Long-Term Involvement
Tom Jaeger talks about the changing face of health care, its effect on codes and standards, and his new role as chair of NFPA’s Board of Directors
NFPA Journal®, September/October 2010
For more than four decades, Tom Jaeger has helped long-term care facilities negotiate the regulatory challenges of the health care industry. Jaeger, 67, worked for an engineering consulting firm for 35 years — 15 as president — before starting his own company, Jaeger and Associates, in 2005. He’s served on NFPA’s Standards Council for nine years and currently sits on the NFPA 101®, Life Safety Code® Correlating Committee; the Health Care Occupancies Committee; the Board and Care Facilities Committee; and the correlating committees for NFPA 5000®, Building Construction and Safety Code®, and NFPA 99, Health Care Facilities.
The newly elected chair of NFPA’s Board of Directors, Jaeger continues to keep a watchful eye on the industry he serves. He helped organize “National Trends in Delivery of Health and Long Term Care: Implications for Safety Codes and Standards” summit in Baltimore in July that brought together NFPA committee members, the American Health Care Association, the American Society for Healthcare Engineering, the Centers for Medicare & Medicaid Services, and the Veteran’s Administration to discuss current and emerging issues. Sponsored by NFPA and the Fire Protection Research Foundation, the event addressed NFPA’s involvement in improving the well-being of residents and patients in acute-care or long-term care environments without compromising building and life safety.
Jaeger recently talked with NFPA Journal about the summit, the future of NFPA, and his desire to balance safety in NFPA documents with quality of life for residents of long-term care facilities.
What does your job entail?
The majority of my work focuses on long-term care, which would include nursing homes and assisted living facilities. The health care industry is the second-most-regulated industry in the U.S. for fire safety — second only to nuclear generating plants. The Centers for Medicare and Medicaid Services [previously the Health Care Financing Administration] adopted the Life Safety Code for new and existing buildings in 1970, and they regulate the industry. Unlike hospitals, nursing homes typically don’t include staffers who are technically qualified in the codes and standards. When they get cited for deficiencies, they often are not well versed in the requirements of NFPA codes and standards. We can assist them with understanding the issues if the problem is legitimate, and what they have to do to fix it.
What were some of the big issues addressed at the NFPA summit?
The number of beds in nursing homes is decreasing, while the beds in assisted living facilities are increasing, and one of the big issues is that we’re getting residents in assisted living facilities who are incapable of self-preservation. You have to provide a level of fire safety and fire protection features in that building to account for that fact. Ten years ago, it would have been assumed that the majority of residents in these places were capable of self-preservation, but that’s not true today — and the trend is continuing in that direction. We don’t classify assisted living facilities as health care facilities, but I will tell you they are looking more like nursing homes every day. While the NFPA 101 provisions for residential board and care occupancies address some of the concerns, assisted living facilities are a distinct class of building with different needs. Also, long-term care facilities are moving from an institutional to residential design, which raises a number of safety and code issues. Another issue is that we have some seriously ill people being treated in their homes through home health care, and that’s something we have to look at. Finally, we’re providing more complex health care procedures in outpatient clinics and ambulatory health care facilities. As the intricacies of the procedures change, the NFPA requirements for ambulatory health care occupancies will have to be evaluated to make sure the proper levels of in-patient protection are being provided.
What’s spurring the shift toward residential design?
The saying used in the industry is “putting the word ‘home’ back into nursing home.” If you look at NFPA’s building code and Life Safety Code, the requirements are really based on what’s called the institutional design — long corridors, nursing units, nursing stations, a sterile environment, all meals served at the same time. The cultural change movement is really trying to improve the quality of life of residents by getting them into smaller household-style units. One of the catalysts for NFPA’s summit was to address this idea of cultural change.
From a codes and standards standpoint, what are the concerns with cultural change?
There’s a big philosophical debate going on about how to balance the life safety goals of the code with the changes to the physical environment in order to improve the quality of life. In cultural change buildings, you have clusters of small nursing units that have a dining room, activity space, an area for resident rooms, and a kitchen. In the institutional design, the kitchen is not allowed to be open to the corridor and it is not located in the sleeping areas. Another issue is placing rest stops in corridors. Many elderly residents can’t walk very far, and they need places to sit down and rest — but that conflicts with the code, which says corridors need to be kept clear because they’re the primary means of egress.
We’re also trying to get the rules changed to make nursing homes more visually appealing and home-like, and to include residents’ walls covered with pictures, photos, and decorations. If a surveyor sees these items today, a facility is required to take them down because of what the code says. Nursing home residents are also demanding the use of computers and other small consumer appliances in their rooms. Some regulators have trouble with the power strips they use; they consider them hazards, like extension cords.
Has NFPA addressed these issues?
We identified some of these concerns, which became the cultural change proposals to the Life Safety Code that were submitted for the 2012 edition. However, all of the proposals were rejected. It wasn’t ready for prime time, but we had time between the proposal period and comment period [which ended September 3] to make the changes the committee said are needed. Part of the summit was to further that discussion. The committee understands the need for these changes, and understands that it is desirable to get them into the code. I’m comfortable that every member of the technical committee who attended the summit understands cultural change. I really do believe they want this to happen — they just want it to happen safely.
What other trends are emerging in areas outside of the traditional health care environment in our codes?
NFPA 99 deals with all the systems that are unique to health care facilities — pipe gas systems, medical vacuum systems, anesthesia location, critical care emergency power. That standard is inappropriate for anything being done in a residential occupancy. There are people in their homes right now who are not just using oxygen, but who are on life-support systems, such as ventilators, and somebody needs to regulate that. There’s a need to identify the degree to which we’re going to require backup power for this equipment. There’s a suggestion that NFPA develop a document for the use of medical equipment and systems in residential occupancies. Right now, communities don’t have the resources to be going into these homes [to inspect or test this type of medical equipment]. I can’t believe a fire department, for example, knows about every household that’s using medical oxygen, which can have a negative influence on a fire they might respond to. How will this kind of information be reported, and by whom? It will be up to the committee that writes the document.
The codes also don’t address clinics located in large retail stores. We’re seeing people going to outpatient clinics in these spaces to receive services, and those outpatient clinics don’t meet health care standards. Code provisions for ambulatory health care have application in some cases, but not in all. During the summit’s technical committee meeting, we broke down what needs to be addressed into short-term, long-term, and research needs. The short-term issues were related to cultural change, as well as to the debate over wet locations in operating rooms. We tabled the long-term [health care in retail spaces, among others] and research issues with a recommendation to hold another summit at a later date.
What else is on your agenda?
As a board member and new chair, there’s nothing that makes my life easier than being a part of a financially secure, well-run organization. The mindset of the board and management team is that we can’t fully perform our mission unless we’re financially secure, and my goals clearly are to make sure those aspects of NFPA continue.
Also, a goal we established last year is to get more involved with the issue of wildfires. It’s an area that NFPA has rallied behind, but we also recognize that we need to get more involved. NFPA’s done a very good job at getting its name out there in relation to wildland fire issues, especially through the Firewise program, and it’s something we can do even more of through public education. I come from the technical side of NFPA, and I’m learning every day about the organization’s array of education efforts.
— Interview conducted by staff writer Fred Durso, Jr.