While the memory of the summer of 2003 and its 19,000 deaths is still vivid, the regularity, intensity, and duration of heatwaves show that these are no longer isolated events.
2003 painfully linked old age with high mortality rates.
Fortunately, recent years have shown that in nursing homes, lessons learned from the past have led to situations that appear to be more under control[i].
However, much remains to be done to ensure that summer months become, for both staff and residents, seasons like any other.
In this article, aimed at both building designers and managers of facilities housing elderly residents, we provide a regulatory and technical overview so that all stakeholders can effectively act on the key factors contributing to summer comfort.
Cooling and Air Refreshment: Clarifying the Terms
In the world of engineering firms and architects, the distinction is fairly clear: cooling is associated exclusively with air conditioning systems, whereas air refreshment often extends to ceiling fans, which reduce the perceived temperature.
However, regulations regarding “air refreshment” in facilities housing elderly residents often equate this concept with “cold production.”
In the remainder of this publication, to use clear terminology, we will refer to three possible situations:
- Air conditioning
- Ceiling fans
- Hybrid refreshment, which combines air conditioning and ceiling fans
Heatwaves and Health Protection in Nursing Homes: Concrete Actions
Regulations issued between 2004 and 2005 introduced a new requirement: the provision of a air-conditioned room accessible to residents with reduced mobility and able to accommodate a significant proportion of residents.
These regulations include:
- Decree No. 2005-768 of July 7, 2005[ii]: requires facilities housing elderly residents to equip a room or space with a fixed air conditioning system.
- Orders of July 7, 2005 & August 8, 2005[iii]: define the specifications of the “plan bleu” (emergency plan for health or climate crises) and the conditions for installing an air conditioning system or providing a cooled room/space.
The term “significant proportion of residents” remains somewhat ambiguous and is left to the discretion of facility managers. In practice, the dining room often becomes the refuge during extreme heat.
However, this creates practical challenges for some frail residents whose health conditions do not allow them to leave their rooms. As a result, they must remain in their often non-air-conditioned rooms, where temperatures can rise to high levels.
Other measures are also implemented (staff training, plan bleu, weather alerts, etc.), but here we will focus solely on thermal aspects.
Solutions to improve summer thermal comfort are funded by the National Solidarity Fund for Autonomy (CNSA). These include a wide range of measures that limit heat exposure and favor natural ventilation. Ceiling fans are often part of these solutions, as seen in the Centre-Val de Loire and Bourgogne Franche-Comté regions.
Other solutions for summer comfort include sunshades, roof and wall insulation, external solar filters, shutters, roof and wall insulation, night-time over-ventilation, and more.
RE2020, Healthcare Facilities and Nursing Homes: Upcoming Changes for New Buildings?
The RE2020 regulation will expand on January 1, 2026, to include certain tertiary buildings that were still subject to RT2012:
- Hotels,
- Restaurants,
- Shops,
- Early childhood care facilities (daycares, nurseries),
- University buildings,
- Media libraries and libraries,
- Healthcare facilities (medical offices, hospitals, etc.) and nursing homes,
- Gyms, sports halls, and changing rooms,
- Industrial and craft buildings,
- Airport terminals.
The draft decrees underwent a public consultation[v], which closed in June 2025.
Thus, in new nursing homes, summer comfort will be much better addressed, with the introduction of the DH (degree-hours) indicator, which aims to prevent overheating through improved design.
In bedrooms, RE2020 requires targeting summer comfort without systematic air conditioning.
Air conditioning may still be present in situations where hygiene or safety rules prevent opening windows or doors to the outside (e.g., for fragile patients). In other areas, ceiling fans can be fully utilized.
Hybrid Refreshment: When Air Conditioning and Ceiling Fans Work Together for the Best
The large-scale deployment of air conditioning in nursing homes faces several obstacles.
First, from a purely economic standpoint, cooling installations are costly both during investment (construction or renovation) and operation (electricity consumption).
Second, they contribute to the development of heat islands, as they release hot air outside.
Finally, the refrigerant gases they use have a devastating impact on the environment.
An effective approach is to limit the number of air conditioning units and, for those that remain, combine them with ceiling fans. A study conducted by the University of Berkeley[vi] in tertiary buildings showed energy savings of 30% when coupling air conditioning with ceiling fans.
In this setup, the setpoint temperature for cooling is intentionally raised by a few degrees. This slight increase does not affect perceived comfort, as the ceiling fan provides an equivalent feeling of freshness.
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Concrete Feedback from Experience
In two facilities in Voiron, the introduction of ceiling fans in the rooms significantly changed how residents perceived the indoor environment.
Before installation, 100% of the surveyed group considered the temperature during the hottest periods unbearable, affecting physical activity.
After installation, 60% of respondents found the situation tolerable, or even completely comfortable. 78% considered the ceiling fan to be quiet or very quiet, and 79% stated that the benefits of the ceiling fan far outweighed any drawbacks.
Testimonials from other facility managers support these findings:
- Director of Bellevue Nursing Home in Decazeville: “Ceiling fans have significantly improved our comfort in both summer and winter, and have also resolved our low ceiling height issue thanks to their slim profile.”
- Director of Sénioriales Nursing Home (Cannes): “These devices are perfectly suited for rooms occupied by elderly residents, as the installed ceiling fan distributes air horizontally at 360 degrees. The air flows along the ceiling, avoiding any sensation of cold directional drafts on the occupants. Residents particularly appreciate their silent and discreet operation (no stroboscopic effect compared to light points).”
Notably, the bladeless Vortex-effect ceiling fans by Exhale are highly appreciated in facilities for elderly residents. They provide a gentle, evenly distributed airflow throughout the room, perfectly suited to residents’ needs.
Excerpt from an article in Dauphiné Libéré featuring the Exhale ceiling fan[vii]
Limits to the Benefits of Ceiling Fans in Nursing Homes
Achieving a perceived temperature reduction of 3 to 4°C in rooms with ceiling fans is obviously very beneficial, and this effect is further enhanced by improvements to the building envelope.
It should also be noted that ceiling fans remain effective over a wide range of temperatures. A publication from the University of Berkeley[viii] (different from the previous study) shows that they improve perceived comfort up to 43°C. Ideally, temperatures should remain below 28°C, but this clearly demonstrates the flexibility of this solution.
How to Take Action?
For institutions hosting vulnerable populations, light equipment purchases or investments are fairly accessible: air conditioners, ceiling fans, sunshades, protective films, blinds, and more.
Meanwhile, real estate investment support plans funded by the CNSA are reserved for large-scale renovation or construction projects (≥ €800k since 2022) and automatically include energy performance criteria.
Consideration of summer comfort can also rely on Regional Advisors and Coordinators for Energy and Ecological Transition in Health (CTEES), who operate within the regional health agencies (ARS). As noted by the CNSA, “since 2022, over 5,200 facilities, including 3,600 in the medico-social sector, have been supported by more than 150 CTEES for diagnostics and follow-ups”[ix].
The goal is to ensure that summer thermal comfort is considered from the design or renovation of facilities hosting or receiving vulnerable populations. These CTEES will enable, within healthcare and medico-social facilities, the conduction of energy audits and the initiation of action plans to reduce energy consumption and improve air quality.
It is also worth noting the special ANAP platform[x], the National Agency for Health and Medico-Social Performance, which is specifically dedicated to grants for ecological projects. By clicking on the link above, users can select “start” and then choose “climate change adaptation” to access the list of available funding.
In addition to this framework, facility managers can also contact OPQIBI-certified engineering firms in their region, qualified to conduct energy audits[xi].
This is all the more relevant today, with the “tertiary decree” requiring significant reductions in energy consumption in tertiary buildings over 1,000 m², making it possible to conduct a comprehensive energy audit that specifically addresses summer overheating. Furthermore, these audits include an evaluation of financial levers, such as energy savings certificates (CEE).
Supporting the energy analysis, it is worth mentioning the existence of a new reference framework dedicated to summer comfort in buildings: Héolem, which, to our knowledge, is the only initiative entirely focused on this topic, while other certifications cover all building characteristics[xii].
By relying on these various elements, facility managers caring for the elderly as well as designers will be in a strong position to take effective action.
Acknowledgements
We would like to thank Murielle Blondeau, Transition Manager specialized in the management of medico-social facilities and Director of SERENALLIANCE, for providing the information used in this article as well as her careful proofreading and corrections.
[i] In 2025, despite two heatwave episodes, Santé Publique France estimated 760 excess summer deaths: see https://www.santepubliquefrance.fr/content/download/739261/4741467?version=1 and https://www.santepubliquefrance.fr/determinants-de-sante/climat/fortes-chaleurs-canicule/documents/bulletin-national/canicule-et-sante-exces-de-mortalite.-bulletin-du-11-septembre-2025
[ii] Decree of July 7, 2005: https://www.legifrance.gouv.fr/loda/id/JORFTEXT000000259713/
[iii] Order of July 7, 2005: https://www.legifrance.gouv.fr/loda/id/JORFTEXT000000633683
Order of August 8, 2005: https://www.legifrance.gouv.fr/loda/id/LEGIARTI000030238866/2005-08-19
[iv] French Society of Emergency Medicine – THE COUR DES COMPTES QUESTIONS THE RESILIENCE OF HEALTHCARE AND MEDICO-SOCIAL FACILITIES AGAINST HEATWAVES – https://www.sfmu.org/fr/actualites/actualites-de-l-urgences/la-cour-des-comptes-s-interroge-sur-la-resilience-des-etablissements-sanitaires-et-medico-sociaux-face-aux-vagues-de-chaleur/new_id/69723?
[v] Accessible on Vie Publique: https://www.vie-publique.fr/consultations/298780-projet-de-decret-performance-energetique-constructions-de-batiments
[vi] See article (in English): https://vcresearch.berkeley.edu/news/hybrid-cooling-leads-significant-energy-savings-tropical-office-buildings
[vii] Full article available here: https://www.ledauphine.com/societe/2024/08/18/voiron-isere-canicule-apres-de-menus-travaux-un-ete-plus-serein-a-l-ehpad-voironnais
[viii] An English summary is available here: https://www.linkedin.com/pulse/when-fans-safe-harmful-during-extreme-heat-stefano-schiavon-udfqc/ – full version available on ScienceDirect: https://www.sciencedirect.com/science/article/pii/S0360132325007413?via%3Dihub
[ix] Publication available here: https://www.cnsa.fr/actualites/plan-daide-linvestissement-2023-un-bilan-positif?
[x] ANAP ecological grants platform: https://www.anap.fr/s/financer-sa-transition-ecologique. From the link, simply click “start,” then choose “climate change adaptation” to access the list of available funding.
[xi] Simply visit https://www.opqibi.com/recherche-plus, specify your region or department, and enter code “1905” corresponding to the tertiary energy audit.
[xii] Many other environmental labels can help improve buildings, whether new or renovated, while also taking summer comfort into account. Examples include HQE, Sustainable Building initiatives, BREEAM, and more.