Fire safety: is your facility legal? The legal structure governing nursing home fire safety: a guide to self-examination

Nursing Homes, Sept, 2004 by Julie A. Braun

Retrofit cost: A barrier to requiring automatic sprinkler systems in all nursing homes. The Hartford and Nashville fires reopened the debate about the need to retrofit older nursing homes with sprinklers. In their aftermath, Connecticut and Tennessee passed laws requiring all nursing homes to install sprinkler systems. Notably, of Connecticut's 254 nursing homes, 206 are fully sprinklered, 31 are partially sprinklered, and 17 have no sprinklers, and of Tennessee's 343 nursing homes, 229 are fully sprinklered, 90 are partially sprinklered, and 24 have no sprinklers.

The decision to allow older, existing facilities to operate without sprinklers is being reevaluated now in light of the 2003 nursing home fires. Historically, CMS and the nursing home industry have considered cost a barrier to requiring installation of automatic sprinklers for all older nursing homes, even though sprinklers are considered to be the single most effective fire protection feature. (3) There has never been a multiple-death fire in a fully sprinklered nursing home, and sprinklers now are required in all new facilities. (3)

Although the amount is uncertain, sprinkler retrofit costs remain a concern, (4-6) and the nursing home industry endorses a transition period for homes to come into compliance with any new requirement. If retrofitting is eventually required, it is likely to be several years before implementation begins. (See News Notes, p. 20, for recent federal legislation seeking to mandate sprinkler systems in all nursing homes, accompanied by reactions from the American Health Care Association and the American Association of Homes and Services for the Aging [AAHSA].)

Although infrequent, multiple-death nursing home fires have prompted some states (e.g., Ohio, Utah, Virginia, Vermont, and West Virginia) to require nursing homes to be retrofitted with sprinklers. (3) States can enforce such requirements because state licensure is a prerequisite to operation. States with relatively high proportions of unsprinklered nursing homes include Arkansas, Iowa, Pennsylvania, and Wisconsin. (3)

As a result of the Hartford and Nashville fires, NFPA is actively considering incorporating a sprinkler retrofit requirement into its 2006 update of the Life Safety Code standards, as urged by AAHSA (see News Notes, p. 20).

Oversight of Fire Safety: The Survey Process

On September 11, 2003, CMS began surveying facilities for compliance with the 2000 edition of the Life Safety Code. Every nursing home receiving Medicare or Medicaid payment must undergo a standard survey not less than once every 15 months, and the statewide average interval for these surveys must not exceed 12 months. (1,7,8) State survey agency personnel conduct the survey to assess compliance with federal quality of care and fire safety requirements. (1) Revised survey forms now capture the status of sprinkler systems--Fire Safety Survey Report 2000 Code, Form CMS-2786R (Rev. Mar. 2004) and Fire Safety Survey: 2000 Life Safety Code Worksheet for Rating Residents, Form CMS-2786M (Rev. Mar. 2004). Most states use fire safety specialists within the same department as the state survey agency to conduct fire safety inspections, but 16 states contract with their state fire marshal's offices. (3) The fire safety portion of a standard survey is not always conducted concurrently with the quality-of-care review, particularly in states that contract with their state fire marshals. All personnel conducting the inspections must complete a self-paced, computer-based course before fulfilling five days of classroom training on fire safety standards. (3)