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

Case Illustrations: Investigations and Outcomes

Failure to cite deficiencies. Postfire investigations in Connecticut and Tennessee revealed deficiencies that existed, but were not cited, during prior surveys (3) (table 3). For example, a survey conducted at the Hartford facility one month prior to the fire did not uncover the lack of fire drills on the night shift, or that on the night the fire occurred, staff failed to implement the facility's fire plan. The survey was conducted during the daytime when night-shift staff were unavailable for interviews, and surveyors relied on inaccurate documentation stating that all shifts were conducting fire drills. On the other hand, Tennessee's postfire investigation failed to explore staff response, a deficiency cited in four prior surveys, and never established a clear chronology of staff response, including whether they closed resident room doors to contain the fire and smoke.

Lack of smoke detectors. Although commonsense features such as smoke detectors in resident rooms are effective in alerting staff to a fire while it is still relatively manageable, smoke detectors are not required in unsprinklered nursing homes. (3) CMS has stated that it will pursue a regulatory change requiring installation of smoke detectors in every resident room. (3)

Only nursing homes surveyed under federal standards for new construction since 1981 are required to have either corridor or in-room smoke detectors. (3) According to fire inspectors, the lack of smoke detectors in resident rooms in the Hartford and Nashville facilities might have contributed to a delay in staff response and fire department notification. (3) Compare this with the presence of smoke detectors in resident rooms in a December 2003 nursing home fire in Nevada where a resident smoking in bed while on oxygen started a fire at 2:20 a.m. (3) Staff were alerted by the in-room smoke detector, and the fire was extinguished before it caused a significant amount of damage. While the resident who started the fire subsequently died as a result of the fire, no other deaths were reported. Although the facility was equipped with automatic sprinklers, the buildup of heat from the fire had not reached a level sufficient to activate the sprinklers.

Lack of smoke dampers. The new standards require smoke dampers where ductwork passes through a smoke barrier, and older homes, such as the Nashville facility, will no longer be grandfathered under earlier editions of the Life Safety Code that do not include such a requirement. (3) However, a facility that lacks dampers in ductwork as required by current federal standards could still be certified for Medicare or Medicaid by obtaining a waiver for this requirement from CMS. However, CMS guidance still requires smoke detectors in resident rooms and fire-rated separation of resident rooms as compensating features when considering waivers for some unsprinklered one-story, wood-frame facilities.

Fire or smoke barriers in unsprinklered facilities. Another potential weakness in federal standards, particularly in an unsprinklered facility, is that resident rooms are not required to be separated from each other by fire or smoke barriers. (3) History has shown that smoke is the cause of most fire deaths. Consequently, fire-resistant smoke barriers extending uninterrupted from floor slab to roof slab passing through all concealed spaces become an important fire-protection feature. In the Hartford nursing home fire, residents in the room adjacent to the room of fire origin died from smoke inhalation. Smoke and fire spread through the space above a false ceiling. The federal standard currently dictates installation of complete fire and smoke barriers between corridor and resident rooms, not between resident rooms.