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Author(s): Ron Cote. Published on January 2, 2018.

In Compliance | NFPA 101

NFPA 101, NFPA 101A, and sprinkler requirements for nursing homes


It has been more than 18 months since the Centers for Medicare and Medicaid Services (CMS) moved from enforcing the provisions of the 2000 edition NFPA 101®, Life Safety Code®, to the 2012 edition as a condition for participation in the Medicare and Medicaid programs for health care occupancies. Even so, health care providers continue to recognize and evaluate the nuanced effects imposed on their facilities by the 2012 edition of the code.

Currently, some nursing home operators are facing a dilemma related to continued code compliance. Previously, nursing homes were made compliant with the 2000 edition of NFPA 101 via an equivalency prepared using the health care occupancies Fire Safety Evaluation System (FSES) of NFPA 101A, Guide on Alternative Approaches to Life Safety. The equivalency balanced the presence of a nonrequired sprinkler system against a noncompliant building construction type. For the most part, the move to compliance with the 2012 edition of NFPA 101 has permitted additional functional needs associated with providing medical services, like those intended to make a nursing homes less institutional and more homelike, to be met without conflicting with code requirements. For example, fixed furniture is now permitted within egress corridors.

The problem has to do with sprinklers. The 2006 edition of NFPA 101 was the first to retroactively require sprinklers in existing nursing homes, and that requirement continues to apply today in the form of the 2012 edition enforced by CMS. The NFPA 101A revision cycle lags that of NFPA 101 by one full year, however, to permit the technical committee to know the code text so it can calibrate the guide’s equivalency measurement systems.

Whereas the 2001 edition of NFPA 101A measures equivalency against the requirements of the 2000 edition of NFPA 101, it is the 2013 edition of NFPA 101A that measures equivalency against the requirements of the 2012 NFPA 101. Given that sprinkler systems are required by the 2012 NFPA 101 for existing nursing homes, the FSES of the 2013 NFPA 101A recognizes a sprinkler system as something that is necessary, is not a voluntarily provided feature, and is not something that can be traded off against a code deficiency.

In cases where a sprinklered existing nursing home with a noncompliant construction type achieved equivalency with the requirements of the 2000 NFPA 101 by using the 2001 NFPA 101A, that same building today has two problems: it is noncompliant with the building construction requirements of Chapter 19 of the 2012 NFPA 101 for existing health care occupancies, and it fails the equivalency analysis performed using the 2013 NFPA 101A.

The technical committee responsible for NFPA 101A has completed its work to produce the first- and second-draft reports as part of the annual 2018 revision cycle that will produce the 2019 NFPA 101A. The committee was unable to achieve consensus on changes to the health care occupancies FSES to permit a sprinklered existing nursing home—one that was compliant via the equivalency analysis using the 2001 NFPA 101A—to remain compliant via the 2019 NFPA 101A. To do so would stray from the fundamental premise that NFPA 101A must measure equivalency against the requirements of a specific edition of NFPA 101. In other words, NFPA 101A is not the place to implement leniencies that are not technically based.

Moving forward, existing nursing home operators can request the authority having jurisdiction (AHJ) to modify requirements of the 2012 NFPA 101 as permitted by the duties it assigns to the AHJ. The key AHJ for this issue is the Centers for Medicare and Medicaid Services. Additionally, the life safety technical committee can work, during the next revision cycle, to revise the provisions of Chapter 19 of NFPA 101 to recognize continued use of a sprinklered building housing an existing nursing home in what has traditionally been a noncompliant building construction type. NFPA 101A can then be revised, without technical compromise, to reflect the NFPA 101 change.

RON COTÉ, P.E. is NFPA technical services lead for life safety.