Every year, wildfires across the western United States and Canada send plumes of smoke into the sky. When that smoke drifts, it blankets Chicago and much of the Midwest in dirty air.
Affected residents include seniors in long-term care facilities, many of them at-risk for smoke exposure because of respiratory or cardiac diseases.
“An astonishing amount of smoke gets inside these facilities,” said Luke Montrose, an environmental toxicologist and researcher at Colorado State University.
Data from monitors that Montrose installed in four Idaho long-term care facilities in 2020 measured the impact during wildfire season. One building let in 50% of the particulate matter outside, another, 100%.
In some cases, Montrose said, “It was no better to be inside than to be outside.”
That’s why he has spent the past few years installing more monitors in care facilities across Idaho and Montana. The study is expanding into Colorado this summer.
Understanding and addressing how wildfire smoke affects indoor air quality could help better treat the roughly 1.4 million seniors in more than 15,500 Medicare- and Medicaid-certified nursing homes nationwide and nearly a million more in assisted-living facilities.
Smoke from fires in eastern Canada barreled into the densely populated Northeast and Midwest last June, making the skies above Chicago, Toronto, New York and much of the Atlantic Coast glow an eerie orange. More than 120 million people were under air-quality alerts. As wildfires increase in size, intensity and duration, fueled by a combination of climate change and forest mismanagement, the smoke they generate will likely affect more people.
“We’re going to see more and more smoke events that reach further across the U.S. and across the world,” said Savannah D’Evelyn, a University of Washington postdoctoral scholar who studies wildfire smoke and its effects on health.
Air pollution from wildfire smoke — a brew of pollutants, water vapor and fine debris — is a growing public health problem. Tiny particles called PM 2.5 are small enough to embed deeply in people’s lungs and sometimes infiltrate their bloodstream. Research has shown PM 2.5 can cause asthma and respiratory inflammation or jeopardize lung function, and the particles have been tied to some cancers. They are especially dangerous for children and people with preexisting heart or lung conditions — including seniors, the focus of Montrose’s work.
For years, public health officials have told people to go inside on bad air-quality days, even though, without testing and filtration, indoor air quality often isn’t much better than what’s outside.
Though skilled nursing facilities follow numerous federal regulations to participate in the Medicaid and Medicare programs, indoor air quality isn’t addressed.
“There really aren’t any regulatory standards for indoor air quality broadly in any country that I’m aware of,” said Katherine Pruitt, national senior director for policy for the American Lung Association.
Without the few indoor air-quality monitors in the study, long-term care facility managers or operators might check their local air-quality index, or AQI, on their smartphone’s weather app or by watching the news. But the monitors don’t always provide accurate information about the air outside, let alone inside a building. Rural areas are particularly underserved by air-quality monitors. According to Montrose, 25% to 30% of skilled nursing facilities in the Mountain West are more than 30 miles from a regulatory-grade monitor. Indoor air-quality monitoring is rare outside of studies like Montrose’s.
That’s why Montrose is on a quest to get more air quality monitors in facilities. In 2019, he contacted more than 80 Boise-area nursing and assisted-living facilities to gauge interest and concern about wildfire smoke. In 2020, he collected data from indoor and outdoor air-quality monitors at four nursing homes in Idaho. The monitors recorded particulate air pollution inside one facility nearly 17 times what’s considered healthy.
In 2021, data collected from six facilities from July to October — four in Idaho and two in the Missoula, Montana, area — also showed that, in some buildings, indoor and outdoor air quality were almost identical on smoky days.
Protecting seniors from wildfire smoke is an important piece of wildfire preparedness, but Montrose said conducting research in nursing homes and care facilities has challenges. Unique ethical considerations arise with dementia or Alzheimer’s patients, who can’t give informed consent. Staff turnover makes it hard for researchers to establish relationships with facility operators, and asking nurses or employees to do extra work, like understand and check air-quality monitors, can be a nonstarter.
Some facilities in Idaho have made changes because of the research. Those include a pre-fire season facility checklist to make sure filtering systems are in good shape and that doors and windows are properly sealed. They also share the area’s AQI as part of their morning safety meetings.
Mark Troen, regional maintenance director for 10 Edgewood Healthcare facilities in the Boise area, four of which had monitors last summer, laid out a litany of things he does when the indoor air quality rises past healthy levels: changing air filters to a higher level that traps more particulates, turning off outdoor air intake and alerting staff to keep doors and windows closed.
Clinical staff members also have identified which residents have respiratory problems or are immunocompromised. In an intense smoke event, those people can get portable air filtration in their rooms for extra protection.
Anyone can take steps to improve the air they’re breathing during wildfire season.
“It’s pretty easy to clean indoor air,” D’Evelyn said.
HEPA air filters are the gold standard but can cost upward of $100. Creating a box fan filter is a cheaper alternative. According to D’Evelyn, making even one room in a building a “clean air space” can make a difference during a wildfire.
In the absence of federal regulations, Pruitt said, the most effective actions would likely come from state or local building codes and ventilation standards.
“Policymakers should be looking at the steps that need to be taken to protect people from exposure to hazardous levels of smoke or other outdoor pollutants,” she said.
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