Monday, 19 June 2017

Sprinkler regulations raise alarm: proposed regs require systems in all nursing homes.

Nursing homes across the country will need to install automatic

sprinkler systems throughout their buildings under a new regulation

proposed by CMS.

CMS published a proposed rule in the October 27, 2006, Federal

Register that would require all long-term care facilities to install

sprinkler systems. The agency did not propose any date for compliance,

but instead asked for public comment on the duration of a phase-in

period to allow long-term care facilities to plan for and install the

systems. The comment period closed December 26.

CMS acknowledged that installing sprinklers will be both an

expensive and time-consuming effort for nursing homes, but one that will

save lives. Under the new regulation, nursing homes would have to

install sprinkler systems if they want to continue to accept Medicare

and Medicaid dollars.

"Automatic sprinkler systems are integral t o increasing safety

in nursing homes, and we look forward to their installation in all of

the nursing homes across the country," said Leslie V. Norwalk,

acting administrator of CMS, in a press release.

Good for the industry?

As expected, fire protection consultants applauded CMS'

decision. "It's an excellent move and a needed move.

Obviously, it's going to save lives," says James K. Lathrop,

vice president of Koffel Associates, Inc., in Niantic, CT.

"My professional opinion is that this is one of the best

things to happen recently in terms of life safety," agrees A.

Richard Fasano, manager of the western office of Russell Phillips &

Associates, LLC, in Elk Grove, CA.

Both Lathrop and Fasano noted that the nursing home industry

supports the installation of automatic sp rinklers in facilities.

"There hasn't been any opposition to this at all," Fasano


In fact, the American Health Care Association (AHCA), the industry

group that represents for-profit nursing homes, worked closely with the

National Fire Protection Association on the sprinkler issue and other

Life Safety Code[R] issues.

"Our first, most basic priority as providers of quality

long-term care is to guarantee the physical safety of frail, elderly,

and disabled residents within a facilit y," said AHCA President

Bruce Yarwood, in a press release. "[Although] major nursing home

fires are rare, fire prevention remains a top priority for our


Smoke Sprinkler System Denton alarm proviso

As an interim step toward the requirement for sprinkler systems, in

March 2005 CMS began requiring all nursing homes that did not have

sprinklers to install battery-operated smoke alarms in all resident

rooms and public areas.

The proposed rule includes a sunset provision for the smoke alarm

requirement, which CMS will phase out to coincide with the requirement

of facilities with full sprinkler systems.

Save a life, even if it costs

Installing sprinklers decreases the chances of fire-related deaths

by 82%, CMS said, citing a July 2004 Government Accountability Office (GAO) rep ort, Nursing Home Fire Safety: Recent Fires Highlight

Weaknesses in Federal Standards and Oversight. The report examined two

2003 long-term care facility fires in Hartford, CT, and Nashville, TN,

that resulted in 31 resident deaths.

The GAO report cited sprinklers as the single most effective fire

protection feature for long-term care facilities. If the Hartford and

Nashville nursing homes were equipped with automatic sprinklers, "I

don't even think we would have ever heard about them," Lathrop


The proposed rule will require every long-term care facility to

install "an approved, supervised automatic sprinkler system"

in accordance with the 1999 edition of NFPA 13, "Standard for Sprinkler System Installation Denton the

Installation of Sprinkler Systems." It also requires the testing,

inspection, and m aintenance of those systems by facilities in accordance

with the 1998 edition of NFPA 25, "Standard for the Inspection,

Testing, and Maintenance of Water-Based Fire Protection Systems."

AHCA said it plans to work with Congress to help provide resources

for nursing homes that will need to tackle the high cost of retrofitting

older facilities with sprinkler systems.

Under existing CMS regulations, newly constructed nursing homes and

those undergoing major renovations, alterations, or modernizations must

install sprinkler systems. However, until now CMS has not required older

homes to have such systems.

In its proposed rule, CMS estimated it would cost thousands of

dollars to install a sprinkler system, depending on the size of the


Yarwood said it is important that CMS recognized the need for a

phase-in period to allow nursing homes planning and installation time.

CMS also acknowledged that facilities might need to reallocate their

resources and possibly secure additional capital resources to fund the

improvements, as well as possibly temporarily relocate residents during

installation. CMS said some facilities may choose to move rather than

install a system in their current location.

How much time do you have to install?

In the final rule, CMS said it wants to see nursing homes install

the sprinklers as quickly as possible, but acknowledged that new

regulations should not place undue burden on facilities. "The cost

of installing sprinklers is substantial, and we do not expect long-term

care facilities to have $75,000 to $615,000, depending on the size of

the area requiring sprinklers and the cost of installing sprinklers,

immediately available to purchase and install sprinklers," CMS

stated i n the rule. "At this time we do not know what would be the

exact length of the phase-in period."

For illustrative purposes, CMS offered cost estimates that looked

at five, seven, and 10-year phase-in periods to implement the sprinkler

requirement. "I think 10 years is more than liberal," Lathrop


Based on a 10-year time frame for implementation, CMS estimates

that the regulation would affect 2,462 nursing homes--1,947 that are

partially sprinklered and 515 without any sprinklers.

The estimated cost for installing a sprinkler system in an average

size building (50,000 sq ft) without any existing sprinklers would be

$205,000 to $307,500, depending on the cost per square foot, CMS said in

the rule.

If a long-term care facility is part of another building, such as a

hospital, then the regulation will require sprinklers only in the
< br>long-term care section.

RELATED ARTICLE: CMS to hold off on 2006 Life Safety Code for now.

While CMS moves ahead to require nursing homes to install automatic

fire sprinklers, the agency is doing so without adopting the 2006

edition of the Life Safety Code[R] (LSC).

In its proposed rule, published in the October 27 Federal Register,

CMS clearly stated that it is not prepared to adopt the 2006 LSC. The

agency said it supports the NFPA's decision to include an automatic

sprinkler system requirement for all long-term care facilities in the

2006 LSC. However, "we have decided to proceed with this rule,

without adopting the NFPA 2006 edition of the LSC, because we want to

avoid further delay in requiring an automatic sprinkler system in

long-term care facilities," CMS wrote in the rule.

To adopt the 2006 LSC, CMS stated it would have to go through

notice and comment rulemaking. "In addition to the time that it

takes to carefully analyze the LSC in its entirety, the rulemaking

process itself is a time-consuming process that, even in the best case

scenario, takes 18 months to complete," CMS wrote.

Because of the large scope of the LSC, that process could take even

longer, CMS stated, speculating it would not be able to adopt and

enforce compliance with the 2006 edition until 2008 or 2009. Then the

2008 or 2009 publication date of a final rule would begin a probable

phase-in period, which could be anywhere from three to 10 additional

years, CMS stated.

"We believe that delaying the rulemaking process would be a

disservice to all long-term care facility residents who reside in

buildings that do not have sprinklers," CMS stated.

CMS said it will continue to work with the NFPA to revise and

refine each edition of the LSC "We are currently examining the 2006

edition of the LSC in its entirety and exploring the possibility of

adopting it for all Medicare and Medicaid participating healthcare

facilities," CMS stated. The agendy said it welcomed public comment

on its decision to proceed with rulemaking on the sprinkler requirements

separate from the 2006 LSC.

While some may be disappointed that CMS did not adopt the 2006 LSC,

the agency's approach will allow it to create an implementation

period to give nursing homes time to install new sprinkler systems, says

A. Richard Fasano, manager of the western office of Russell Phillips

& Associates, LLC, in Elk Grove, CA.

If CMS adopted the 2006 LSC, nursing homes would have to

immediately comply with t hose requirements on the date the new code took

effect, Fasono says. "I think CMS is wise in taking the approach it

did."--Joanne Finnegan


Joanne Finnegan is a senior managing editor at HCPro, the parent

company of CLTC.

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