DAL: NH 13-07 - Cold Weather Advisory

October 17, 2013

DAL: NH 13-07 - Cold Weather Advisory

Dear Administrator:

With the arrival of cold temperatures, you are encouraged to take the necessary precautions to ensure that residents are comfortable and safe in nursing homes throughout the winter months.

Both New York State (10NYCRR 415.5) and Federal (42.CFR 483.15) regulations require residential health care facilities to maintain comfortable and safe temperature levels within their facilities. For those residents who might be leaving the facility for any reason, including outside visits or community events, facilities must assure that any health or safety issues associated with cold weather have been assessed and addressed.

During the winter months, many residents may be a risk for cold-related illnesses. Elderly residents, and those with health problems such as diabetes, circulatory or thyroid disease, are at risk to develop hypothermia and frostbite. Hypothermia is a drop in body temperature below 96 degrees, and it can occur when exposure to the cold causes a person's body to lose heat faster than it can be produced. Frostbite is a decrease in blood flow to a person's extremities due to exposure to extreme cold, resulting in freezing of the skin.

Hypothermia can occur when indoor air temperatures are 60 to 65 degrees Fahrenheit. The regulations contained in 10NYCRR Part 713 require nursing homes to be equipped with a heating system capable of maintaining all resident areas at a minimum temperature of 70 degrees or 75 degrees Fahrenheit depending upon the construction date of the facility. However, occupied areas are not required to be kept at these temperatures if residents are comfortable at a lower temperature. If low room temperatures are identified, individual body temperatures should be monitored to assure there is no risk of hypothermia to the resident. Nursing homes should be cognizant of the needs and wishes of each resident, and assure that a safe and appropriate temperature is provided.

To assist in preventing illness among your residents during the winter months, it is recommended that all staff be especially alert to the signs, symptoms and consequences of hypothermia and frostbite.


Signs and Symptoms:

Shivering; confusion; memory loss; drowsiness; exhaustion; Slurred speech; glassy stare; slow, irregular pulse; numbness; and decreased level of consciousness.


  1. Remove all wet clothing.
  2. Place resident in dry blankets/clothing.
  3. Move resident to warm environment inside.
  4. If conscious, give resident warm beverage.
  5. Seek medical attention to determine if further treatment is required.


Symptoms and Signs:

Any discoloration of skin such as flushed, white, yellow, or blue depending on the length of exposure; waxy appearance of skin; and lack of feeling or numbness.


  1. Handle the frostbitten area gently.
  2. Do not rub the area.
  3. Place the affected area against warm body part (ex: armpit) or blow warm air onto it.

The following measures should also be taken by nursing homes to protect resident health and safety during cold weather months:

  • Maintain heating systems in good working order in accordance with program regulations. If heating equipment malfunctions during normal business hours (8:00 a.m. to 5:00 p.m.), the Department of Health Regional Office should be contacted in the customary manner. For malfunctions that occur on nights, weekends, or holidays, please contact the NYS Department of Health Duty Officer at 1-866-881-2809. Under such circumstances, individual room temperatures should be frequently monitored. Calibrate thermometers to ensure their accuracy.
  • Ensure that carbon monoxide detectors are installed and frequently monitored to ensure functionality.
  • Familiarize all staff with policies and procedures, and know when to implement them.
  • Familiarize all staff with the symptoms of cold-related illness and the initial treatment that should be initiated.
  • 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 the windows/shades.
  • 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.
  • Offer warm fluids/beverages to residents during the winter months.
  • Know the whereabouts of all residents to assure their health and safety is maintained.

I would like to thank you for your continued efforts to maintain the health and safety of those who reside in nursing homes in New York State. If you have further questions, please contact the Bureau of Quality Assurance and Surveillance for Nursing Homes at (518) 408-1282.


Jackie Pappalardi, Director
Division of Nursing Homes and ICF/IID Surveillance
Center for Health Care Quality and Surveillance