DAL 13-25: Cold Weather Advisory

December 6, 2013

DAL: DAL 13-25

Dear Administrator/Operator:

During extended periods of cold temperatures you are expected to provide your residents with a comfortable and safe environment throughout the winter months and to take the necessary precautions to prevent cold-related conditions. Section 461-q of Social Services Law requires the New York State Department of Health (Department) to set allowable temperatures for resident-occupied areas of the facility. Compliance with this regulation requires you to maintain your facility at a safe and comfortable temperature level.

During the winter months residents may be at risk for cold-related conditions. Elderly residents and those with chronic medical conditions such as diabetes, circulatory or thyroid disease are at increased risk for hypothermia and frostbite. The following information summarizes both conditions.

Cold-Related Conditions:

Hypothermia: A drop in one's core body temperature below 95 degrees. This may occur when exposure to the cold causes a person's body to lose heat faster than it can be produced. Hypothermia can occur with air temperatures of 60 to 65 degrees Fahrenheit (15-18 degrees Celsius).

Symptoms: Symptoms of hypothermia vary depending on how long the individual has been exposed to the cold temperatures.

  • Early Symptoms: Shivering, fatigue, loss of coordination, confusion and disorientation.
  • Late Symptoms: No shivering, blue skin, dilated pupils, slowed pulse and breathing and loss of consciousness.

Management: Move the person into a warm room and warm their body with a blanket. Seek medical attention to determine if further treatment is needed.

Frostbite: A decrease in blood flow to an individual's extremities due to exposure to extreme cold resulting in freezing of the skin. Frostbite causes a loss of feeling and color in the affected areas. In extremely cold temperatures, the risk of frostbite is increased in residents with reduced blood circulation and those who are not properly dressed.

Symptoms: Symptoms of frostbite include reduced blood flow to hands and feet, numbness, tingling or stinging, aching, bluish or pale, waxy skin.

Management: Move the person into a warm room. Immerse the affected area in warm (not hot) water (the temperature should be comfortable to the touch for unaffected parts of the body). Do not rub or massage the frostbitten area; doing so may cause more damage. Do not use a heating pad, or the heat of a stove, or radiator for warming. Affected areas are numb and can be easily burned. Seek medical attention to determine if further treatment is needed.

When the outside temperature is 65 degrees Fahrenheit or less (18 degrees Celsius or less), you must maintain the inside temperature in residents' bedrooms and all common areas at the following temperatures as required by regulation:

  • Adult Care Facility: 487.11(m) a minimum temperature of 68 degrees Fahrenheit (20 degrees Celsius)
  • Residences for Adults: 490.11(n)] a minimum temperature of 68 degrees Fahrenheit (20 degrees Celsius)
  • Enriched Housing: 488.11(i) a minimum temperature of 72 degrees Fahrenheit (20 degrees Celsius) unless the Operator can demonstrate that the building is in compliance with local heating requirements which are lower and that the Operator does not have control of the building.

Additional information regarding steps to be taken by adult care facilities in cold weather, steps to prevent hypothermia and frostbite and symptoms of cold exposure and treatment are attached. This information is to be posted in a conspicuous area in your facility that is accessible to both staff and residents. Please be advised that this letter and attachments will be available on the Department's website at: http://www.health.ny.gov/facilities/adult_care/dear_administrator_letters/

Thank you in advance for your efforts to provide our residents with a safe environment that allows them to enjoy a meaningful and satisfying quality of life. If you have any questions regarding the information in this letter or its attachments, please contact your appropriate Regional Office.


Valerie A. Deetz, Director
Division of ACF and Assisted Living Surveillance


Steps to Be Taken By Adult Care Facilities In Cold Weather

  1. Maintain heating systems in good working order in accordance with program regulations [Adult Homes 487.11(k)(9), Enriched Housing Program 488.11(g)(9) and Residences for Adults 490.11(i)(9)].
  2. Routinely monitor the temperature in the facilities when the outdoor temperature is below 65 degrees Fahrenheit (18 degrees Celsius) to assure the inside temperature in residents' bedrooms and all common areas is maintained at the temperature stated in regulation [487.11(m), 488.11(i) and 490.11(n)] for your type of ACF.
  3. If there are areas that fall below the required indoor temperature required by regulation, residents must be moved to common areas that meet the proper temperature. The area must be of sufficient size to safely accommodate the residents.
  4. If the minimum temperature is not sustained, the emergency plan must be activated.
  5. All staff should be familiar with the policies and procedures and know when to implement them.
  6. All staff should be familiar with the symptoms of cold-related conditions and their management.
  7. Check all doors/windows for drafts. Eliminate drafts when possible by drawing curtains/shades on days when the temperatures are below freezing. Encourage residents to sit away from windows/drafts.
  8. Encourage residents to wear appropriate winter clothing while indoors and to dress in layers with appropriate outerwear when leaving the building. Residents should always wear a hat or ear covering and gloves when going outdoors.
  9. Encourage residents not to partake in outdoor activities for extended periods of time.
  10. Offer warm fluids/beverages to residents during the winter months.
  11. The whereabouts of all residents must be accounted for as required by each program's regulations [Adult Homes 487.7(d)(i)(1), Enriched Housing Program 488.7(b)(i)(1), and Residences for Adults 490.7(d)(i)(iv)].

Steps to Prevent Hypothermia and Frostbite

  1. Avoid prolonged outdoor exposure on very cold days. Do not stay outdoors for extended periods.
  2. Increase your activity level according to the temperature. Avoid activities that cause physical exhaustion.
  3. Dress in layers. Layers of clothing are warmer than one thick layer of clothing.
  4. Avoid tight clothing as it reduces blood circulation.
  5. Wear clothing to protect your ears, face, hands and feet in extremely cold weather.
    • Boots should be waterproof and insulated
    • Wear gloves
    • Wear a hat; it will keep your whole body warmer (hats reduce the amount of body heat that escapes from your head).
  6. Drink large amounts of non-alcoholic and decaffeinated warm fluids.
  7. Replace wet or damp clothes as soon as possible during the winter months.
  8. If you feel cold or begin to shiver, add a layer of clothing and/or notify a staff person.

Symptoms of Cold Exposure and Management

Cold-Related Conditions Signs and Symptoms Management
  • Shivering
  • Fatigue
  • Drowsiness
  • Exhaustion
  • Blue skin and/or numbness
  • Confusion/disorientation
  • Loss of coordination
  • Memory loss
  • Slurred speech
  • Glassy stare
  • Slow, irregular pulse
  • Decreased level of consciousness
  1. Remove all wet clothing.
  2. Place resident in dry clothing or blanket.
  3. Move resident to warm environment inside.
  4. If conscious, give resident warm nonalcoholic beverage.
  5. Seek medical attention to determine if further treatment is needed.
  • Any discoloration of the skin; bluish, pale, flushed, white or yellow
  • Skin appears waxy
  • Lack of feeling, numbness, tingling, stinging or aching.
  1. Move resident into warm area.
  2. Handle the frostbitten area gently. DO NOT RUB THE AREA.
  3. Immerse affected area into warm (not hot) water or place the affected area against a warm body part (e.g. armpit).
  4. Seek medical attention to determine if further treatment is needed.