December 21, 2006
The Honorable Leslie Norwalk
Acting Administrator
Centers for Medicare and Medicaid Services
Department of Health and Human Services
Room 445-G
200 Independence Avenue, SW
Washington, DC 20201
Re: CMS-3191-P
Dear Ms. Norwalk:
The National Citizens’ Coalition for Nursing Home Reform and the undersigned organizations
are pleased to support CMS’s intent to require retrofitting of automatic sprinklers in long-term
care facilities and to provide you with our comments on issues raised in the October 27, 2005
Notice of Proposed Rulemaking, Medicare and Medicaid Programs; Fire Safety Requirements
for Long Term Care Facilities, Automatic Sprinkler Systems. In addition, we would like to take
this opportunity to thank CMS for the recent addition of sprinkler status and Life Safety Code
compliance data to Nursing Home Compare. Your responsiveness to requests for this
information is providing consumers an important new tool to assess the safety of individual
nursing facilities.
While we strongly endorse CMS’s proposal to require all nursing home providers to install
automatic sprinklers throughout their facilities, we are very concerned about several aspects of
the NPRM:
• It would not only delay implementation of the 2006 Life Safety Code but also
compliance with the most recent National Fire Protection Association standards for
installation and maintenance.
• Proposals for a lengthy phase-in period for sprinkler installation, if adopted, could leave
residents in many facilities at risk of dying in fires well over a decade from now.
Thanks to better standards and regulations, fire deaths in nursing homes have declined
significantly since the Senate Special Committee on Aging investigated the tragedy in the
1970s. Nevertheless, the occurrence of 2,300 structural fires in long-term care facilities each
year is alarming, particularly as they occur in combination with chronic, epidemic rates of low
staffing and staff turnover. (The NFPA Life Safety Code Handbook,