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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 to 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 sprinklers in facilities. "There hasn't been any opposition to this at all," Fasano says.

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 facility," said AHCA President Bruce Yarwood, in a press release. "[Although] major nursing home fires are rare, fire prevention remains a top priority for our members."

Smoke 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) report, 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 says.

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 the Installation of Sprinkler Systems." It also requires the testing, inspection, and maintenance 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 facility.

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 in 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 says.

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 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 those 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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Author:Finnegan, Joanne
Publication:Contemporary Long Term Care
Date:Jan 1, 2007
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