Let it be known that even regulators see the point of a homelike environment. At least the National Fire Protection Association (NFPA) understands. And because of that, the Centers for Medicare & Medicaid Services (CMS) may soon make changes impacting skilled nursing facilities nationwide.
The NFPA 101: Life Safety Code, 2012 Edition, now available to non-NFPA members for $85, features four distinct culture change amendments courtesy of the Pioneer Network and its National Life Safety Task Force. The organization, well known for its efforts to “create home in the nursing home,” drafted these proposals, which introduce rules on open kitchens, furniture in corridors, combustible decorations and facility fireplaces, and had them approved by the NFPA for integration into the code.
Yes, those changes will conflict with local and federal regulation—that much is not a surprise. The Life Safety Code update is, however, an important step forward in the culture change movement. At the LeadingAge Annual Meeting this past October in Washington, D.C., James Merrill, a life safety engineer in the nursing homes branch of CMS, confirmed during an educational session that his agency “feels it is appropriate” to adopt the 2012 code for skilled nursing facilities, although expect that process to take a few years. And that process is as follows: review and compare the 2012 edition to the 2000 edition, which CMS currently employs; draft regulation, which is anything but swift; submit a notice of proposed rulemaking and review incoming comments, typically of an inflammatory nature; and finally, publish the final regulation.
To provide an idea of how long that takes, CMS did not complete its adoption of the 2000 edition until 2003—the year that a new edition of the code was to be published by the NFPA. All in all, it's about a 30-month process, according to Merrill.
In the meantime, those four culture change provisions are here to stay, ready to be integrated by the few senior living providers who can find a place for them within their designs. It's there on the design level where fostering a safety and compliance culture begins, argues former fire marshal and current NFPA member Stan Szpytek, Jr., president of Fire and Life Safety, Inc. “The development of a compliance culture has to start when the first design concept is brought to paper,” he says.
Szpytek, a 30-year safety veteran, was invited to comment on each of the four culture change provisions within the 2012 Life Safety Code, the details of which follow.
Cooking with culture change: An intro to open kitchens
Tired of that institutional look? The code now allows for a truly residential eatery—if you can look past the mandated range hood and fire suppression system. But residential or commercial stoves and cooktops are kosher, and the kitchens themselves are permitted to be open to other living spaces and adjoining corridors. Some requirements include a 500 cfm minimum exhaust fan in that range hood with grease cleaning functionality, local smoke detection and a deactivation switch. Also, the kitchen may not serve more than 30 residents, although each smoke compartment within a facility may have its own open kitchen serving that many residents each. The smoke compartment where the kitchen is located must also be covered by sprinklers.
Szpytek says kitchens must be maintained in a clean, fire-safe condition and that staff must be fully trained on their upkeep. “Are rags too close to the burners? Are ovens being properly cleaned? Staff in a facility that's designed with this new feature will clearly have to be cognizant of the hazard that now exists,” he says.
A place to rest while they travel the home
Both visually appealing and functionally helpful to mobile seniors, seating within corridors is now relaxed. Before getting to the requirements, Szpytek emphasizes that limitations here are necessary to ensure a protective environment. “There is sometimes an overwhelming attitude that the life safety code handcuffs the design and free flow of a facility,” he says. “But I think it needs to be viewed in a perspective that this is here to safeguard the residents and occupants of a building.”
The criteria for compliance are as follows. Furniture must be fastened to the wall or floor, with as little as a metal bracket, to prevent unintended migration into cleared walking paths. Furniture depth may not reduce the corridor below 6 feet of walking clearance, and the furniture itself must only be located on one side, allowing residents—or emergency personnel—to navigate without weaving. Lastly, groupings of furniture are limited to 50 square feet in size, and the groupings themselves should be 10 feet apart from one another.