Philip Knowles, a firefighter in South King County, goes on hundreds of emergency calls every year. But those during the extreme heat wave of summer 2021 are etched in his brain.
The bulk were from people reporting heat-related illnesses like heat stroke, heat exhaustion or other complications from overheating as temperatures climbed to triple digits.
His fire district with the Puget Sound Regional Fire Authority encompasses East Hill in Kent and is mostly residential. Many adult family homes are nestled in the neighborhood. Those long-term care homes serve vulnerable populations like seniors and people with disabilities, but many do not have air conditioning.
"We went to three critical patients," he said. "And then we went to two that were deceased."
Fearing a repeat of the deadly heat, Knowles approached Sen. Mark Mullet, D-Issaquah, and asked for a legislative fix. Senate Bill 5147 seeks to provide small grants for adult family home operators to purchase air conditioning, and eventually require new facilities to be equipped with cooling units.
Assisted-living facilities are required to have cooling systems capable of keeping temps down to 75 degrees. Nursing homes built after 2000 must have air conditioning. But the state doesn't yet have specific AC requirements for adult family homes.
As climate change contributes to increasingly severe heat waves in the Pacific Northwest, the bill could provide a means of protecting some of the state's most vulnerable residents.
In 2019 and 2020, King County saw a maximum of 10 heat-related emergency calls in one day. In 2021, the county's peak was 236 calls. And across the state, 157 people died of heat-related illnesses that year. Almost 70% were over the age of 65.
"We're just trying to make sure the next time it happens we don't have a bunch of people passing away in adult family homes," said Mullet, the bill's lead sponsor.
Adult family homes provide care for up to six unrelated people in a residential setting. Rather than the big institutional assisted living facilities, these are residential homes, often tucked in neighborhoods. They often operate on limited funds. About 65% of the beds available in adult family homes are funded by Medicaid.
The ideal adult family home is a single-level rambler, said John Ficker, executive director of the Adult Family Home Council. That home design dates back decades, and most of those homes were built without air conditioning.
Less than one-third of adult family homes in Western Washington likely have air conditioning, Ficker estimates. When it gets hot, some operators will take their residents to cooling centers or hotels. Otherwise, the homes often end up reaching unhealthy temperatures.
The bill proposes grants of up to $5,000 for adult family homes funded by Medicaid or state programs. That small pot of money wouldn't necessarily help operators buy anything too expensive, like a heat pump, Mullet said. Something as small as a window unit could qualify for a grant.
Under the proposed legislation, the state Department of Social and Health Services would be required to survey the number of adult family homes with air conditioning and report back to the Legislature. By 2025, all new homes coming online would be required to have air conditioning or another cooling system.
"We think it's important that the Legislature be making those investments now, so we can make sure we are delivering on the promise to our elders and to our vulnerable adults," Ficker said, "that they will have access to safe and meaningful care."
In some ways, the heat dome of 2021 was a one-off, said Washington state climatologist Nick Bond. The conditions aligned to create an extreme heat wave.
A high-pressure system blocked cooling marine air and prevented clouds from forming, allowing the sun to directly warm the air and land. As it got hotter the air rose and was pushed back down by the pressure, continuing to heat. One study revealed that climate change played a role.
The heat dome was an estimated 150 times more likely today as compared with the preindustrial climate. And as temperatures ratchet up over the years, extreme weather will become increasingly frequent and intense, Bond said.
"There's no question that greenhouse gas concentrations are rising due to fossil fuel combustion," he said. "With more greenhouse gases, that leads to more thermal energy radiated from the atmosphere towards the ground."
While there wasn't a comparable heat wave last summer, there was a record number of days at or over 90 degrees, Bond said. Overnight lows have been gradually increasing, making it harder for people to recover from thermal stressors on the body.
Communities of color and low-income neighborhoods are of high temperatures — exacerbated by the "heat island" effect. Heat islands are found in dense urban areas with limited green space and large amounts of impervious surfaces like concrete sidewalks and paved parking lots and roads.
A 2021 heat mapping study found "more urbanized areas" were up to 20 degrees hotter than less urbanized areas. Areas with more natural landscapes retained less heat.
Older people and people with chronic conditions like heart disease or asthma are disproportionately affected by extreme heat. Seniors especially 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.
