Culture Change in the Code: Decorations

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 in July, 2010, 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 fourth in a series of four articles addressing the proposals.

An important part of creating a person-directed environment is giving residents the ability to personalize their living environments is a way that has meaning for them. Many aging residents want to hang pictures and artwork of loved ones, including grandchildren and great-grandchildren, on the walls of their room. Besides making the room more closely resemble the home they left, the photographs and artwork are also a visual link to memories and life beyond the walls of the nursing home or assisted living facility. Feeling a part of their family and the world at large is very important to maintaining a high quality of life.

The Life Safety Code, however, places a severe limitation on combustible decorations. One option is to limit the quantity of decorations such that, "a hazard of fire development or spread is not present.” Whether a hazard of fire development or spread is present is determined by the Authority Having Jurisdiction (AHJ), which could be either the State surveyor or the local fire marshal. Not surprisingly, many AHJ's consider a hazard to be present with even one photograph, and the Code gives them authority to prohibit all pictures and artwork.

The second option is to treat the decorations so they are flame-retardant. This is typically impractical and raises questions regarding how one can tell a picture is flame-retardant and how long the retardant lasts. Once again, the effect is that pictures and artwork are often completely forbidden.

The Pioneer Network submitted a proposal for the 2012 edition of the Life Safety Code that would allow combustible artwork in both new and existing nursing homes, provided that several 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:

• Decorations may cover no more than 50% of the walls, ceilings and doors in the resident sleeping room (with the following caveats)
  • The resident sleeping room cannot have more than four persons
  • The entire smoke compartment in which the resident room is located must be fully sprinklered
• Decorations may cover no more than 30% of the walls, ceilings and doors in rooms other than resident sleeping rooms, provided the smoke compartment is fully sprinklered
• In rooms located in smoke compartments that are not fully sprinklered, decorations may cover no more than 20% of the walls, ceiling and doors
• Doors that are not required to be fire rated are the only doors on which decorations are allowed and the decorations must not interfere with the operation or latching of the door
• Decorations may include photographs, paintings and other art, including hanging objects and three-dimensional items
• Combustible decorations are not allowed in stair enclosures under any circumstances

The percentage is measured for each individual wall or ceiling and the door is counted as part of the wall.

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.