At least eight elderly people died in a sweltering South Florida nursing home after it apparently lost its air conditioning amid ongoing, widespread power outages related to Hurricane Irma.

The deaths, which prompted a criminal investigation on Wednesday, were what many feared might happen after Irma knocked out power for millions of people in Florida, which is known for its extreme heat. Without the respite of air conditioning, the heat poses a particular threat to Florida’s large population of elderly residents, who are more susceptible to heat-related illnesses.

In Hollywood, Florida, where temperatures are forecast to reach the 90s through the end of the week, authorities were called early Wednesday to the Rehabilitation Center at Hollywood Hills, a nursing home not far from Fort Lauderdale with a troubled history.

What they found was gruesome: Three people inside already were dead, while other patients were in “varying degrees of medical distress,” city officials said. At least five were pronounced dead later, while dozens of the home’s residents were spirited from the stifling building to local hospitals, including Memorial Regional Hospital just down the street.

Those who died – five women and three men – were between the ages of 71 and 99.

“We believe at this time it may be related to the loss of power in the storm,” Tomas Sanchez, the Hollywood police chief, said at a news briefing Wednesday. “It’s a sad event.”

Police later said they are working to determine what caused the tragedy.

“The initial investigation has determined that the facility’s air conditioning system was not fully functional,” Hollywood city officials said in a statement Wednesday evening. “Portable units were being used in the facility, but the facility was excessively hot.”

The first call came in to firefighters at 3 a.m. Wednesday, about a patient believed to be in cardiac arrest, officials said. Firefighters returned to the facility an hour later for a patient with breathing problems, and they then called a state agency with concerns about the facility. When a third call for help came in, more Hollywood Fire Rescue crews were dispatched, and they were joined by Memorial Regional Hospital staff.

“There was no air conditioning,” said Randy Katz, chairman of the department of emergency medicine at Memorial. “The temperatures, particularly on the second floor, were extremely hot.”

Ellie Pina, whose 96-year-old mother, Mirelle, is a resident at the center, said the facility had been running on generators since the power went out on Sunday while Hurricane Irma swept through Florida. Pina said she and others repeatedly called Florida Power and Light about the lack of electricity and were ignored.

“I told Florida Power and Light the generators were going to give up soon. And it happened,” said Pina, reciting her ticket number, which recorded her seeking help. “I told my husband people were going to die in there. And it happened.”

Florida Power and Light, which said Wednesday it serviced part of the facility, said it extended its sympathies to those who lost loved ones and was limited in what it could say because of the investigation.

Robert Gould, chief communications officer for Florida Power and Light, the state’s largest utility, said during a briefing Wednesday that Broward County did not list the Hollywood facility as critical infrastructure in a hurricane planning meeting earlier this year. Such locations are prioritized for power restoration after a storm because of the services they provide to vulnerable people.

Broward County said in a statement Wednesday that it selected critical infrastructure based on a Florida Power and Light guidance document. Going by this document, the county said, nursing homes were deemed “non-critical.”

On Tuesday, the county said, the nursing home contacted county officials to say it had lost power, information Broward said it reported to the power company. The nursing home reported later Tuesday that a tree was on a transformer, Broward said, information that was also relayed to the utility.

“Hollywood Hills, when asked if they had any medical needs or emergencies, did not request assistance or indicate any medical emergency existed,” Broward County Mayor Barbara Sharief said in the statement.

Pina said the nursing home’s staff set up portable air conditioners and put patients, clothed in as little as possible, in the hallways close to the cooling units. She was there Monday and Tuesday around noon and said it was extremely hot.

“They were trying to help the people,” she said of the staff, which she said kept calling the utility for help. Pina said she and others also called 911 and received no response. On Wednesday morning, Pina said, she was told by a staffer that “the generators gave up.”

Pina said her mother is hospitalized but doing well. She is among the more than 150 patients taken from the facility to one of the hospitals in Memorial’s system. Katz said they were treated mainly for dehydration, respiratory issues including respiratory failure, heat exhaustion and high fevers.

“There’s no reason patients that age with chronic medical issues should be in a facility without air conditioning,” Katz said.

Federal requirements state that nursing homes must have written, detailed plans and procedures for emergencies and disasters such as severe weather. Kristen Knapp, spokeswoman for the Florida Health Care Association, said hundreds of facilities for the elderly have relied on backup systems since Irma passed over the state Sunday.

“Throughout this whole process, we haven’t heard of any affected nursing homes operating without a generator,” Knapp wrote in an email.

While Hurricane Irma did not fulfill the most dire forecasts, the storm still managed to wreak enduring havoc across all of Florida. After Irma lashed the state and parts of the Southeast with rain and wind, power outages remain the chief concerns. Power companies had restored power to millions, but about 3.5 million power company customer accounts in Florida – or 1 in 3 statewide – still lacked electricity on Wednesday. Utilities have warned it could be days or weeks before the lights come back on in some places.

This presents a particular risk in Florida, where about 1 in 5 residents are 65 or older. People in that age range are more prone to heat-related health problems because they do not adjust as well as younger people to sudden shifts in temperature, are more likely to have chronic medical conditions and often take medications that affect the body’s ability to regulate its temperature, according to the Centers for Disease Control and Prevention.

“The elderly and the young are more susceptible to getting dehydration from the heat,” said David Gifford, senior vice president of the American Health Care Association. “Keeping them well hydrated is important and keeping them as cool as possible.”

The Florida association, which represents more than 4 in 5 nursing homes in the state – it does not represent the Hollywood facility – said about 150 out of nearly 700 facilities in the state did not have full power services restored as of Wednesday.

“As with millions of other Floridians, our centers are coping with the loss of power and infrastructure in the communities that were most affected by the devastation,” the association said in a statement.

Florida Gov. Rick Scott (R), a former hospital chief executive, called the situation at the Hollywood nursing home “unfathomable.”

“I am going to aggressively demand answers on how this tragic event took place,” Scott said in a statement. “Every facility that is charged with caring for patients must take every action and precaution to keep their patients safe – especially patients that are in poor health.”

Scott said he directed two state agencies – the Department of Children and Families and the Agency for Health Care Administration – to work with local authorities on the investigation, and he warned that “if they find that anyone wasn’t acting in the best interests of their patients, we will hold them accountable to the fullest extent of the law.”

According to Scott’s office, the facility had reported as recently as Tuesday afternoon that they had power and access to fans and spot coolers.

The facility’s administrator, Jorge Carballo, said in a statement sent to media outlets that the center had evacuated “due to a prolonged power failure to the transformer which powered the facility’s air conditioning system as a result of the hurricane.” Carballo did not respond to The Washington Post’s requests for comment.

The facility has a history of citations, and it is rated “below average” on the Medicare website. Federal records, court documents and state inspection reports show the facility’s owners and managers had lurched from one problem to another during the past decade, including a federal bankruptcy, allegations of fraud, complaints from residents and repeated documentation of poor care and unsafe conditions.

State inspectors last year found patients who had been left in their nightgowns, facing televisions that had been turned off. Others were unshaven and had untrimmed nails, including a man with blackened, jagged nails who had scratched himself raw.

“The facility failed to ensure residents were treated with dignity with respect for their individuality and preferences,” the report found, saying inspectors observed a “failure to address residents in a respectful manner.”

State reports show violations were recorded on 23 visits to the facility since 2010, with the violations in several reports describing systemic mistreatment.

Safety also was a repeated concern. Smoke alarms, emergency exits and the nursing home’s emergency generator were cited for deficiencies.

In February 2016, an inspector wrote that the facility failed to maintain its emergency generator to manufacturer and code requirements – and that it wasn’t the first time. More recently, in May, another state official who visited the facility wrote that he found no problems. “All previously cited Fire & Life Safety deficiencies were corrected” and no new deficiencies were found, he wrote.

Since the power outages began in Florida, concerns have mounted across the state. Before the deaths in Hollywood, an assisted living facility on the southwest coast of Florida spent three terrifying days without power before it flickered back on.

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Scott Unger in Key West, Florida, Leonard Shapiro in Fort Lauderdale, Lori Rozsa in Gainesville, Florida, and Wesley Lowery, Julie Tate and Alice Crites in Washington contributed to this report.