The heat is on nursing homes to install sprinkler systems.

A deadly fire this fall that killed 14 residents of a Nashville nursing home without a sprinkler system has ignited calls for all nursing homes to have sprinkler systems, which currently are required by federal regulations only in new or renovated facilities. A Centers for Medicare and Medicaid Services (CMS) spokeswoman estimated the cost of such an effort at more than $1 billion, reported the congressional newspaper The Hill.

"We know that fire sprinklers can control fires where they start and alleviate the burdens placed on staff to deal with the fire while relocating or evacuating patients," said James M. Shannon, president of the National Fire Protection Association (NFPA). "Sprinklers must be included in our stock of existing nursing homes because it is evident that common fire protection measures in nursing homes that work well now need to be strengthened."

Calling for at least a review of current fire-safety standards, Senate Majority Leader Bill Frist, a Republican from Tennessee, commented, "This terrible tragedy calls for an examination of the rules in place to protect nursing home residents. That's why we've already spoken with the Tennessee Department of Health and CMS, and asked for the GAO [General Accounting Office] to conduct a thorough review of existing fire standards."

The National Citizens' Coalition for Nursing Home Reform charged that federal policy contributed to the deaths and injuries, pointing out that in January 2003 CMS adopted new Life Safety Code regulations that allow older buildings to operate without an automatic sprinkler system.

Sprinklers decrease the chances of dying in a fire by one-half to two-thirds, according to NFPA research. When measured by the average number of deaths per 1,000 fires from 1994 to 1998, the reduction associated with sprinklers is 82% for properties that care for the aged or sick. NFPA says that 10 to 15% of nursinghomes do not have sprinklers, and 25% of nursing home fires occur in facilities without them.

For its part, the parent organization of the Nashville facility, National HealthCare Corp., is installing sprinkler systems in all of its licensed nursing homes without them, as well as hiring a fire safety engineer to a new corporate position with the responsibility of improving existing systems, policies, and training.

The Nashville newspaper The Tennessean reported that Tennessee state lawmakers intend to pass legislation next year requiring sprinklers in all nursing homes built before 1994, when newly built facilities were required to install them. Somewhere in the neighborhood of 70 Tennessee nursing homes would need the upgrades, a process that could take up to three years with a $13 million price tag. The state is considering a loan program or increases in reimbursement rates to cover the costs, although the AARP suggests nursing homes could finance the upgrades without additional funds.

Impediments to sprinkler installation include displacing patients, the availability of sprinkler contractors, and the possibilities that retrofit costs could exceed a facility's value and that a facility's water supply might not accommodate sprinklers, reported The Tennessean.