residential board & care - nfpa
TRANSCRIPT
State Regulation &
How it Relates to Life Safety
Dan Purgiel, LRS Architects Inc.
Residential Board & Care
NFPA Health Care Summit
Outline of Presentation
Key issues
1. National overview
2. Resident types
3. Challenges of a State regulated industry
4. Life safety & building codes
5. Moving forward
Background
Background
How I got here
– Trying to help clients with conflicting
regulations
– Helped the states of Oregon and Hawaii deal
with AL/RCF life safety regulation
– Worked in about half the states
– Currently working for ALFA/ ICC trying to
create more consistent national life safety
regulation
– Other opinions will vary
What is this?
Residential Board & Care
What is this? – Assisted Living Facilities (AL)
– Residential Care Facilities (RCF) (for the elderly)
– Personal Care Homes
– Residential Treatment (overnight)
How is it regulated?
Residential Board & Care
Regulated by States – No consistency of names of types of facilities
– No exact consistency of type of care
– Generally less “care” than next level of care -
Nursing
National Analysis
National Survey
Centers for Disease Control & Prevention
CDC 2010 National Survey of
Residential Care Facilities
(RCF): (CDC - NSRCF)
General Data
CDC Survey - NSRCF
Commonly referred to as: RCF
(Residential Care Facility) – Provide housing and supportive services
(personal care services)
– 24 hour basis for those who cannot live
independently
– Generally do not require level of care provided
by nursing homes
– (Generic term RCF = Assisted Living Facilities)
Sizes
CDC Survey - NSRCF
RCF number of facilities & residents
Other Analysis
Other Surveys
ASHA (Leading Age)
– Seniors Housing State Regulatory Handbook
NCAL – Assisted Living State Regulatory Review
Need for National Resident Type/Life Safety Analysis - Hawaii
2006/2007 Hawaii Analysis
Need for resident capability analysis – Reviewed all 50 State assisted living licensing
(DHS/DOH) regulations
– Reviewed issues relative to life safety and building
codes
– Developed methodology of analysis
– Created findings, conclusions and
recommendations to Hawaii
on how to regulate AL
based on other states
Hawaii Summary
Hawaii AL Analysis
Summary
– Two-page summary of each State based on:
• Definitions and types of facilities
• If Alzheimer’s allowed and type and extent of
care
• Admissions and discharge criteria
• Nursing care, meds, and bedridden limitations
• Minimum life safety and/or if NFPA 101 or IBC
were referenced or required in State DHS or by
State Fire Marshal
Analysis
Hawaii AL Analysis
Analyzed AL capability levels
– Not clearly stated in many State regulations
– So developed analysis criteria for each state to
determine if residents may require evacuation
assistance in emergencies
– Because then building requirements then more
stringent for:
–wood story limits, sprinklers, smoke barriers
etc.
Used NFPA
Hawaii AL Analysis
Used NFPA 101A as guide for determining if
evacuation assistance during emergencies was needed by residents as inferred in regulations
Evacuation Assistance
Hawaii AL Analysis
NFPA 101A evacuation assistance criteria
– Mild resistance to instructions, cannot physically
or mentally self start evacuation
– Physical: Have impaired mobility and need more
than gentle arm holding, requiring some to
extensive physical assistance during evacuation
– Mental: Requiring supervision, considerable
attention, having partially impaired
consciousness, and are not likely to respond to
an emergency or alarm
State Evacuation Assistance Analysis
Hawaii AL Analysis
State evacuation assistance analysis
– Most State DHS/DOH do not state resident type
relative to emergency evacuation capability
– So analysis reviewed the following:
• If State referenced NFPA 101 slow or impractical
categories (assumed incapable levels)
• If admissions or discharge criteria actually stated or
implied lack of self capability occurred in care
• If med assistance allowed physically helping person,
then assumed incapable
• If allowed specialized Alzheimer wings, then assumed
incapable
Findings
Hawaii AL Analysis
Findings showed in AL with over 5 residents
– Over 30 states have both capable and evacuation
assistance AL categories
– About 15 states have all evacuation assistance AL
categories
– 0 to 2 states have all capable AL categories (ND?,
SD?)
– Twice as many AL/RCF than nursing facilities (NF)
buildings
– (Analysis is 6 years old so some states may be
different now)
Different from Nursing
Hawaii AL Analysis
Showed AL different from Nursing
– No general “bedridden” in AL (No resident
permanently in bed that cannot get out of bed into
a wheelchair in an emergency)
– Generally only intermittent nursing care allowed
(Varying but limited days of nursing care allowed
in some states if facility can provide care and
safety for resident up to intermittent care but not
full-time care as allowed in nursing)
Conclusion
Hawaii AL Analysis
Conclusion
– Most AL have residents that may require assistance with evacuation
Relating to IBC/NFPA
Hawaii AL Analysis
Code findings and conclusions
– IBC classifies personal care, assisted living, and
residential care as all being capable of self
preservation:
Conflicts with Hawaii findings
– NFPA 101 implies that personal care has persons
who may require evacuation assistance (except
maybe old prompt category)
• NFPA has about 20 year history of creating appropriate
hybrid between health care and residential occupancies for RCF/AL (board and care)
IBC
Hawaii AL Analysis
Detailed IBC findings
– All states and local jurisdictions use IBC as building code
– Half of the states adopt IBC at state level other half adopt in each jurisdiction
– Most states do not amend IBC so less than five states amend IBC to allow evacuation assistance (I-1) hybrid occupancies
– Most jurisdictions building permit approval is a completely separate approval not tied to licensing approval
• (non coordinated approvals)
NFPA 101 & HA
Current NFPA 101
Detailed NFPA 101 findings and conclusions • About 1/2 to 2/3 of states DHS or DOH also
reference or enforce to varying degrees NFPA 101 Residential Board and Care RCF/AL regulations 2003 or newer editions
• Recommended HA use similar NFPA 101 requirements to amend the IBC: – Allow evacuation assist RCF/AL with no timing
• Limits wood frame stories
• Require commercial NFPA 13 sprinklers
• Require smoke barriers
• Leaves other corridor and other residential requirements
AL/ RCF Inconsistencies
Hawaii AL Analysis
AL/RCF Inconsistencies
Inconsistencies
• IBC: Only a “Capable” classification of IBC AL
causes inconsistent enforcement of RCF/AL in
building code by states and local jurisdictions and is
commonly in conflict with what State DHS/DOH
allows and enforces
Hawaii AL Analysis
Inconsistencies:
– Less that 5 states have amended IBC allowing
correct resident type, fully coordinated with SFM
and DHS/DOH regulations
– About 1/2 to 2/3 of States DHS/ DOH at least
reference NFPA 101 but are not coordinated with
state or local IBC building code = conflicting
– About 1/4 to 1/3 of States DHS/ DOH allow
evacuation assistance but have no life safety
reference to NFPA 101 or IBC or in state or local
building code
IBC Revisions?
IBC & the Future
IBC: Hopefully 2015 edition revision
– Myself (ALFA) and Tom Jaeger (Pioneer
Network, Leading Age, AHCA) are working with
ICC/ IBC
– Helped push ICC to form special committee
created in 2011: (ICC IBC/ IFC CTC Care Study
Group) created to help with assisted living
regulation in the IBC/ IFC)
– If changes approved should help eliminate
inconsistencies
Proposed New IBC
IBC & the Future
IBC: Hopefully 2015 edition revision
– Creates two conditions for Group I-1 and R-4:
– One capable and one needing assistance with
evacuation
– Makes similar requirements that NFPA 101 has
for RB&C
– Except allows one more wood story than NFPA
and adds limited attic protection options in small
facilities
Nursing Argument & Differences
Nursing Differences
Health Care (Nursing):
– Has different occupant type than AL/ RCF • Bedridden, unconscious, some on life support
• So less story allowed, wider egress, electrical and structural redundancy
– Has higher staff ratios than AL/ RCF • “Defend in place” (residents stay in place during
emergencies)
• Some less stringent requirements than AL/RCF like open spaces, corridors, smoke detection exceptions
– Some less stringent requirements than AL/RCF like open spaces, corridors, smoke detection exceptions
AL/ SNF Comparison
AL (RB & C) Compared to HC RBC/ AL
Staged Evacuation
Health Care
Defend in Place
2/3 stories type VA
Moving Forward
Moving Forward
Keep track of U.S changes in RCF/AL
resident types allowed by states
– Follow the money
• Medicaid and Medicare $ is pushing people out of
hospitals into nursing
• Moving people out of Nursing into RCF/AL
– My opinion: State regulation will follow the $
• Allowing higher acuity in RCF/AL
• Staffing requirements will still push residents to nursing
facilities (Oregon already there)
Can SNF-AL Differences Be Maintained?
Moving Forward
Can differences be maintained between
SNF and RCF/AL in the future?
• Future regulation trends will determine:
– Should residents be capable enough to actively
participate in fire drills and evacuation?
– Should residents be limited to not receive full
nursing care as provided in nursing homes
– Should residents not be permanently
bedridden?
Some Code Answers May be Here
Moving Forward
Some code answers may already be here:
– Main concepts of full sprinklers/smoke
barriers/story limits are shared between both SNF
and RCF/AL
– Differences include staffing assumptions and
higher acuity in SNF compared to RCF/AL
– For AL/RCF?
• Smaller smoke compartments?
• Attic sprinkler coverage for large & small facilities?
• horizontal exits in wood frame?
End
End
Daniel Purgiel
LRS Architects Inc.
Portland, OR
503-221-1121
Questions?