As temperatures plummeted and power went out across Texas during the February 2021 Winter Storm Uri, a record-breaking winter storm that brought unprecedented cold and ice, staff at Gainesville Nursing and Rehabilitation, a nursing home in the rural North Texas town of Gainesville, made a desperate call: evacuate all 36 residents. The nursing home had lost both power and water and the facility’s backup systems had failed.
Fire-rescue crews scrambled to borrow school buses to move everyone to a temporary shelter at a nearby college. “We had two buses, and it probably took us four hours to move those 36 residents,” Gainesville Fire-Rescue Chief Twiner told the Gainesville Daily Register in 2021. “We had to take some of their beds—there were beds at [the shelter], but it wasn’t enough.”
Research indicates that extreme weather disproportionately affects rural areas, which also have limited capacity to respond to weather events and the prolonged utility outages that often follow.
A 2025 report from the Federation of American Scientists found that rural communities faced heightened risks from extreme heat, with residents more likely to have pre-existing health conditions, limited healthcare access, and older or substandard housing. In rural areas, heat waves disrupted work, strained local businesses, and exposed weaknesses in aging energy infrastructure, revealing a pressing need for targeted investments in health systems and resilient energy.
A 2025 study published in Natural Hazards Review further found that rural communities hit by natural disasters faced significantly longer power outage recovery times than urban areas, highlighting how limited infrastructure and resources can leave rural populations disproportionately vulnerable.
Power Outages Can Lead to Death
New research is beginning to explain the toll that Winter Storm Uri had on older populations in rural areas. The chaos in Gainesville was just one of hundreds of stories that unfolded across Texas in February 2021. Now, a 2025 study has confirmed the human toll of the severe weather event on these communities. Long-term nursing home residents whose facilities lost power or water during the storm faced significantly higher death rates than those in facilities that remained operational.
Madeline de Figueiredo
“We can estimate that [the outages] would contribute to about 11 or 12 excess deaths, had those nursing homes not experienced a utility outage,” said Brian Downer, PhD, associate professor in the School of Public and Population Health(SPPH) at the University of Texas Medical Branch (UTMB) and one of the article’s authors. “To better contextualize those 11 excess deaths, the state of Texas was able to attribute about 150 deaths among adults aged 60 and older…to Winter Storm Uri.”
A 2022 study in Nature found that rural communities faced greater challenges during Winter Storm Uri. Limited resources and slower emergency support made outages harder to manage. Residents in these areas were also less prepared for prolonged power loss, highlighting vulnerabilities in infrastructure and disaster response.
“It is the rural communities that are being disproportionately affected by the power outages,” Downer said about the Nature study.
New Texas Legislation Helps Essential Services Adapt to Severe Weather
In response to such risks, the Texas Legislature authorized $1.8 billion this year for the Texas Backup Power Package, an initiative aimed at strengthening energy resilience through backup power systems and microgrids in critical facilities, including those in rural areas. The program, funded through the broaderTexas Energy Fund, was designed to ensure that essential services like nursing homes, hospitals, and water systems are better equipped to remain operational during future grid emergencies.
“The extreme weather events that crippled Texas in recent years made it clear this investment was overdue,” said Texas State Representative Ana Hernandez, who serves on the Texas Backup Power Package Advisory Committee. “These backup systems allow vital facilities to keep operating even if the main grid goes down.”
The Texas Backup Power Package was passed in 2023, but didn’t receive funding until the 2025 legislative session. It will provide grants and loans for generators, battery storage, and solar systems.
State Representative Hernandez said the program rules will be drafted later this year and applications are expected online by spring 2026, with installations starting that summer. Final eligibility is still being decided, but critical facilities will be prioritized.
“By providing multi-day, stand-alone backup systems, the program ensures that vital services don’t go dark when the grid fails. Health centers, senior living facilities, emergency responders, and other critical operations will be able to stay open and serve the public,” Hernandez said. “In short, it helps communities hold steady in the face of long outages and strengthens overall resilience.”
Outages Deepened Health Risks for Older Adults
During Winter Storm Uri, Texas experienced historically low temperatures and sweeping power failures as the state’s electric grid struggled to meet surging demand.
According to the Texas Health and Human Services Commission, 578 of the state’s 1,212 nursing homes, nearly half, reported at least one incident during the storm, including 139 that lost power, 327 that had to boil water, and 121 that suffered burst pipes, water shortages, or complete water loss.
An estimated 39,000 residents, about half of all nursing home residents in the state, lived in facilities that reported such incidents, according to data compiled by the Texas Health and Human Services Commission.
For residents, those outages were more than an inconvenience. They intensified existing health risks and exposed the particular dangers that extreme temperatures pose to older adults.
Andrea Earl, associate state director of advocacy and outreach at AARP Texas, said older adults in care facilities faced heightened risks during extreme temperatures because their bodies struggle to regulate heat and cold. Many residents also have mobility issues, chronic health conditions, or cognitive impairments that limit self-care. Medication, medical equipment needs, and social isolation further increased vulnerability to extreme temperatures, according to Earl. But some nursing facilities lacked staff expertise to recognize early signs of heat or cold stress, making reliable utilities critical for protecting residents’ health.
Some of the effects of extreme weather and utility outages are not immediately detectable.
“In extreme cold, your blood starts to thicken, especially if you’re older, and that increases the risk of blood clots and other cardiovascular incidents. And I think the hard part about both is these things don’t come on right away,” Earl said.
In the JAMA study, researchers captured these longer term effects by reviewing outcomes over the course of the weeks following the storm.
“We really need to start paying attention to these more delayed effects that are coming up,” said Alex Holland, a doctoral student in population health sciences at UTMB and a co-author of the JAMA article. “In our study, we didn’t really see that difference in mortality until three weeks after winter storm Uri, so there’s somewhat of a delayed effect.”
New Backup Systems Target Future Outages
The Texas Backup Power Package aims to strengthen the state’s energy infrastructure by installing generators, microgrids, and batteries at critical facilities across the state that could run independently when there are grid failures.
Winter Storm Uri caused economic losses upwards of $80 billion. The state’s power grid faced an unprecedented surge in electricity demand and critical parts of the system failed.
To prevent a total collapse that could have taken weeks or even months to recover from, the Electric Reliability Council of Texas (ERCOT), which manages most of Texas’s electric grid, implemented emergency blackouts.
Some of the water shortages were directly tied to ERCOT emergency directives, which required utilities to reduce power consumption to stabilize the electric grid.
In Medina County, a rural area west of San Antonio, water was unavailable during Winter Storm Uri, even for essential needs like drinking, bathing, and flushing toilets. Nursing homes in the county were among those affected, facing dangerous conditions as power and water systems failed.
As part of their research, Downer and Holland spoke with nurse practitioners at UTMB who conduct home visits to nursing homes in the area. They said the access to water can be critical to mitigate health risks and manage hygiene.
“[The nurse practitioners] were really emphasizing how both physical and oral hygiene can be really important, not only to just general quality of life and a person’s comfort, but also, too, from an infection risk, especially when it comes to oral health,” Downer said. “We felt that it would be interesting to include water outages for that reason. And then also, too, since power and water outages tend to occur together.”
Those health risks are amplified in rural areas, where limited infrastructure and slower emergency response make outages harder to manage.
Although this utility collapse was widely attributed to frozen power plants, a University of Texas study highlighted the need for better energy efficiency measures to reduce strain on the grid and protect vulnerable populations during extreme weather events.
“There’s a whole host of reasons why extreme weather events can result in lower supply,” said Joshua Rhodes, PhD, a research scientist at the University of Texas and one of the report’s authors. “[During Winter Storm Uri,] we saw [that] every single kind of power plant didn’t perform as well as we would have liked it to perform. We saw power plants freeze, be they coal, natural gas or nuclear, wind. We saw snow on top of solar panels. But we also saw the natural gas sector freeze…we lost the ability to produce about 80% of the natural gas in the Permian Basin, and so we weren’t able to move as much natural gas. We also had a bunch of power plants that just couldn’t get fuel.”
Winter Storm Uri brought the state’s energy sector to a standstill and future extreme weather threatens to do the same.
“Texas is seeing more disasters as more people live in areas where we have hurricanes, and as, just generally, more people are around, and we rely on more things for electricity,” Rhodes said.
To boost energy resilience, Texas lawmakers approved $1.8 billion in 2025 for the Texas Backup Power Package.
“We’re recognizing that there are thousands of facilities across the state, many in rural areas, but some also in urban areas, that provide vital community services, like water treatment facilities, fresh water facilities, assisted living centers and other medical facilities…,” said Texas Senator Nathan Johnson, who led legislation to create and fund the Texas Backup Power Package. “So in order to make that more affordable, what we wanted to do is just put some state money behind it.”
“Modern life runs on electricity,” Rhodes said. “I think it’s good that we’re at least keeping the critical parts of that life, of that livelihood, up and running whenever we run into issues.”
An Uncertain Pathway Forward
Researchers and advocates said that while the Texas Backup Power Package has potential to serve long-term care residents, it is not a guaranteed fix.
During the 2025 legislative session, lawmakers failed to pass SB 481, which would have required nursing and assisted living facilities in Texas to maintain safe temperatures during emergencies with backup power systems. Without such state regulations, Earl expressed concern that many facilities may be unaware of the Texas Backup Power Package program or lack the capacity to apply for it.
“A lot of these places are understaffed…so any extra administrative processes might be a hindrance to why they would apply,” Earl said. “We’re hopeful that facilities out there are paying attention to [the backup power package], but I think that’s another thing too. How well is this fund going to be marketed? Are we going to see these facilities know firsthand that they can apply for this? How are they going to find out about it?”
Holland said that the successful implementation of backup power also depends on training and education for effective emergency preparedness.
“Now there’s funding available to help with these backup power sources, like the Texas Backup Power Package. But then the question becomes like, well, then what? These facilities might not know, what is the best power supply backup for us? Where should we put them?” Holland said. “We see sometimes that generators end up getting put on the floor and ground level in areas that are prone to flooding or nursing home staff aren’t trained on how to use this emergency backup equipment.”
Without proper guidance and preparation, the funding alone cannot guarantee that facilities will be ready when disaster strikes.
“Disaster preparedness is for everybody,” Holland said. “I think especially that’s something that lends itself very strongly to rural communities [where] you kind of have that ‘everybody knows everybody’ feel. And so taking that into the disaster preparedness side of things, and knowing how your city or your county is preparing for some of these events, or, what are the resources in place, kind of at that local level, also definitely come into mind.”
Earl emphasized that emergency preparedness shouldn’t wait for tragedy.
“We don’t think death should be the underlying reason for, or the catalyst for, doing backup power and requiring a certain level of power in these facilities,” Earl said. “We think that there’s a lot of dignity with this stage of life and where you’re at and that that should be preserved, especially if you are paying to be in a facility and putting your hard earned dollars and assuming and expecting a certain level of care.”
This story first appeared in The Daily Yonder. Read the original here.
