Sprinklers Now a Must for Nursing Homes

The new regulation says the best insurance against fires is sprinklers: "There has never been a multiple-death fire in a long-term-care facility that had an automatic sprinkler system installed throughout the facility."

The blazes in Hartford and Nashville focused regulators on gaps in fire-protection rules. Intense media scrutiny and a Government Accountability Office report in July 2004 helped prompt the push for mandatory sprinklers.

The GAO report was critical of "weaknesses" in federal fire standards and oversight. It said neither home had smoke alarms or sprinklers where the fires originated. It was critical of waivers that regulators handed out to excuse homes from fire standards. And it said state and federal oversight relied on faulty and unaudited state surveys.

Still, the number of fatal nursing home fires has dropped dramatically since 1971 when 15 to 18 fires a year resulted in three or more deaths each, the government said in issuing the rule. The average number of deaths each year since then is 5.

The reduction is "reflective that they aren't fire traps or horribly unsafe places to be," Bentley, of the nursing home trade group, said of the facilities.

That's not to say nursing homes are hazard-free. The GAO report said that from 1994 to 1999, an average of 2,300 facilities reported a fire each year.

Hamilton said his agency and state inspectors, in responding to the GAO's findings and recommendations, have cracked down on fire-code violations.

In 2004, inspections uncovered 48,732 problems with fire-safety rules, 11.5 percent of which were considered to have widespread potential for harm. Last year, 62,359 deficiencies were found, with 23.5 percent considered severe.

Enforcement actions, including other issues besides fire safety, have increased from 306 in 2004 to 1,299 in 2006.

Nursing home advocates and fire-safety experts say they are pleased regulators won't permit waivers to the sprinkler requirement, and that stronger state laws won't be preempted.

Advocates said in comments and interviews that they are opposed to a provision in the rule that allows smoke alarms to be taken out once sprinklers are installed.

Hamilton said the rule took into account the expense of maintaining smoke alarms. "You have to balance the cost involved with the benefits," he said.

Cindy Skrzycki is a regulatory columnist with Bloomberg News. She can be reached at cskrzycki@bloomberg.net.