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John Rickard, AIA, PE

 

Several years ago, Pioneer Network led an effort to identify code requirements that hinder the ability of nursing and assisted living facilities to implement culture change (person-centered and person-directed care) in their facilities. This effort was particularly timely, as the Centers for Medicare and Medicaid Services (CMS) has indicated they hope to move from the 2000 edition to the 2012 edition of the Life Safety Code next year. CMS has advocated for culture change for some time and, at a conference last summer, strongly encouraged the National Fire Protection Association (NFPA) to remove impediments to culture change in the codes. As a result of the combined efforts of SAGE, Pioneer Network, AAHSA, AHCA, and others, four areas were identified and proposals submitted to change NFPA 101 Life Safety Code, one of the key codes mandated by CMS. The four areas identified relate to seating in corridors, residential kitchens, fireplaces, and flammable artwork. Following is the first of a series of four articles addressing the proposals.

In a person-centered care setting, residents are encouraged to get out of their rooms and socialize. Maintaining mobility and independence enhance quality of life and can slow or even prevent a decline in function. In facilities with long corridors, however, difficulty walking to one's destination limits opportunities for socialization and independence. Furniture placed along corridors allows residents the opportunity to walk a distance, rest, and then continue independently to their destination.

The Life Safety Code requires that corridors in nursing homes maintain a clear width of eight feet with no obstructions. Because of cost, architects rarely design corridors that are wider than eight feet and few corridors have room for seating. In many facilities, this means residents must walk down a long corridor with no intermediate places to sit and rest. Residents who are physically unable to walk such distances without being able to rest periodically must either use a wheelchair or stay in their rooms more, outcomes that are counter to maintaining their ambulatory skills. This loss of independence can lead to depression and a general decline in function and acuity.

The Pioneer Network submitted a proposal for the 2012 edition of the Life Safety Code that would allow furniture to be placed in corridors, provided that a minimum clear width of six feet is maintained and several other restrictions are observed. This proposal was initially rejected by the NFPA Technical Committee on Health Care Occupancies that reviewed it, but a year later the committee voted to approve a modified version of the proposal. The final language includes the following provisions:

It should also be noted that the code requirements for wheeled carts in use was also changed. Wheeled carts that are in use may not reduce the corridor width to less than five feet. "In use” has been defined by CMS as being in the same location no more than 30 minutes, but this language has been removed from the appendix in the 2012 edition. In effect, the requirements for wheeled carts in use have been tightened somewhat.

The code language approved by the NFPA Technical Committee went before the general membership at the annual NFPA Technical Session in June, 2011 and was approved for inclusion in the 2012 edition of NFPA 101 Life Safety Code. This code change will not go into effect in new and existing nursing homes until CMS moves to adopt this latest edition. If CMS does move forward, the adoption process will likely take a year or more. There is also the possibility that CMS may move more quickly and adopt only the four culture change provisions that were approved, with adoption possibly occurring as soon as this Fall. Hopefully, another tool for implementing culture change is close at hand.