Two recent news stories may have you re-examining your emergency preparedness plans, especially as they pertain to fires.
Four residents died and more than 160 residents and staff members were evacuated, including more than two dozen residents who were taken to hospitals, during a five-alarm fire Nov. 16 at the Barclay Friends continuing care retirement community in West Chester, PA. Investigators are still trying to determine the cause of the blaze, which destroyed part of the community, forcing parent company Kendal Corp. to relocate residents. Foul play is not suspected.
In a Nov. 18 fire at Safe Haven Care Center, a former nursing home in Pocatello, ID, that was operating as an assisted living community and also included a psychiatric hospital, no deaths were reported. The building and all of its contents are gone, however, and damage reportedly exceeds $2 million. Again, investigators do not believe the fire was intentionally set.
The Idaho fire is believed to have started in the building’s attic, where state regulations did not require a sprinkler system because it was unoccupied. Idaho operates under the International Fire Code and National Fire Protection Association codes, the state fire marshal told the Idaho State Journal. He added that he will be recommending a review of those codes to ensure that they protect people as much as possible.
Given what Robert Solomon, a division manager for the nonprofit NFPA, told me, the Quincy, MA-based organization will welcome that opportunity.
“When we have these fires, they are unusual, they are unexpected,” he said. “At NFPA, we want to know what the circumstances were, what the scenarios were, because what we do with that information is go back and evaluate our code. …These codes do not remain static. The Life Safety Code, for instance, is updated every three years.”
|Life Safety Code
The Centers for Medicare & Medicaid Services mandates that nursing homes, hospitals and other facilities that receive Medicare and Medicaid reimbursement comply with the 2012 edition of the Life Safety Code, also known as NFPA 101.
State and local jurisdictions also can decide to mandate compliance with the NFPA’s codes and standards, in part or in whole, for buildings under their purview, including assisted living communities.
Want to see the parts of the Life Safety Code that relate to assisted living communities (referred to as residential board and care in the code)? They’re accessible at no charge (although registration is required) on the NFPA website at http://www.nfpa.org/101. Chapter 32 is about new construction, and Chapter 33 pertains to existing construction.
Compliance with the Life Safety Code, also known as NFPA 101, is mandated by the Centers for Medicare & Medicaid Services for nursing homes, hospitals and other facilities that receive Medicare and Medicaid reimbursement. State and local jurisdictions — licensing authorities, health departments, fire marshals, building commissioners, etc. — also can decide to mandate compliance with the NFPA’s codes and standards, in part or in whole, for buildings under their purview, including assisted living communities.
“The NFPA codes have detailed requirements about how you design and install these [sprinkler] systems, and we also have a set of detailed requirements that mandate regular inspection, testing and maintenance of the systems to make sure that they are going to function when needed,” Solomon said. Staff training, responses to emergencies and other topics also are covered, he added.
Fires such as the ones in Pennsylvania or Idaho serve as a reminder of the importance of maintenance of systems, Stan Szpytek, a president of Fire and Life Safety Inc. in Mesa, AZ, told me.
“The role of the maintenance director in an assisted living or independent senior complex is often undervalued or even underestimated,” said Szpytek, a former deputy fire chief and fire marshal who is the life safety consultant for the Arizona Health Care Association and the California Association of Health Facilities. “They have got so much responsibility in making sure that those systems are maintained and operational at all times, and when they fail, the results can be catastrophic.”
But some assisted living community may not have systems to maintain in the first place, he said.
“Most providers will be very proactive, and they’ll take a total system approach, which oftentimes includes fire sprinklers, fire alarm system, fire drills and sometimes emergency generators,” Szpytek said, “but the problem is, there isn’t federal oversight, and there are plenty of older assisted living and independent living buildings that weren’t originally required to have sprinkler systems.”
Depending on available state and local government resources, he said, assisted living communities may have to “police” themselves to ensure that they are complying with any relevant regulatory requirements.
Another challenge for private-pay operators, Solomon said, is that those who choose to exceed regulatory requirements will incur costs that must be passed on to residents.
In addition to knowing which regulations apply to your community and maintaining systems, Solomon and Szpytek shared the following additional fire safety tips for assisted living communities:
• Have a plan.
“A facility or a community needs to have an ‘all hazards’ approach to emergency preparedness,” Szpytek said. “That means regardless of whether it’s a fire, flood, active shooter, storm, earthquake or tornado, they have an emergency plan that will address all of the different emergencies that can occur.” Fire is one of the most common types of emergencies, he added.
• Conduct drills.
“As we saw both in Idaho and in Pennsylvania, the response of the staff was absolutely crucial,” Solomon said.
A drill, however, “isn’t just sitting around and having a cup of coffee and talking about it,” he added. “It’s actually doing it.”
Again, make sure you know the requirements that affect your community. “Most states minimally require fire drills, one per shift per quarter,” Szpytek said. “So if there are three shifts, then that’s typically 12 drills a year.”
Your state may require additional drills, he said. In Arizona, for instance, assisted living communities and skilled nursing facilities also must conduct two evacuation drills per year.
Don’t follow identical scenarios when practicing, Solomon said. He shared the case of one facility that encountered problems when a fire broke out in the location that staff members always had used to stage the evacuation of residents during drills. “They had alternative exits that they had never practiced with,” Solomon said. “That particular fire resulted in four fatalities.”
• Recruit a fresh pair of eyes.
Work with your local fire department, hire a consultant to conduct a mock Life Safety Code inspection and/or ask staff members to help you see your facility from a different point of view.
“It’s just not good enough that they meet their paper compliance,” Szpytek said. “They want somebody with a fresh set of eyes, with a focused set of eyes, looking at the building.”
In an “internal safety run,” he said, have an employee walk the floor looking for any kind of fire hazard.
“As a consultant, I’ll go into these buildings, and to the chagrin of an executive director or maintenance man, I’ll say, ‘Okay, your exit sign is not illuminated at the front door and your sprinkler heads have dust and dirt on them,’ ” Szpytek said. “They’ll say, ‘Why don’t we see that?’ It’s just because they’re there every day. So sometimes, it’s just a fresh perspective.”
Other potential fire hazards to look out for, he said, include extension cords, multiple power strips that are “piggybacked” together, fire extinguishers that are blocked by a piece of furniture or a cart, blocked exits, covered smoke detectors and sprinkler heads, holiday decorations made of combustible material and live Christmas trees, wreaths and garlands. (See also: “12 holiday hazards and how to address them.”)
“It’s really about being proactive and looking for any kind of practice or piece of equipment that could cause a fire,” Szpytek said.
• Assess acuity.
Emergency preparedness planning offers an opportunity for owners and operators to ensure that “residents are in the right environment based on their daily care needs and their ability to self-preserve,” Solomon said. If a resident’s needs or abilities have changed, he said, then it might be time for a move.
Solomon cited a fire, for instance, where “the investigation uncovered that the staff successfully got people out, but then some of the residents, because of some intellectual disabilities, to them, the safest place was in the building, and they actually went back in.”
Lois A. Bowers is senior editor of McKnight’s Senior Living. Follow her on Twitter at @Lois_Bowers.