Older Nursing Homes Must Add Sprinkler Systems for
Medicare, Medicaid Patients
We now will hold all 16,000 nursing homes in the
nation to this standard. CMS says
June
20, 2008 Older nursing homes that have escaped modern regulations that
require wall-to-wall life-saving sprinkler systems to protect residents
from fire, will now have get the systems installed, if they want to
continue to serve Medicare and Medicaid beneficiaries.
Under a new regulation to be issued by the Centers
for Medicare & Medicaid Services, these facilities will have a five-year
phase-in period to be fully compliant with the new rule.
Approximately three million elderly and disabled
Americans reside in the nations 16,000 nursing homes, all of which must
have comprehensive sprinkler systems in place by 2013. To date, there
has never been a multiple-fatality fire in a facility with a sprinkler
system that meets the requirements of todays rule.
There was a peak in fire deaths 2003 (220 deaths in
non-residential buildings), which included included 31 deaths in nursing
home fires in Connecticut and Tennessee, according to a report issued
last year by the
U.S. Fire Administration pertaining to fires from 1995 through 2004.
Click here to read.
CMS is taking further action to protect the lives
of our beneficiaries through a more comprehensive and effective approach
to fire safety, said Kerry Weems, acting administrator of CMS.
In the past, certain older facilities were exempt
from having an automatic sprinkler system, but we now will hold all
16,000 nursing homes in the nation to this standard.
Deadliest fires in U.S. facilities for
older adults since 1950
1. Katie Jane
Nursing Home, Warrenton, MO, February 17, 1957, 72 killed vs.
total of 149 patients.
2. Golden Age
Nursing Home, Fitchville, OH, November 23, 1963, 63 killed vs.
total of 84 patients.
3. Nursing home,
Largo, FL, March 29, 1953, 33 killed, including 32 patients vs.
total of 45.
4a. Convalescent
home, Marietta, OH (nurses present but may not have been a
nursing home), January 9, 1970, 31 killed vs. total of 46
patients.
4b. Rest home,
Keansburg, NJ (sheltered care facility, not a nursing home, some
residents were older adults), January 9, 1981, 31 killed vs.
unreported total of residents.
6a. Nursing home
(intermediate care type), Chicago, IL, January 30, 1976, 24
killed vs. total of 83 patients.
6b. Boarding
home, Bradley Beach, NJ (boarding home, not a nursing home, most
residents were older adults), July 26, 1980, 24 killed vs. total
of 36 residents.
8. Convalescent
home, Hoquiam, WA (may not have been a nursing home), January
30, 1951, 21 killed vs. total of 29 patients.
9. Nursing home,
Hillsboro, MO, October 31, 1952, 20 killed vs. total of 70
patients.
10. Nursing home,
Hartford, CT, February 26, 2003, 16 killed vs. total of 148
patients.
As an interim step taken prior to publication of
this rule, CMS in March 2005 began requiring all long term care
facilities that did not have sprinklers to install battery-operated
smoke alarms in all patient rooms and public areas.
Although fatal fires in nursing homes are rare, the
Government Accountability Office estimated in a July 2004 report that
automatic sprinkler systems can decrease the chance of fire-related
deaths by 82 percent.
CMS says it has already taken many actions to
increase resident safety over the past several years, including
stepped-up frequency in the number of fire safety inspections performed.
The agency previously began publishing on its
Nursing Home Compare Web site the number of fire safety violations, as
well as information on the extent to which nursing homes had sprinkler
systems, for every long term care facility in the country.
Under previous CMS regulations, newly constructed
and rehabilitated nursing homes must be equipped with sprinkler systems.
But prior to adoption of todays rule, existing homes were not required
to have such systems by the federal government.
CMS follows the fire safety guidelines developed by
the National Fire Protection Association (NFPA) and all new sprinkler
systems installed as a result of this rule will have to meet NFPA
technical specifications.
To be in compliance with the new rule, nursing
homes must have sprinkler coverage in all areas such as resident rooms;
kitchen, dining and activity areas; corridors; attics; canopies;
overhangs; offices; waiting areas; closets; storage areas for trash and
linen; and maintenance areas, etc.
(Read NFPA recommendations for nursing homes below
news report.)
This is an important new rule for protecting the
health and safety of persons living in long term care facilities such as
nursing homes who are, by definition, some of the most vulnerable among
us, Weems said.
It is widely believed by fire safety experts that
automatic sprinkler systems are the single most effective fire
protection step facilities can take.
Nursing Home
Recommendations National Fire Prevention Association
Senior Citizens Dominate Fire Deaths in
U.S.
2007 Report by
U.S. Fire Administration on 1995-2004
Nursing homes of all manner fall into the broad
category of a "health care occupancy" for most fire regulation. A health
care occupancy is generally defined as "an occupancy used for purposes
of medical or other treatment or care of four or more persons where such
occupants are mostly incapable of self-preservation due to age, physical
or mental disability, or because of security measures not under the
occupants' control." Health care occupancies might include the
following: hospitals, limited care facilities, and nursing homes among
others.
A nursing home is
specifically described by the National Fire Prevention Association as "a
building or portion of a building used on a 24-hour basis for the
housing and nursing care of four or more persons who, because of mental
or physical incapacity, might be unable to provide for their own needs
and safety without the assistance of another person." The term nursing
home includes nursing and convalescent homes, skilled nursing
facilities, intermediate care facilities, and infirmaries in homes for
the aged.
Health care
occupancies are characterized by the presence of persons who are
considered to be incapable of using available exits to relocate within
or evacuate the building. Such occupants may be unable to use the exits
because they are bed-ridden or otherwise immobile, wired to monitoring
or life-sustaining equipment, debilitated, recovering from surgery, or
disabled in some other way.
Since most, if not
all, occupants in health care occupancies are generally considered
incapable of self-preservation, code provisions are based upon the
"defend-in-place" concept. This concept uses a complete fire protection
package, which incorporates any combination of building construction,
sprinkler systems, detection and alarm systems, horizontal movement,
compartmentation, and staff training, to provide occupants with enough
protection to enable them to survive a fire while remaining in the
building.
NFPA code
provisions mandate that a considerable number of safety systems and
features be present in order to keep everyone safe should a fire occur.
The level of safety provided is not the result of any single safety
system or feature, but rather is achieved through the combination of
multiple safeguards that are provided.
NFPA has a number
of codes and standards that work in harmony to prevent the type of
life-loss that occur in nursing homes.
The following
elements provide an outline of the most basic requirements and criteria
as found in NFPA 101ฎ, Life Safety Codeฎ, 2003 edition.
Compartmentation
Barriers, such as walls, smoke barriers, partitions, and floors,
separate building spaces. These barriers delay or prevent fire and
smoke from spreading from one compartment to another.
On-site fire
protection
Fire alarm
systems this includes means for detection of a fire,
initiation of the alarm and/or suppression systems, and
notification of occupants, especially the staff.
Automatic
sprinkler systems sprinkler systems are required in all new
health care occupancies and many existing occupancies,
especially when a facility undergoes major renovation.
Portable
fire extinguishers extinguishers must be provided in all
health care occupancies and must be used only by properly
trained personnel.
Exiting
Strategy
Unlike other types of occupancies, movement and evacuation of
all patients is not practical and is reserved as a measure of
last resort. The related exit provisions must keep this thought
in mind.
Relocation
Often times, it is preferable to transport patients to a
separate smoke compartment. This is referred to as horizontal
relocation.
Occupant
Load - the number of people anticipated to be in the building.
This calculated value is used to derive the number of exits and
the width of these exits.
Number and
arrangement of exits-in general terms, at least two exits need
to be provided from each building. In a health care occupancy,
two exits are required to be provided for each floor or section
of a floor. Depending on the level of compartmentation in the
facility, there could be several exits, including horizontal
exits, accessible from each floor.
Exit signs
signs are needed to identify exits and direct the ways to get to
those exits. This includes location of such signs and how to
illuminate them.
Emergency
lighting When a fire occurs in a building, visibility is one
key factor that could affect how the staff react to an emergency
situation and their ability to take appropriate action.
Staff training The
action taken by staff in a health care occupancy is an integral part
of the life safety features required. The proper response from staff
in terms of numbers, actions, and management of the fire can readily
influence the outcome of a fire.
Since health care staff is a key factor in the success of the
emergency action plan, it is important to regularly evaluate their
ability to perform critical functions to protect patients in place
or to perform rapid relocation of those who are threatened by the
fire. Emphasis must be placed on training the staff to sound an
alarm, to rescue patients (as needed), and to close all doors. The
Code requires eight specific actions with respect to this
part of the "defend-in-place" concept.
All health care staff must be periodically instructed, through fire
drills and written instructions, in the proper procedures for
emergency relocation and/or evacuation. The purpose of a fire drill
is to test and evaluate the efficiency, knowledge, and response of
institutional personnel in implementing the facility fire emergency
plan. Its purpose is not to disturb or excite patients. Fire drills
should be scheduled on a random basis to ensure that personnel in
health care facilities are drilled not less than once in each
3-month period. Many health care facilities conduct fire drills
without disturbing patients by choosing the location of the
simulated emergency in advance and by closing the doors to patients'
rooms or wards in the vicinity prior to initiation of the drill.
Furnishings &
contents The
purpose of interior finish requirements is to slow the fire spread
across these surfaces to allow additional time for occupants to
relocate or evacuate the building.
Interior
finish exposed surfaces of walls and ceilings within
buildings.
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June
20, 2008 Older nursing homes that have escaped modern regulations that
require wall-to-wall life-saving sprinkler systems to protect residents
from fire, will now have get the systems installed, if they want to
continue to serve Medicare and Medicaid beneficiaries.