On June 18, 2008, the Centers for Medicare & Medicaid Services (CMS) stated that all nursing homes participating in the Medicare and Medicaid programs will be required to have automatic sprinkler systems installed within five years. In the announcement, the Acting Administrator of CMS, Kerry N. Weems also stated that CMS would develop a five-star rating system for nursing homes that would be available by the end of the year on the agency’s Nursing Home Compare Web site for consumers.
CMS initially proposed the sprinkler requirement in October 2006, citing two separate 2003 nursing home fires in which 31 residents died and a subsequent 2004 Government Accountability Office (GAO) report, Nursing Home Fire Safety: Recent Fires Highlight Weaknesses in Federal Standards and Oversight (GAO-04-660) that called for more effective fire safety measures in long-term care facilities. In 2006, CMS said the proposal was consistent with the National Fire Protection Association's (NFPA) 2006 edition of the Life Safety Code (LSC), which calls for the addition of sprinkler systems in all nursing homes that do not already have them installed. CMS historically has adopted the NFPA's LSC annual updates. Following the GAO report, the OIG issued an interim final rule (70 Fed. Reg. 15229) calling for the installation of smoke detectors in all long-term care facilities without sprinkler systems. (CMS noted in the proposed rule that in the final rule on smoke detectors, the language will be changed to read "smoke alarms.")
In 2006, CMS said structural fires at nursing homes were common, though few fatalities were reported each year because of such fires. Nevertheless, CMS said that the low number of fire-related deaths in nursing homes might be attributable to the increasing use of automated sprinkler systems.
“According to NFPA data cited in the 2004 GAO report, there is an 82 percent reduction in the chance of death occurring in a sprinklered building when compared to the chance of death occurring in an unsprinklered building," CMS said. "In addition, we note that there has never been a multiple-death fire in a long-term care facility that had an automated sprinkler system installed throughout the facility." Weems reiterated this statement in the call with reporters on June 18, 2008. CMS already requires newly built long-term care facilities to install automatic sprinkler systems; the new rule would make the same requirements of older nursing facilities.
Under the rule, nursing homes will be required to have sprinkler coverage in all resident rooms, facility kitchens and dining areas, activity areas, corridors, attics, canopies, overhangs, offices, waiting areas, closets, storage areas for trash and linens, and maintenance areas. Weems did not indicate the cost of nursing home compliance with the new sprinkler rule. It was stated, however, that CMS would not direct funding or grants toward the initiative. Rather, he said that nursing homes routinely finance improvements to their facilities and that this update should be part of those improvements.
Sen. Chuck Grassley (R-Iowa), ranking member of the United States Senate Committee on Finance, praised CMS's initiative, saying in a news release that the sprinkler rule "solidified" an important step toward better safeguarding residents of nursing homes against fire hazards.
Foley will continue to provide updates on this important development and the potential implications it holds for long-term care facilities that would be affected by the CMS mandate. Additionally, we will advise on CMS’ announced five-star rating system for nursing homes on the Nursing Home Compare Web site in a separate Alert.
Michael A. Okaty
Robert E. (Rob) Slavkin