Long-Term Care

Tip of the week: Reeducate your staff about fire safety

Contemporary Long-Term Care Weekly, March 20, 2008

A rash of recent nursing home fires serves as a reminder to administrators about the need for continued fire safety training of staff in long-term care facilities.

There were at least five nursing home fires from late May through early August in facilities across the country. You can find a rundown of the individual fires below.

The worst fire from a safety perspective occurred May 26 at Regency Place in Dyer, IN, when a wheelchair-bound resident in restraints allegedly caught on fire. The victim died six days later from his burns in a Chicago hospital.

In at least one case--a fire in a resident room at Manor Care Health Services in Chevy Chase, MD--a sprinkler kept the flames from spreading, says Pete Piringer, spokesperson for the Montgomery County (MD) Fire and Rescue Service. "There's no question in our minds that [the sprinkler] saved lives," Piringer says.

Nursing home staff did a good job of relocating residents near the fire to other areas of the building and closing the door to the room where the fire began, Piringer says. The fire started after a malfunctioning fluorescent light fell off of the ceiling, igniting a bedroom with two residents in it.

Had a smoke detector been installed in the room, staff might have been able to respond more quickly and put out the fire with a portable extinguisher, Piringer says. The nursing home wasn't required by law to have these detectors, though, he adds. However, the rules on that will soon change.

Tip: Be aware of a new regulation that takes effect May 24, 2006. CMS will require nursing homes that lack sprinkler protection or a hard-wired smoke detection system to have battery-operated smoke detectors in all resident rooms and public areas. CMS estimates that 4,200 nursing homes in the country will need to install smoke detectors.

Tip: CMS also released a letter in July to state surveyors that clarified Life Safety Code® survey issues in nursing homes. The agency provided clarification on the requirements for wardrobe/closet sprinklers, exit surfaces, and canopy sprinklers. Go to www.hcpro.com/content/49418.cfm to read the letter.

Authorities took four of the 140 residents at Manor Care to the hospital for smoke inhalation, and all of the victims were expected to recover, Piringer says. He estimated that the building suffered about $25,000 in damage, mostly from water.

Investigation continues into fatal fire

It's not fully clear why the fatal fire in Indiana occurred, says attorney Daniel Stephens of the law firm Timothy F. Kelly and Associates in Dyer, IN. Stephens represents the widow of the victim, who at presstime planned to file a lawsuit against Regency Place for wrongful death.

Authorities continue to investigate the fire. The nursing home's administrator and a spokesperson for its parent chain didn't return phone calls.

Regency Place is a nonsmoking facility, yet "allegedly there was a lighter found on the floor in close proximity to [the victim]," Stephens says. The victim may have caught fire twice, although if that indeed occurred, it's not known why he reignited after staff initially put out the flames, he says.

The victim had a history of smoking but allegedly had not smoked in the nursing home, where he was admitted in March because he suffered from Alzheimer's disease, according to an autopsy report from the Cook County Medical Examiner's Office in Chicago.

Stephens--a volunteer firefighter and a former nurse manager at a hospital--says nursing homes are in a tough position because they must balance resident rights against safety measures. Federal regulations state that nursing home residents' rooms are akin to their homes, and thus staff are limited in how much they can check for items such as lighters. On the other hand, facilities must be vigilant.

"That's a big judgment call," Stephens says of this dilemma. (For more information about setting a reasonable smoking policy in nursing homes, see the story on p. 9 of the April BLTCR. )

When planning for fire responses, there are a pair of critical points about which to educate workers, says Russell Phillips, president of the consulting firm Russell Phillips, LLC, in Rochester, NY. Nursing homes should train staff to

  • stay familiar with fire protection features in the building, such as the layout of the smoke compartments that separate areas of the facility with barriers to keep smoke from spreading and to where employees can safely evacuate patients

  • recognize the medical needs of residents during an evacuation, particularly when relocations will involve staff moving a resident's medical equipment

    It's also a good idea to let your local fire department know about your evacuation plans so that firefighters are familiar with your techniques when they respond to an alarm, Phillips says.

    Successful evacuation due to training

    An incident at Marshall Lane Manor nursing home in Derby, CT, shows how practical training pays off. On July 25, smoke from a burned-out air conditioning motor drifted into the building, says administrator Anthony Simonetti.

    An employee saw the smoke and immediately pulled the fire alarm. A smoke detector also went off. Staff evacuated about 75 residents in the middle wing to adjacent smoke compartments on either side of the wing or to an outside, enclosed patio.

    The building has sprinklers, but they didn't activate because there was never a fire.

    All 23 staff on duty at the time assisted with the evacuations, which took about five minutes to complete, Simonetti says.

    After the fire department arrived and determined the cause of the smoke, residents returned to the evacuated parts of the building.

    Good ideas to reiterate to staff

    Marshall Lane Manor has many intermediate care residents who generally can walk on their own, which helped staff to evacuate areas more quickly. "Even new employees did very well getting people out," Simonetti says. He partially credits the successful evacuations to practical training that he and his maintenance director provide to staff. Information they emphasize to staff includes

  • general safety precautions

  • an introduction to the fire alarm system, including what sounds and strobe lights to expect when the system activates

  • exiting strategies, including when and how to activate the alarm system

  • which doors in the building will close if a fire alarm sounds

    Staff also regularly evaluate the residents' movement and walking abilities. With that knowledge, employees know who will need more assistance during an evacuation, Simonetti says.

    Editor's note: For more help with fire safety training, go to www.hcmarketplace.com/Prod.cfm?id=2675 for information about the video " Long-Term Care Facility Evacuations: Ensuring Resident Safety During Emergency Situations." The video offers strategies geared toward the effective evacuation of elderly and non-ambulatory residents.

    What happened during these five nursing home fires

    Dyer, IN--May 26, 2005

    Where: Regency Place

    What happened: A man restrained in a wheelchair somehow caught fire in a dining room. Staff put out the fire with an extinguisher and moved him nearby, where he may have reignited shortly after. Authorities transported the victim to a hospital. He died of his injuries June 1.

    Chevy Chase, MD--July 8, 2005

    Where: Manor Care Chevy Chase

    What happened: A fire broke out in a resident's room after a fluorescent light malfunctioned and fell onto a bed. A sprinkler kept the fire from spreading beyond the room. Staff moved residents to safe areas within the building. Four residents suffered smoke inhalation.

    Wickliffe, OH--July 22, 2005

    Where: Wickliffe Country Place

    What happened: A fire broke out in a wing of the nursing home, forcing staff to relocate more than 100 residents to other sections of the building. Firefighters extinguished the fire and helped with evacuations. The state fire marshal's office ruled the incident arson, although as of mid-August, police hadn't charged anyone. Up to 10 residents went to the hospital for treatment of various injuries.

    Derby, CT--July 25, 2005

    Where: Marshall Lane Manor

    What happened: An air conditioning motor burned out, causing smoke to enter part of the facility. Staff pulled the fire alarm and evacuated about 75 residents to safe smoke compartments within the building and to an outdoor patio. Authorities determined that no fire occurred and allowed residents back inside. There were no injuries.

    Manchester Township, NJ--August 2, 2005

    Where: Keswick Pines Lifecare

    What happened: A boiler on the second floor of the nursing home exploded while a contractor worked on it at night. Staff and authorities evacuated 243 residents from the facility to a makeshift shelter set up in a nearby counseling center.

    Four residents, two staff, and the contractor went to the hospital with injuries. The contractor was admitted and is expected to recover.

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