Seeking sprinkler support

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In the wake of deadly tragedies and tougher policies, providers and advocates are on a quest for fire-fighting funding.

Charlotte Burns runs a 73-bed nursing home in Savannagh, TN, built in the 1960s. It's attached to a 58-bed county hospital. When hundreds of sick patients flocked the emergency room over the last decade, doubling the volume to 1,000 patients a month, it was time for Burns to find space for them. So she developed an $8 million expansion plan.

Because she was renovating, Burns was forced to retrofit the nursing home with a costly full sprinkler system under a 1971 federal law. Construction began in May. Her timing could not have been better: Tennessee became the first state in the nation in June to pass mandatory sprinkler laws. The state's lawmakers reacted fast after a deadly fire last December at the NHC Healthcare Center in Nashville that killed 15 residents, mandating that every nursing home in the state must have installed a full sprinkler system by November 2006.

"It was a very smooth process," Burns says of the three months the sprinkler company monopolized the facility. Residents had to leave their rooms only for one day at a time, and families were kept aware of the changes. The state signed off on her finished sprinkler system in August. Burns sounded relieved, but she said although she didn't have exact figures, the cost for the retrofit was high.

Burns is not alone. But she chose to renovate, while cash-strapped nursing homes are expected to feel pressure to retrofit.

Providers nationwide are gearing up for heightened regulations on the heels of a Government Accountability Office report released in mid-July to Congress. The report, impelled by the Nashville fire and another in Connecticut that led to 16 additional deaths, has prompted major pressure for reform in the industry.

The most startling fact in the report was that a multi-death fire has never occurred in a nursing home with a full sprinkler system. So while fire trucks screamed in the middle of the night to rescue vulnerable seniors, it's assumed those tragic deaths could have been prevented.

The fires shook up the industry, with nursing home administrators, owners and directors of nursing feeling the ripple effects and thinking: "What if that happened at my facility?"

Unforeseen but minor obstacles

But retrofitting a 30- to 40-year-old building is not always as easy as it might appear, as Burns learned. Not only are costs high -- $5 to $9 a square foot – precluding nursing home managers from starting the process, but unanticipated problems also could arise.

Buildings erected in the late 1960s and early 1970s, when asbestos was commonly used, are likely to have asbestos in the walls and flooring. The Environmental Protection Agency finally banned asbestos in 1989 because it was linked with cancer and other health problems when the particles were stirred up and circulated in the air. With asbestos in the walls, maintenance staffs have to evacuate residents and disrupt care to operate drills.

When running up against this roadblock, one option is to simply have the sprinkler heads and pipes showing in the rooms. Another is to take the extra time and continually communicate with the residents and their families the importance of the procedure.

In homes without asbestos, cutting into the ceiling to cover up the pipes can maintain the home-like feel of the rooms.

Dick Strub, a 30-year nursing home veteran and chairman of the life safety subcommittee for the American Health Care Association, said if nursing homes do decide to cut into the ceilings in asbestos-free homes, it's only semi disruptive. He oversaw 40 homes retrofitted for sprinklers over three years when he ran maintenance, renovations and life safety for 450 buildings at Hill Haven, based in Tacoma, WA.
"We didn't have to limit admissions," he said, "and the residents actually enjoyed the change."

Another obstacle nursing homes face in implementing sprinkler systems is a shortage of water supply. Some nursing homes, especially in ru