Sprinklers Now a Must for Nursing Homes

After decades of partial solutions to fire threats in nursing homes, regulators are finally requiring sprinkler systems for the 2,466 facilities that still don't have them fully installed.

On Aug. 13, the Centers for Medicare and Medicaid Services issued a rule declaring that the $144 billion long-term care industry has five years to install the systems. Some 1.4 million residents live in 16,000 U.S. nursing homes.

The government, which has adopted fire standards developed by the nonprofit National Fire Protection Association since 1971, was spurred to action by the deaths of 31 nursing home residents in incidents in Nashville and Hartford, Conn., in 2003.

"It is 35 to 40 years overdue," said Janet Wells, director of public policy for the National Citizens' Coalition for Nursing Home Reform, a Washington group that works to protect residents' rights.

The Department of Health and Human Services recently began listing on a Medicare Web site, under "nursing home compare," whether a facility has sprinklers, when fire-safety inspections took place, and the number of deficiencies found and corrected.

Nursing homes support the rule and pushed for it, said Lyn Bentley, director of regulatory services for the American Health Care Association, a Washington trade group. Until now, sprinklers only had to be installed when providers built new facilities or made major renovations.

Two-thirds of nursing homes are for-profit operations. HCR ManorCare of Toledo, which had 38,372 beds, was the largest at the end of last year, according to Provider, the trade group's magazine. Carlyle Group, the D.C. private-equity firm, purchased Manor Care for $6.3 billion last year.

"The concern was primarily the cost," Thomas Hamilton, director of CMS's survey and certification group, said in explaining opposition to the blanket requirement. The rule estimates that the industry will have to spend $847 million over the five-year phase-in period to meet the new standard.

The industry said the cost of sprinklers will be a financial hardship on some owners, especially in rural areas.

The Centers for Medicare and Medicaid Services told homes without ceiling-installed sprinklers in 2006 that they could use smoke alarms instead. The alarms won't be required under the new rule, a change opposed by advocates for the elderly.

Long-term care facility owners have been lobbying Congress for a bill that would provide $450 million in loans and another $100 million in hardship grants to finance the new sprinklers. The federal government spends almost $50 billion a year on nursing homes.

The trade group also supports offering waivers to homes that, "through no fault of a particular facility," can't meet the five-year phase-in schedule.