homes, and their operators struggle to generate the capital improvement dollars needed to repair or replace heating, ventilation and air conditioning (HVAC) systems.

“We need funding to address the infrastructure needs of long-term care to ensure the entire system for the next excessive heat wave,” Murphy said.

Robin Dale, of the Washington State Health Care Association, which represents nursing homes, said he wasn’t aware of any facility that doesn’t have heating and cooling systems in place to maintain a comfortable temperature — when there isn’t a heat wave.  

“The concern is that some of them might be older and not able to keep up with temperatures we had over the weekend,” Dale said.

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Assisted-living facilities must have air conditioning or some type of cooling system capable of keeping the facility at 75 degrees, if temperatures hit 85 degrees or higher, 2% of the year — about seven or eight days, well under Seattle’s average of 11 days per year.

At Providence Mount St. Vincent, which has assisted living units and skilled nursing care, families also brought in fans or took their loved ones somewhere else, said Jacquie Stock, whose mother lives there.

Providence recently installed central corridor air on one of its skilled nursing floors, which cost $440,000, according to spokeswoman Molly Swain. Stock said there was some confusion regarding AC in the building’s corridors and whether it worked, as residents were urged to leave room doors open and windows shut.

The state doesn’t have specific AC requirements for adult family homes, which provide care for up to six non-related people in a residential setting. Over the weekend, some providers whose homes don’t have AC rented hotel rooms for exceptionally frail residents, according to John Ficker of the Adult Family Home Council, or worked with families to find a cooler spot.

Temperature control has long been a challenge in adult family homes, Ficker said, noting that it’s not uncommon to have a resident who is always hot, and another who is always cold. And most homes use a residential heating and cooling system that can’t be adjusted in each room. He called AC not required, but “best practice” in designing homes.

“Now that we anticipate more 100-plus degree days and also considering what we learned about airflow during this pandemic, we are definitely working to explore options,” he said.

Staff reporter Daisy Zavala contributed to this report.