Author(s): Ashley Smith. Published on December 29, 2014.

FOR DECADES, NFPA HAS ADDRESSED the problem of unsprinklered or inadequately sprinklered nursing homes. The 1991 version of NFPA 101®, Life Safety Code®, for example, required all newly constructed nursing homes, along with hospitals and long-term care facilities, to install automatic sprinkler systems.

Existing nursing homes, however, were mostly exempt from the sprinkler requirement. These existing facilities were only required to comply with the sprinkler provisions of NFPA 101 when and if they undertook renovation projects that impacted a smoke compartment or a substantial portion (more than 50 percent) of a floor; in that case, only the smoke compartments, floor, or floors being renovated had to be fully sprinklered. Some facilities may have skirted the rule by renovating 48 percent of a floor to avoid the sprinkler provision, according to Robert Solomon, division manager of Building Fire Protection and Life Safety for NFPA. As a result, many nursing homes in older buildings were still operating with incomplete or inadequate fire protection.

The catalysts for change were two devastating nursing home fires in 2003. In February of that year, a fire broke out in the Greenwood Health Center in Hartford, Connecticut. The fire was contained to just one wing of the building, but heavy fire and smoke that spread through the wing killed 16 people and injured 23. In September of 2003, a six-alarm fire raged through the NHC Healthcare Center in Nashville, Tennessee, killing eight women between the ages of 76 and 96. The Hartford nursing home had no sprinklers, while the Nashville facility did not have them in the residential area. Families of the residents, many of whom did not know the buildings lacked adequate fire protection, were outraged. The incidents sparked a national debate about the need for sprinkler requirements in nursing homes.

“After the Hartford fire, nursing home facilities were all talking about installing sprinklers,” Solomon said. “After the Nashville fire, there was just no question.”

As a result, the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rule Making in 2007 requiring that all existing nursing homes and long-term care facilities install complete sprinkler systems in order to collect Medicare and Medicaid reimbursements. Although facilities were required to comply with the 2000 version of NFPA 101, the CMS rule duplicated the change made in the 2006 edition of NFPA 101, which required existing nursing homes to be retrofitted with sprinklers. They had to follow installation requirements spelled out in the 1999 version of NFPA 13, Installation of Sprinkler Systems, which sets the standards for, among other things, where sprinklers must be placed in the building.

The CMS rule went into effect on August 13, 2008. Facilities that wanted to continue in the Medicare and Medicaid reimbursement programs were given until August 13, 2013, to complete the work, with few exceptions. The rule only applied to nursing homes, not hospitals and other health care facilities. CMS estimates that about 97 percent of the nation’s nursing homes are now fully sprinkler protected.

Even so, work remains. CMS data provided to the Associated Press and published in October revealed that 385 nursing home facilities in 39 states still had not met the sprinkler requirements. The facilities house a total of more than 52,000 patients. Of the 385 not in compliance, 44 had no sprinklers at all. These facilities continue to operate, and it’s unclear whether CMS has yet to begin imposing penalties that may be as severe as withholding Medicare and Medicaid reimbursements. The federal agency told the Associated Press in the fall that it is working to verify compliance in these facilities, and that it plans to take action for those that are not compliant.

ASHLEY SMITH is a freelance writer in Boston.