Sprinklers--No More Exceptions?

GAO blames lack of sprinklers, lax federal fire safety standards & inadequate oversight for 31 lives lost

by Keri Losavio

Fires pose true threats to long-term care facilities and their residents. In 2003, two nursing home fires claimed the lives of 31 residents in facilities located in Hartford, Conn., and Nashville, Tenn.

According to a new report from the Government Accountability Office, an average of 2,300 of the nation's approximately 16,300 nursing homes reported a structural fire (GAO-04-660) from 1994 to 1999. During the same time period, the average number of fire-related nursing home deaths nationwide was about five, with one multiple-death fire that resulted in three fatalities.

Although the Hartford and Nashville fires were unique in the number of lives they claimed, they prompted the GAO to launch a yearlong investigation. The findings were released in July. The fires and the GAO findings have prompted the Centers for Medicare and Medicaid Services (which is responsible for enforcing federal fire safety standards for nursing homes) to re-evaluate its current standards that allow older, existing facilities to operate without sprinklers.

According to the GAO report, post-fire investigations determined that both the Hartford and Nashville facilities had met all federal standards prior to the fires, but some deficiencies existed that had not been previously cited. For instance, the Hartford facility had been surveyed less than one month before the fire, but the survey didn't reveal that the facility was not conducting fire drills during the night shift. The night of the fire, the staff failed to follow the facility's fire plan. The report concludes that federal and state oversight of fire safety issues is inadequate.

Unfortunately, such deficiencies are not unique. The report includes an appendix listing the percentage of surveyed nursing homes cited with fire safety deficiencies by state. North Dakota tops the list with 98.8% of its facilities cited for deficiencies. Montana, Utah, Wyoming, Nevada, and Michigan also had 90% or more of their facilities cited. Only Kentucky had less than 10% of its facilities cited for fire deficiencies. And these are the known violations.

Additionally, the GAO report found federal standards inadequate. The standards didn't require either facility to have smoke detectors. And although both had smoke alarms in the corridors, neither had smoke alarms in the residents' rooms. Federal fire safety standards don't require sprinklers in existing nursing homes constructed of certain noncombustible materials, and CMS lacks data to identify which facilities have sprinklers. Neither the Hartford facility nor the one in Nashville had an automatic sprinkler system. Note: There has never been a multiple-death fire in a fully sprinklered nursing home, and sprinklers are required in all new facilities.

An estimated 20% to 30% of long-term care facilities don't have full sprinkler protection. Why not? The cost to retrofit existing facilities. An October 2003 estimate developed for the American Health Care Association suggested that the cost to install sprinklers in all nursing homes would be about $1 billion. Despite the cost, on July 23, the AHCA endorsed new federal legislation sponsored by U.S. Rep. John Larson (D-CT), the Nursing Facility Fire Safety Act of 2004, which would ensure every nursing home in America is equipped or retrofitted with automatic fire sprinkler systems within five years.

AHCA Director of Communications Jeff Smokler said that AHCA endorsement of the bill hinges on two factors:

• That funding assistance is provided through Medicare and Medicaid; and
• That adequate time is allowed for compliance.

"The government has a responsibility to help pay for this because it's really unaffordable," said Smokler. "Under Congressman Larson's bill, Medicare and Medicaid would pay for the retrofit."

To improve federal oversight of fire safety, the GAO report recommends that CMS collect and record data on sprinkler coverage in nursing homes, make information on fire safety deficiencies available to the public, and work with the National Fire Protection Association (NFPA) to explore the feasibility of requiring sprinklers in all nursing homes and to develop a strategy for financing such requirements.

According to CMS Administrator Mark B. McClellan, MD, PhD, the agency plans to comply with these and the report's other recommendations. In his reply to the report, Dr. McClellan said, "The GAO findings, together with other findings from our review of the issues, are helping us to develop additional action steps that can improve the safety of nursing home residents."

Also as a result of these fires, the NFPA is actively considering incorporating a sprinkler retrofit requirement into its 2006 standards update. Some states, including Virginia, Connecticut, and Tennessee, have already passed bills requiring all nursing homes to have sprinklers.

Act Now

With lives and property at stake, long-term care facilities shouldn't wait for new standards to be agreed upon and implemented. Take the first steps now. If your facility doesn't have smoke detectors in residents' rooms, install them immediately. If your facility doesn't have sprinklers, get quotes on a retrofit and start budgeting for a system. At minimum, ensure all employees on every shift know the protocol for responding to a fire, and conduct regular fire drills for all shifts.

Remember, federal standards are minimum standards. Nothing says you can't do more. Within three to five years it's likely that all nursing homes will be required by federal or state law to have sprinklers. So get a head start.

Note: To obtain a copy of the report, visit www.gao.gov/docdblite/details.php?rptno=GAO-04-660.

Contributing Writer Keri Losavio's articles have appeared in the Journal of Emergency Medical Services, Anesthesiology News, and CPA Health Niche Advisor.

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