In the District of Columbia, licensed nursing homes are inspected at least once a year by the D.C. Fire Marshal's office to determine whether they meet standards set forth in the National Fire Protection Association's Life Safety Code, a requirement of all institutions that receive Medicare or Medicaid patients.
"They need to do everything that will make it a safe environment for the folks that stay in the homes," said Lt. Jack Fletcher of the Fire Prevetion Division. "We make sure that when they are in their rooms they are protected by a good door and they have a window to open. When they come out of that door, we assure that they are in a safe atmosphere. There must be at least two ways out along the corridor. Hazardous areas, like a laundry, must have sprinkler systems."
To become licensed in the District of Columbia, a nursing home must demonstrate to the fire marshal's satisfaction that it substantially complies with the Life Safety Code. Inspectors have authority to waive certain requirements of the code if they would work a particular hardship on the nursing home, but only if such waivers would not endanger the health or safety of the patients.
"It comes down to a tradeoff," said Fletcher. "No one is in 100 percent compliance. You're not supposed to have any dead-end corridors, but you might agree to one if they put a sprinkler system there."
All licensed nursing homes in the District of Columbia must have fire emergency plans approved by the fire marshal's office, and they are required to have fire drills at least 12 times a year. The fire emergency plan must set forth in detail the duties of each staff member in case of a fire, and it must contain the details of a plan of evacuating the building.
Leon Ferguson, deputy director of the city Office on Aging and a member of the Facility Life Safety Subcommittee for the American Association of Housing for the Aging, said that When he was director of the Stoddard Baptist Home, "we had a very close working relationship with the fire department. They came in on several occasions, conducted inspections, made recommendations and we complied, even when they suggested we put in more extinguishers than the law demanded."
Ferguson noted that fired safety is more of a problem when older people who smoke are involved. "They may light up a cigarette and forget about it or forget to watch where the ashes fall," he said.
Some nursing home, Ferguson added, allow patients to smoke only in specified lounges. "Nurses or aides keep their cigarettes for them, but I'm a smoker myself, and I know there must be a tendency to stash cigarettes away. I heard of a nursing home resident, not in the District, who went into her closet to smoke and started a fire. No one was hurt because there were sprinklers and smoke detectors.
"I'm not saying there are no problems, but five hazards are a combination of things when you serve a population of people who are not in a position to look after themselves," he added.
Ferguson said he believes that "District regulations are as good as anywhere else, and in my experiece, they're well enforced in nursing homes."
A separate set of licensing and inspection requirements govern other group homes in the city, including the one in which nine women residents were killed in a fire April 11. Six other women were injured in the blaze which swept through the Mount Pleasant home, a facility for mental outpatients from St. Elizabeths Hospital. City officials said the house should not have been allowed to operate because of an array of fire safety and licensing violations. They said the home was not equipped with either the required fire doors or a fire escape.
Privisons of the Life Safety Code that govern fire safety in licensed nursing homes cover in detail the requirements for fire doors, smoke barriers, exits, construction materials, sprinkler systems and evacuation plans, among other safety systems.
The Life Safety Code requires automatic sprinkler systems throughout the building with periodic inspections and appropriate maintenance. There is an exception to this requirement for one-story structures built of fire-resistant material, but these buildings must at least have sprinkler systems in all hazardous areas and must have smoke detectors.