The median date for the first one-inch snowfall in the Twin Cities is November 15, by Minnesota DNR records going back to 1884. The earliest was September 26. A nursing home or clinic in Minnesota, Wisconsin, Iowa or the Dakotas that has not stocked its winter outage kit by the first week of November is planning to buy it during the storm, from a distributor whose trucks are in the same ditch. This is the supply plan: what the CMS emergency preparedness rule expects a facility to have, what an outage actually consumes, and the order to place now. Keystone stocks janitorial and facility supplies, ice melt, gloves, wipes and safety and emergency supplies in Edina, Minnesota and ships next day across the Upper Midwest.
What this winter looks like
NOAA's Climate Prediction Center issued its 2026-27 winter outlook on October 15, 2026. For the Upper Mississippi River Valley it favors warmer than normal temperatures at 40 to 60 percent odds and gives equal chances for drier, near normal or wetter precipitation. El Nino is strengthening, and a strong to very strong El Nino is likely through January to March 2027. The National Weather Service in La Crosse adds that past strong El Nino winters brought near to below normal snow and then says the part a facility manager should keep: "Snowstorms will occur at times this winter."
A warm outlook is not a quiet outlook. The ice storms that caused the longest outages in the region recently came in shoulder seasons: northern Michigan on March 29, 2025, where more than 100,000 customers lost power and one cooperative told members to plan for an outage of five days or more, and central Wisconsin in early April 2026, where more than 55,000+ customers lost power and 14,700 were still out on April 4. Warm, wet winters produce ice, and ice takes lines down for days. Plan for the outage, not the snow total.
What the CMS rule actually requires
For skilled nursing facilities, 42 CFR 483.73(b)(1) requires emergency policies and procedures that cover "the provision of subsistence needs for staff and residents, whether they evacuate or shelter in place," and names the categories: food, water, medical and pharmaceutical supplies, and alternate sources of energy to maintain temperatures that protect resident health and safety and the safe storage of provisions, emergency lighting, fire detection and alarm systems, and sewage and waste disposal. Paragraph (d)(2) requires exercises to test the plan at least twice a year, including unannounced staff drills, and paragraph (e) ties generator installation, inspection, testing and maintenance to NFPA 99, 101 and 110. Hospitals carry the same subsistence wording at 42 CFR 482.15(b)(1).
Rural health clinics and FQHCs are under 42 CFR 491.12, which requires a plan, policies and annual testing, but does not carry the subsistence-needs list. A clinic therefore has more discretion and less direction, and the clinics that close for three days in an ice storm are usually the ones that treated that discretion as permission to skip the kit.
The Minnesota Department of Health's long-term care toolkit annex on severe weather says it plainly: make sure there are enough supplies, including food, water and generators, if winter weather causes a power outage. The rule does not say how much. The next section does.
What an outage consumes
A 72-hour shelter-in-place with no power changes the consumption rate of ordinary supplies, and that is the number the kit is sized to.
| Item | Why the rate changes | Sizing rule |
|---|---|---|
| Nitrile exam gloves | No laundry, no dishwasher, more hand contact with food service and waste | Three days of normal glove use plus 50 percent |
| Disinfecting wipes and hand sanitizer | Limited hot water; hand hygiene moves to sanitizer and wipes | Sanitizer at every station, wipes at one canister per 10 residents per day |
| Incontinence briefs and underpads | Showers stop; changes increase | Three days of use plus 25 percent |
| Bottled water | Pumps and wells may stop; CMS counts water as a subsistence need | Minimum one gallon per person per day for three days |
| Batteries and flashlights | Emergency lighting covers egress, not resident rooms | One light per room, batteries for 72 hours |
| Blankets and warming packs | Temperature protection when the generator covers life safety only | One extra blanket per resident |
| Ice melt and sand | Walkways and ambulance access must stay open | 50 lb per 1,000 sq ft of walkway per event, three events on hand |
| Can liners and biohazard bags | Waste pickup stops; waste still accumulates | Three days of liners plus one day of red bags |
| Rapid tests and masks | Respiratory illness peaks in the same months | Four weeks of par, per the respiratory season plan |
Keep the kit in one place, sealed, with a count sheet on the lid and a date. Rotate it into normal stock each spring and rebuild it each October. A kit that was opened for a staff party in August and never refilled is the finding surveyors write up most often.
The order to place in the first week of November
Order the kit, then order the operating par for December, in one PO so the delivery lands once. For a 60-bed skilled nursing community the kit is roughly a pallet: six to eight cases of gloves, two cases of wipes, sanitizer refills, a week of briefs and underpads, bottled water, batteries, four bags of ice melt and a case of can liners. For a primary care clinic with eight exam rooms it is a shelf: two cases of gloves, a case of wipes, sanitizer, batteries, two bags of ice melt and the respiratory test par.
Three timing rules:
- Ice melt before the first freeze. The calcium chloride versus rock salt decision is made by temperature, and both are on the truck in October and on backorder in January.
- Respiratory season par before Thanksgiving. Flu positivity passed 5 percent nationally in CDC week 40, and the rapid flu test stocking math applies to every community with a nursing station.
- Standing order for the consumables that run out first. Gloves, wipes and briefs on a monthly standing order at the winter rate mean the January reorder is already on the truck when the storm is on the radar.
Staff safety is part of the kit
OSHA has no cold stress standard, so the General Duty Clause applies, and OSHA's winter weather guidance asks employers for warm break areas, frequent short breaks in warm dry places, radiant heaters where workers are outside, and slower, shorter steps on ice. For a facility that means work gloves and eye protection for the maintenance staff clearing the entrance at 5 AM, a warming area near the dock, and enough ice melt that nobody is rationing it on the ambulance approach. The safety and industrial line covers the gloves, eye protection and spill absorbents the maintenance team needs on the same PO as the clinical kit.
How Keystone fills a winter order
Keystone ships from Edina, Minnesota 55439, one truck day from the Dakotas, Iowa, Wisconsin and the Upper Peninsula, and holds the glove, wipe, incontinence and ice melt lines that fill a winter kit. Send a bed count or exam room count and your current par, and Keystone returns a kit quote the same business day during business hours, with case pricing and a freight estimate. Approved accounts ship on Net 30. Multi-site operators get one PO, one delivery per site and one invoice, which is the whole point of consolidating medical and janitorial supply on one vendor.
The first inch is three weeks out on the median, and the first ice storm does not read the outlook. Browse janitorial and facility supplies or request a winter kit quote at (320) 808-3686.
Sources
- 42 CFR 483.73, Emergency preparedness, long-term care facilities: https://www.law.cornell.edu/cfr/text/42/483.73
- 42 CFR 482.15, Condition of participation: Emergency preparedness, hospitals: https://www.law.cornell.edu/cfr/text/42/482.15
- 42 CFR 491.12, Emergency preparedness, rural health clinics and FQHCs: https://www.law.cornell.edu/cfr/text/42/491.12
- NOAA, El Nino looms large over U.S. winter outlook (October 15, 2026): https://www.noaa.gov/news-release/el-nino-looms-large-over-us-winter-outlook
- NWS La Crosse, 2026-27 Winter Outlook: https://www.weather.gov/arx/winter2627outlook
- Minnesota DNR, First one-inch snowfall in the Twin Cities: https://www.dnr.state.mn.us/climate/journal/first_one_inch_snow_twin_cities.html
- Minnesota Department of Health, Long-Term Care Toolkit, Annex H: Severe Weather: https://www.health.state.mn.us/communities/ep/ltc/annexh.html
- OSHA, Winter Weather: Cold Stress: https://www.osha.gov/winter-weather/cold-stress
- CBS News Detroit, Northern Michigan ice storm power outages (March 31, 2025): https://www.cbsnews.com/detroit/news/northern-michigan-ice-storm-power-outages/
- WSAW, Almost 15,000 people still without power following ice storm (April 4, 2026): https://www.wsaw.com/2026/04/04/almost-15000-people-are-still-without-power-following-ice-storm/
