Skip to Highlights
Highlights

In 2003, 31 residents died in nursing home fires in Hartford, Connecticut, and Nashville, Tennessee. Federal fire safety standards enforced by the Centers for Medicare & Medicaid Services (CMS) did not require either home to have automatic sprinklers even though they have proven very effective in reducing the number of multiple deaths from fires. GAO was asked to report on (1) the rationale for not requiring all homes to be sprinklered, (2) the adequacy of federal fire safety standards for nursing homes that lack automatic sprinklers, and (3) the effectiveness of state and federal oversight of nursing home fire safety.

Skip to Recommendations

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should ensure that CMS regional offices fully comply with the statutory requirement to conduct annual federal monitoring surveys by including an assessment of the fire safety component of states' standard surveys, with an emphasis on unsprinklered homes.
Closed - Implemented

Recommendation status is Closed - Implemented.

CMS regional offices now routinely include fire safety as part of the statutory requirement to conduct annual federal monitoring surveys in at least 5 percent of surveyed nursing homes. CMS expects to have completed life safety code validation surveys in sufficient numbers to meet the statutory requirement by the end of fiscal year 2005, giving priority to conducting such surveys in unsprinklered facilities. In Dec. 2005, we reported that CMS completed a total of 859 fire safety comparative surveys in FY 2005, exceeding the statutory requirement of 5 percent by about 40 surveys (GAO-06-117, p. 29).
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should ensure that data on sprinkler coverage in nursing homes are consistently obtained and reflected in the CMS database.
Closed - Implemented

Recommendation status is Closed - Implemented.

CMS made changes to the Fire Safety Survey Report forms used in the Life Safety Code Surveys to capture the sprinkler status of facilities. The revised forms were made available to all surveyors by means of the CMS web site. In addition, CMS officials report that its automated information systems have been reprogrammed to ensure that the sprinkler status of each nursing home is reflected in its Online Survey, Certification and Reporting (OSCAR) database. Data is being gathered and verified as each nursing home undergoes its annual survey. By early to mid-2006, data on the sprinkler status of all nursing homes should be in OSCAR. In an August 2006 update, Jim Merrill of CMS indicated that this effort was virtually complete with the sprinkler status of 99+ percent of nursing homes ascertained during routine surveys
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should until sprinkler coverage data are routinely available in CMS's database, work with state survey agencies to identify the extent to which each nursing home is sprinklered or not sprinklered.
Closed - Implemented

Recommendation status is Closed - Implemented.

CMS has contacted state survey agencies and collected data on the sprinkler status of approximately 95 percent of nursing homes. This data is being validated during each nursing home's next annual survey. In an update obtained in August 2006, Jim Merrill of CMS indicated that the agency had collected data on the sprinkler status of 99+ percent of nursing homes.
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should on an expedited basis, review all waivers and Fire Safety Evaluation System assessments for homes that are not fully sprinklered to determine their appropriateness.
Closed - Implemented

Recommendation status is Closed - Implemented.

CMS instructed its regional offices and state survey agencies to submit all waiver requests to the regional offices for disposition. All waivered facilities will receive this higher level of review over the course of the year as they receive their annual survey and seek to renew their waivers. In addition, CMS has instructed state survey agencies to submit Fire Safety Evaluation System (FSES) assessments to the CMS regional offices for review on an annual basis. CMS officials expect to complete their reviews of life safety code waivers and FSES assessments by the end of 2005. According to an August 2006 update, Jim Merrill of CMS indicated that CMS had completed its waiver and FSES review and noted that the number of homes using FSES had dropped significantly as a result of the review.
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should make information on fire safety deficiencies available to the public via the Nursing Home Compare Web site, including information on whether a home has automatic sprinklers.
Closed - Implemented

Recommendation status is Closed - Implemented.

The CMS Nursing Home Compare web site now contains information on nursing homes' fire safety deficiencies as well as whether the home has automatic sprinklers. According to CMS, this information was posted on the web site as of October 2006.
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should work with the National Fire Protection Association to strengthen fire safety standards for unsprinklered nursing homes, such as requiring smoke detectors in resident rooms, exploring the feasibility of requiring sprinklers in all nursing homes, and developing a strategy for financing such requirements.
Closed - Implemented

Recommendation status is Closed - Implemented.

CMS issued regulations effective May 24, 2005 requiring nursing facilities to install smoke detectors in resident rooms and public areas if they do not have a sprinkler system installed throughout the facility or a hard-wired smoke detection system in those areas. Facilities have one year--until May 24, 2006--to come into compliance with this requirement. In addition, in July 2005, the National Fire Protection Association approved a revision to the 2006 Life Safety Code which will require the installation of automatic sprinkler systems in all existing facilities.
Centers for Medicare and Medicaid Services To improve federal oversight of state fire safety activities, provide the public with important information about the fire safety status of nursing homes, and better ensure the adequacy of fire safety standards, the Administrator of CMS should ensure that thorough investigations are conducted following multiple death nursing home fires so that fire safety standards can be reevaluated and modified where appropriate.
Closed - Implemented

Recommendation status is Closed - Implemented.

CMS developed and issued a standardized procedure to ensure that both state survey agencies and its own staff take appropriate action to investigate fires that result in serious injury or death. CMS directed state survey agencies to investigate any nursing home fire that results in injury using CMS complaint procedures for the level of "immediate and serious jeopardy" requiring investigation within 2 days. Information regarding these incidents will be tracked in CMS's complaint database.

Full Report