DAL: NH 17-07 - Cold Weather Advisory

November 8, 2017

DAL: NH 17-07 - 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 (10 NYCRR 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 ensure that any health or safety issues associated with cold weather have been assessed and addressed.

During the winter months, many residents may be at 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 Fahrenheit that 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 10 NYCRR Part 713 require nursing homes to be equipped with a heating system capable of maintaining all resident areas at a minimum temperature of 75 degrees Fahrenheit. 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 ensure 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.


Signs and Symptoms

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


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


Signs and Symptoms

Any discoloration of the 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. 1. Handle the frostbitten area gently.
  2. 2. Do not rub the area.
  3. 3. Place the affected area against a 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 the 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 Centralized Complaint Intake Unit should be contacted. Contact instructions may be found at: www.health.ny.gov/facilities/nursing/complaints.htm. For malfunctions that occur on nights, weekends or holidays, please contact the 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.
  • Ensure that you have sufficient generator fuel on hand, and that you follow the manufacturer's recommended maintenance schedule.
  • Ensure that all means of egress to the public way are kept clear and functional at all times.
  • Review emergency evacuation plans and ensure that they are up to date.
  • Familiarize all staff with cold weather policies and procedures, and know when to implement them.
  • Familiarize all staff with the symptoms of cold-related illness and the initial treatments that should be initiated.
  • Check all doors/windows for drafts. Eliminate drafts when possible by drawing curtains or shades on days when the temperatures are below freezing. Encourage residents to sit away from the windows.
  • 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.

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.


Shelly Glock, Director
Director of Nursing Homes and ICF/IID Surveillance Center for Health Care Provider Services and Oversight