The Room Says 89 and She Says She's Fine

Delfina "Del" Montes has been a home health aide in the Phoenix metro area for eleven years. She carries a caseload of six to eight clients per day across Maricopa County: elderly and disabled adults on oxygen concentrators, power wheelchairs, and medication regimens that interact with heat in ways no one explained to her in training. She drives a 2014 Honda Civic with intermittent air conditioning. She bought her own digital thermometer at Walgreens because the agency didn't issue one. She makes roughly $17 an hour.

Del does not, strictly speaking, exist. But every condition of her work — the scheduling grid, the equipment, the indoor temperatures, the wage, the triage — is drawn from documented sources. Think of her as the space between what public health systems count and what actually happens in the room. We spoke on a Wednesday in July, which in Phoenix is less a day of the week than a position on a heat calendar.¹

You've been doing this work for over a decade. Has the summer part of the job changed?

Del: The summer part is the job now. Used to be June through September, you're more careful, you check the AC, you carry extra water. Now I'm thinking about heat in May. I had a client last year whose window unit started making a sound in April. April. And I'm standing there thinking, if this thing dies in July, the repair wait is going to be seven to ten days. During peak. For a repair, not a replacement.

And 72 percent of the indoor heat deaths in Maricopa last year, the AC was there. In the window. Just not working.² People hear "heat death" and picture someone stranded outside. No. It's a twenty-year-old box unit that nobody maintains because who has the money, and when it stops, there's no alarm, no alert. The room just gets warm. And the person in the room might not register it the way you or I would.

Why wouldn't they register it?

Del: Older adults on certain medications — diuretics, some psych meds, anticholinergics — their body doesn't sweat right, doesn't signal thirst right.³ I have a client who'll tell me she's fine. "It's nice in here, mija." And the thermostat says 89. There's a protocol for this. You're supposed to ask what the thermostat reads, not whether the room feels hot.⁴ Because the feeling is broken. The thermostat is the truth.

So you're checking the thermostat before you're checking the client.

Del: I'm checking everything. The thermostat, the sound of the AC, the bill envelope on the counter. If that envelope is from APS and it's unopened, I know something. During the summer moratorium they can't disconnect you, but the charges keep coming.⁵ So someone might be rationing. Running the AC only at night. Sitting in 95 degrees during the day to keep the bill from hitting $400.

She's not going to volunteer that. She's going to say she's fine.

What happens when multiple clients are in trouble at the same time?

Del: (long pause)

That's the day. That's the day I think about when people ask me what this job is.

The system, the visit verification, the EVV, it knows I'm supposed to be at Client A from 9 to 9:45 and Client B from 10:15 to 11.⁶ It doesn't know that Client A's oxygen concentrator alarmed overnight because the power flickered, and Client B didn't answer her morning call, and Client C, who I'm not even seeing until 2, her daughter texted me — not the agency, me — to say the AC is making that sound again.

The emergency plan says "notify supervisor."⁷

Do you notify the supervisor?

Del: I notify the supervisor and I drive to Client B. Then my visit times are wrong and I have to document why, and the documentation doesn't have a box for "heat triage." It has a box for "missed visit" and a box for "deviation from care plan." If I do it right and nothing happens, there's no record that anything almost happened. If I do it wrong and Client B is on the floor —

(stops)

Fifty-three of the indoor heat deaths last year were found on welfare checks.⁸ A welfare check means nobody got there in time through the normal system. The aide didn't come, or the aide came and the door didn't open, or nobody called. I think about that number more than I should.

You mentioned your car's AC is intermittent. What's your own heat exposure like during all this?

Del: (laughs) Oh, we're doing this part now? Okay. I make $34,900 a year.⁹ I live in an apartment with a window unit. I drive between visits in a car that blows warm air half the time. I show up at a client's door already sweating through my polo, and then I'm doing physical work — lifting, repositioning — in rooms that might be 88, 90 degrees.

Here's the thing that would be funny if it weren't my life: OSHA doesn't have a heat standard for my work environment because my work environment is someone else's living room.¹⁰ I am the person the system sends to check if someone is safe from heat, and I am experiencing the same heat. That's the whole arrangement.

Is there anything in the formal system that captures what you actually know about your clients' heat vulnerability?

Del: No.

Just no?

Del: There are registries. emPOWER, the utility lists.¹¹ I don't have access to them. They work at the ZIP-code level, population level. What I know is: Mrs. Reyes has a generator but her grandson hasn't tested it since 2023. Mr. Washington's wheelchair won't fit through the stairwell if the elevator goes down. The woman on the third floor of the building on 35th Avenue keeps her curtains closed so I can't tell from outside if she's moving.

None of that is in a database. It's in my head. And if I quit tomorrow — which, for $17 an hour in this heat, is not an abstract thought — all of it walks out the door with me.

What would you want someone reading this to understand?

I'm not complaining. I'm describing.

Footnotes

1. Maricopa County's 2025 heat season recorded 430 heat-associated deaths. Maricopa County Department of Public Health, 2025 Annual Heat Report, April 2026. https://www.maricopa.gov/Archive/ViewFile/Item/6510 ↩

2. Among indoor heat-related deaths where AC was present (94% of indoor deaths), the unit was not functioning in 72% of cases. Maricopa County, 2025 Annual Heat Report. ↩

3. CDC's 2025 clinician guidance lists drug classes for heat-day review including diuretics, anticholinergics, psychotropics, ACE inhibitors/ARBs with diuretics, stimulants, antihistamines, and SSRIs. Health Canada's June 2026 guidance notes older adults may have reduced sweating and altered heat sensation. ↩

4. Maricopa County's Senior and Adult Services Division instructed staff during the 2023 heat season to ask clients what the thermostat reads rather than whether the home "feels hot." Maricopa County Senior and Adult Services Division, 2023 heat-season protocol documentation. ↩

5. The Arizona Corporation Commission's 2026 summer disconnection moratorium runs June 1 through October 15 for most regulated electric utilities, but bills are not paused or forgiven. EIA's 2024 RECS estimated 8.16 million U.S. households unable to use AC equipment due to broken/unaffordable repair or electricity disruption. https://www.eia.gov/consumption/residential/ ↩

6. Federal Medicaid electronic visit verification requires recording of service type, recipient, date, location, provider, and visit start/end times for covered in-home services. 42 U.S.C. § 1396b(l). ↩

7. CMS emergency-preparedness rules require home health agencies to maintain emergency plans covering hazards, equipment/power failures, and communication interruptions. CMS emergency-preparedness compliance materials. ↩

8. 53 of 111 indoor heat-related deaths in Maricopa County in 2025 were discovered through welfare checks. Maricopa County, 2025 Annual Heat Report. ↩

9. Median annual wage for home health and personal care aides was $34,900 in May 2024. The occupation held approximately 4.3 million jobs. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook. https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm ↩

10. OSHA's heat-exposure guidance addresses employer-controlled worksites. Home health aides work across multiple private residences with no single employer-controlled environment defining their exposure. https://www.osha.gov/heat-exposure ↩

11. The HHS emPOWER Emergency Response Outreach Individual Dataset is available only to authorized state or territorial public health authorities that meet statutory requirements. Home health agencies and aides do not have direct access. https://empowerprogram.hhs.gov/outreach-individual-dataset.html ↩