Fire safety: Is your facility legal?
The legal stru cture governing nursing home fire safety: A guide to self-examination Federal regulations expect facilities to "be designed, constructed, equ ipped, and maintained to protect the health and safety of residents, personnel, and the public," 1 p lus satisfy applicable provisions of the Life Safety Code of the National Fire Protection Association (N FPA, www.nfpa.org).2 The regulatory framework also de mands that nursing homes have "detailed written plans and procedures to meet all potential emergencies and disa sters, such as fire[.]" 1 The facility must, according to federal regulations, train employees in di saster and emergency procedures when they begin working in the facility, periodically review these procedures w ith existing staff, and conduct unannounced drills (with care not to disturb or excite residents) to test the e fficiency, knowledge, and response of institutional personnel in the event of an emergency.1 Local l aws may surpass federal requirements for staff training in emergencies, as is the circumstance in New York.2
Two deadly nursing home fires in Hartford, Connecticut, and Nashville, Tennessee, last year focused considerable attention on the safety of our nation's nursing home residents, a highly vulnerable popul ation of elderly and disabled individuals. The general statements in the previous paragraph notwithstanding, ex amination of the lessons learned from these two fires found systemic problems with the adequacy and enforcement of federal fire safety standards that go well beyond these two tragic events.3
Frequency of Nursing Home Fires
The most recent data show that an average of 2,300 of the coun try's approximately 16,300 nursing homes reported a structural fire each year from 1994 through 1999, and that there was an average of five fire-related nursing home deaths nationwide annually.3 While cooking an d laundry dryers represented the leading causes of fires, resident deaths were chiefly associated with smoking, and resident rooms were the principal areas of fire origin.3 During this same period, one multiple- death nursing home fire resulted in three fatalities.3
In contrast, the fire-related death to ll in 2003 was considerably higher-31 residents died in the nursing home fires in Hartford (16) and Nashville ( 15)3 (table 1). Neither home was required to have an automatic sprinkler system, even though such sy stems are effective in reducing the number of multiple deaths from fires.3 Federal fire safety stand ards do not require sprinklers in older nursing homes, such as the Hartford and Nashville facilities (built in 1970 and 1967, respectively), constructed with certain noncombustible materials (e.g., concrete, steel, or bric k) that have a certain minimum ability to resist fire.3 It is estimated that 20 to 30% percent of nu rsing homes nationwide lack full automatic sprinkler systems.3
Nursing Home Fir e Safety Standards
Nursing home fire safety standards are built on principles that combine certai n construction and operational features along with an acceptable staff response. These standards reflect the mo bility and cognitive limitations of many elderly and disabled residents who cannot be evacuated easily during a fire. The principles include:
- appropriate facility design and construction, particularly compartmentali zation to contain fire and smoke;
- provision for fire detection, alarm, and extinguishment (e.g., smoke d etectors and sprinkler systems); and
- fire prevention policies and the testing of staff response (e.g., t aking steps to isolate the fire and transferring residents to areas of refuge).
Examples of s pecific requirements. The fire safety standards for nursing homes cover 18 categories, ranging from buildin g construction to furnishings. Examples of specific requirements include: