After two deadly nursing home fires in 2003 in Connecticut and Tennessee, which claimed 31 lives, most of us had a 'who'd-a-thunk-it-moment' when we learned that all nursing homes are NOT required to have sprinkler systems.  Waivers are granted for facilities constructed prior to certain time periods and/or for certain building construction types.  With the numerous concerns about the quality of care for vulnerable patients, it wouldn't occur to most of us to ask or to look overhead to see if a facility has a fire sprinkler system.  It would seem to be a no-brainer requirement, particularly in multi-storied structures.  Not so.
 
The notion that it is acceptable for a population of vulnerable people, many bed-bound or wheelchair-bound, many with dementias, to be left to the mercy of a fire is beyond comprehension.
 
The GAO (Government Accountability Office) studied the issue after these fires and produced a report in July 2004 regarding the practices of our nations' nursing homes in regard to fire safety issues, the existing requirements and current oversight practices.  The report can be found at: http://www.gao.gov/cgi-bin/getrpt?GAO-04-660
 
The most astounding revelation for me was the first item:
 
(1)  "THERE HAS NEVER BEEN A MULTIPLE-DEATH FIRE IN A FULLY-SPRINKLERED NURSING HOME."
 
(2)  Overall, 58.9% of our nation's facilities surveyed had been previously cited for fire safety deficiencies.  North Dakota had the most, with 98.8%, and Kentucky with the least, 9.8%.
 
(3)  Approximately 2,300 of our nation's approximately 16,300 nursing homes reported a structural fire each year (1994 - 1999).
 
(4)  Deaths averaged five per year (PRIOR to the two fires in Connecticut and Tennessee which claimed a total of 31 lives).
 
(5)  Twenty to thirty percent of our nursing homes lack fully-automatic sprinkler protection.
 
(6)  State and federal oversight of fire safety is inadequate.
 
(7)  Federal agencies provided limited oversight of state survey activities to address fire safety concerns.
 
(8)  Federal agencies monitored fire safety surveys in only 23 states.
 
Appendix I of the GAO report lists the percentages of each state's nursing homes surveyed which had fire safety deficiencies.  Appendix II gives examples of fire safety deficiencies missed or not cited.
 
According to the GAO report, "The standards differentiate between 'existing' and 'new' facilities.  In the past, whenever a new edition of the NFPA (National Fire Protection Association) code was adopted by CMS (Centers for Medicare & Medicaid Services), nursing homes had the option of complying with the new standards or with an earlier edition of the standards.  Thus, a nursing home that began serving Medicare and Medicaid residents under the 1967 edition of the standards could have continued to be surveyed under those standards up until 2003."  
 
I found it appalling that, "contrary to actions taken in previous multiple-death nursing home fires, neither CMS nor NFPA investigated the Hartford or Nashville fires to assess the adequacy of the current fire safety standards. Consequently, they lack the firsthand information needed to determine the degree to which the multiple-deaths were due to weaknesses in federal fire safety standards and to make recommendations for future revisions to the standards."
 
However, this report and the two deadly fires did not result in mandating retrofitting our nursing homes with sprinkler systems.  Instead, smoke detectors are now required to be installed in each resident's room by May 2006 (however, they may be battery operated).  After the deadly fires in Connecticut and Tennessee, both of those states passed laws requiring nursing homes to begin retrofitting facilities with sprinkler systems.
 
Not surprisingly, the excuse for not retrofitting existing non-sprinklered facilities was  financial concerns to the nursing home industry.  If someone else foots the bill, they're all for it.  Therefore, nursing home residents in unsprinklered facilities will be forced to rely on smoke detectors (and their needed maintenance) as they are installed over the next year, while the facility owners and state and federal oversight agencies are willing to take the risks.