The recent issue of NFPA Journal featured an article about the numerous deadly fires in health care occupancies, predominantly hospitals, that continue to occur throughout other parts of the world. Had that story been written in the 1960s, it could have included the United States, but we have been fortunate to have not experienced such fires or losses since 2003. Within a seven-month period that year, two multiple fatality nursing home fires occurred. As noted in the article, one of the main reasons for our favorable experience in the US centers around the various layers of regulation, enforcement, and commitment to maintain a rigorous oversight and surveillance of the safety systems and features required by codes such as NFPA 101, Life Safety Code. Adoption of the 1967 edition of NFPA 101 in 1970 by the predecessor organization to the Centers for Medicare & Medicaid Services (CMS) has cast a wide net over the appropriate fire and life safety provisions that hospitals, nursing homes, ambulatory health care, and certain residential board and care occupancies must adhere to.
In 2016, CMS finalized their rule for adoption of the 2012 edition of NFPA 101, along with the 2012 edition of NFPA 99, Health Care Facilities Code. While much discussion, publicizing, and retraining around those editions of these important codes took place in 2016 and 2017, the question on the table is, “Have people forgotten about how these regulations work?”
A recently released report by the Office of the Inspector General (OIG) from the US Department of Health and Human Services provided an insight into violations at 18 nursing homes in Texas. The report cites provisions and requirements contained in NFPA 99, NFPA 101, as well as the Fire Safety Survey Report (K-Tags) that is developed by CMS. NFPA developed a resource that provides all the content from the 2012 editions of NFPA 99 and NFPA 101 along with an interactive version of the Fire Safety Survey Report Form that connects these provisions. The OIG report also cites a lack of facility preparation and measures surrounding the Emergency Preparedness (EP) rule that CMS finalized in 2017. Like the rule adopting NFPA 99 and NFPA 101, the EP criteria applies to nursing homes as well as 16 other provider types that are regulated through CMS.
NFPA worked diligently to provide background, knowledge and relevant information for both of these federal rules. We created a specific landing page on our website to consolidate that information and to offer selected resources. While we’ve had approximately 3+ years of experience with these relatively new provisions, is it possible that some level of complacency has set in? The OIG report on the Texas nursing homes is alarming, but fortunately identified potential hazards and violations before anything bad has happened. While some will argue that this particular OIG report notes some minor violations, which is probably fair, others are not so minor. The regulatory structure of not only the federal government criteria but also of the NFPA codes and standards does not make a judgment that providing inspection, testing, and maintenance (ITM) oversight of a fire door is more or less important than providing that same level of ITM for a sprinkler system or anything else. The NFPA code provisions, backed up by the supplemental regulations put forth by CMS, are intended to work as a total system or package. This part of the regulatory infrastructure is highlighted in several cogs of the NFPA Fire and Life Safety Ecosystem.
While NFPA cannot enforce or determine how well or not so well our code provisions are applied to any building during the construction phase or lifecycle phase of the building, we can offer tools that work to assist operators of these facilities with their code compliance obligations. While we have delivered various pieces of content, including press releases, resource materials, and fee-based materials around this topic, this is a good time to remind everyone what we have available. Our goal at NFPA is to be the resource that designers, AHJ’s, owner/operators and even contractors can turn to in order to provide quality, safe and usable facilities. Occupants of nursing homes are obviously in a vulnerable state; maintaining a high level of readiness for all the building systems and features is of paramount importance.
While it is by no means a formal relationship, the regulatory structure for the built environment surrounding the health care system in the US is made up of a combination of private-sector resources such as those available from NFPA and the resources provided by CMS. Maintaining these facilities for a level of readiness regardless of the hazard was essentially the sole purpose of the emergency preparedness rule. Protecting the occupants from the impact of a fire was the purpose of the rule previously mentioned dating back to 1970 that mandates the use of various editions of NFPA 99 and NFPA 101.
The OIG report coming out of Texas is a prompt that this is the time to provide a reminder to everyone involved in the operation, oversight, or enforcement of these federal regulations of what is available. I have provided a list of those resources below that includes information directly or indirectly referenced and utilized by CMS. This also includes information that is acknowledged for use by another entity within the US Department of Health and Human Services — the Assistant Secretary for Preparedness and Response-ASPR.
I suspect that the items identified in the OIG report from Texas are not unique to that state by any means. Likewise, I wonder if such reports will extend beyond nursing homes to other types of provider types, including acute care, and residential board and care occupancies among others. Although nothing is forever, federal rule-making criteria such as that utilized to adopt NFPA codes and standards remains in effect until the responsible federal agency says otherwise. Those provisions are merely not words and the criteria they reference such as the NFPA codes sitting on your shelf, or perhaps in the cloud somewhere, are not intended to be an academic exercise or some nice ideas. They provide the foundation for safe buildings and for the appropriate level of emergency preparedness.
Following are links (in no particular order) to resources and information that provide guidance on meeting fire and life safety requirements in healthcare facilities. (Some of these resources are also referenced in the above blog.)
- Life Safety and Emergency Preparedness Deficiencies Found at 18 of 20 Texas Nursing Homes
- NFPA 99, Health Care Facilities Code
- NFPA 101, Life Safety Code
- NFPA resources for health care facilities including CMS requirements
- The NFPA Interactive CMS 2786 R Fire Safety Survey Report Form
- September 2016 Federal Register – Rules and Regulations: Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
- Department of Health and Human Services – Public Health landing page
- May 2016 Federal Register - Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities
- NFPA 1600, Standard on Continuity, Emergency, and Crisis Management
- NFPA 1300: Standard on Community Risk Assessment and Community Risk Reduction Plan Development
- White Paper: Using NFPA 1300 as a Tool to Comply with CMS Requirements for an Emergency Preparedness program
- “Burn Treatment” – NFPA Journal, December 2019
- The NFPA Fire and Life Safety Ecosystem
- NFPA Fire Investigations report: Nursing Home, Hartford, CT - February 26, 2003