GAO: fire safety hazards in nursing homes.

Nursing home fires can be deadly--and it's partially the government's fault due to poor oversight of current safety standards.

That was the conclusion reached in a new report by the Government Accountability Office, which noted that 59 percent of U.S. nursing homes were cited for fire safety deficiencies during their most recent inspections in 2003.

"Nursing Home Fire Safety: Recent Fires Highlight Weaknesses in Federal Standards and Oversight" also noted, however, that state surveyors missed or failed to cite, on average, more than two deficiencies per nursing home surveyed that year.

Such oversights led to tragedies such as last year's fatal fires at nursing homes in Tennessee and Connecticut in which a combined 31 residents died, according to the report.

In the case of the fire at Greenwood Health Center in Hartford, Conn., state surveyors visited less than a month before and found no violations of federal standards, according to the report. But subsequent investigations after the late night/early morning fire--which killed 16 people--found that the home's night shift had not been conducting required fire drills, nor did that shift's staff follow its prescribed fire plan when the blaze started in a resident's room on Feb. 26, 2003.

Eight months prior to the Sept. 25, 2003 fire at NHC Healthcare Center in Nashville, surveyors failed to detect a deficiency that allowed smoke to travel between floors, according to the study. Five of the 15 fatalities were residents on upper floors who died due to smoke inhalation, the report stated.

In addition, the Centers for Medicare and Medicaid Services (CMS) is required each year to conduct its own safety inspections in at least 5 percent of all state-surveyed nursing homes. Yet, no assessments were conducted in 27 states in 2003, according to the report.

The report was also critical of federal standards that do not require sprinklers in older nursing homes of "certain noncombustible construction," such as the Nashville and Hartford facilities. An estimated 20 to 30 percent of nursing homes nationwide do not have full automatic sprinkler protection, the report noted.

According to Kathryn Allen, director of Medicaid and private health insurance issues at GAO in Washington, D.C., CMS avoided requiring installation of sprinklers in all facilities due to the high cost involved and a decline in multiple-death fires as a result of fire safety standards adopted in 1971.

There was an average of one fire-related death per year in non-sprinkler-systemed nursing homes from 1983 to 2002 and 0.3 deaths per year during the past 10 years.

"(It was believed) that the estimated cost of retrofitting older nursing homes nationwide outweighed the benefit," Allen said. "This position is being reevaluated, however, because of (those) nursing home fires."

A sprinkler requirement is likely to be years away, however, because "stakeholders" such as the nursing home industry, CMS, and the National Fire Protection Association must develop a consensus and implement such a standard, Allen said.

William Benson, president of the National Citizens' Coalition for Nursing Home Reform in Washington, D.C., said such a timeline could mean more tragic fires. "Further delays will almost surely ensure future untimely and horrifying deaths for the other 'stakeholders'--the residents of nursing facilities," he said.

The nursing home industry would support such a requirement if the federal government helped pay the estimated $1.1 billion needed to install sprinklers industry wide, according to Alan DeFend, vice president of the American Health Care Association in Washington, D.C. Facilities should also have at least three years to meet the requirement, he added.

Rep. John Larson, D-Conn., said he has a bill in the works that would require every nursing home reimbursed by Medicare or Medicaid to have full automatic sprinklers.

The federal government would reimburse nursing homes for all costs of sprinklers installed since September 2003.

Meanwhile, CMS has improved fire safety inspection oversight, CMS Administrator Mark McClellan said. Its actions include increasing the number of validation surveys the agency will conduct in 2005.

CMS will also update the CMS automated information system to ensure that the sprinkler status of each nursing home is available to all surveyors, issue new instructions to states and regional CMS offices to ensure prompt investigation of injury-causing fires, and issue an updated set of national life-safety code manuals to each state to ensure investigators know all existing standards.

The 10 states with the highest percentage of nursing home fire
safety deficiencies following their most recent surveys in 2003:

Rank   State          Number of        Percentage of surveyed homes
                      homes surveyed   with fire safety deficiencies

1.     North Dakota           84                                98.8
2.     Montana                101                               97.0
3.     Utah                   90                                96.7
4.     Wyoming                39                                94.9
5.     Nevada                 44                                93.2
6.     Michigan               431                               92.1
7.     South Dakota           113                               88.5
9      Texas                  1,143                             84.4
10     Pennsylvania           740                               82.3
       Nation                 16,334                            58.9

Source: Government Accountability Office [formerly U.S. General
Accounting Office]