Responding to an uptick in extreme heat waves this summer, US cities have increased their efforts to establish cooling centers to keep people safe but continue to encounter a problem: actually getting people to enter the public air-conditioned spaces.

Lower-income people, who often do not have – or cannot afford to operate – air conditioning, face a greater risk of heat-related illness or deaths, which means public agencies in the US concentrate their efforts on trying to reach them.

But for various reasons, including the length of a commute to a cooling center or a sense that the extreme heat is not especially dangerous, they often still remain outdoors or at home, experts say.

“It’s not easy to survive unsheltered in New York City, even in the best of weather,” David Giffen, executive director of the Coalition for the Homeless, a non-profit in New York. “These are individuals that have skills and strength and resilience that has allowed them to survive like that, so they don’t necessarily think, ‘Oh, now it’s getting hot, and I should finally come indoors.’”

The United States and other parts of the world have this year repeatedly experienced heat domes, a phenomenon in which high pressure traps hot air over a region, preventing cool air from entering. The continental US endured the second-hottest first half of the year on record in 2026, according to the National Centers for Environmental Information.

The affected areas have seen a spike in heat-related illnesses and deaths. On 3 July in New York, when temperatures reached more than 100F, hospitals saw 156 visits to emergency rooms because of heat-related illnesses, the highest number since at least 2017, according to city data. On 4 July and the week prior in Maine, hospitals received 128 heat-related visits to emergency rooms, which was also the highest number since at least 2017, according to state data.

This summer in Maryland, there have been at least 38 heat-related deaths, already surpassing the total number from 2025, the Baltimore Sun reported.

To prevent such outcomes, New York officials added 23 cooling centers to the city’s network. This year, the city has had an average of 585 cooling centers open on weekdays; last year, it averaged 560, according to New York City emergency management.

The centers are air-conditioned facilities such as libraries, community centers and senior centers.

In addition to having air conditioning and drinking water, the spaces must also feature staff who tell visitors, “Hey, we are a cooling center. Is there anything that you might need?” said Jocelyn Rajaballey, a human services specialist at the emergency management agency.

The city’s health system started using vans too this year to reach older adult and homeless populations and offer wellness checks, medical care, water, and transport to cooling centers or healthcare facilities, according to the city.

In Maine, where residents are less likely to have or use air conditioning than much of the country, the state had until recently seen about 60 to 70 cooling centers open over a five-day period during the summer; this year and last year, the state had stretches were the government opened more than 100 centers, according to Bill Guindon, mass care coordinator at the Maine emergency management agency.

“It’s kind of a resort for people that don’t have access to cooling resources,” Guindon said. “In some areas, with the individual on fixed incomes … they have to choose between feeding and heat and air conditioning.”

Still, some cooling centers are often underutilized, even during extreme heatwaves.

Maine used to have more mild summers and people are accustomed to not needing air conditioning, said Vanessa Corson, public information officer for the state’s emergency management agency.

The state is largely rural, which means residents might have to travel a fair distance to get to a center.

They “may not feel like getting up to go to a cooling center and think, ‘I can just tough it out at home,’” Corson said. “Another challenge is, honestly, swallowing your pride, and there are people who think that they don’t need a cooling center.”

New York City has tried to help residents by installing kiosks with walking directions to the nearest cooling center.

But people who are homeless and stay away from shelters because of a bad experience might also avoid the centers, Giffen said.

Emergency management officials encourage people to check on their neighbors during extreme heatwaves.

Particularly since the Covid-19 pandemic, “we tend to be not as socially connected to our own neighbors as we once were”, Guindon, from Maine, said. “The communities that have had success on this know their neighbors and where the needs are.”