Issue 52: Changes to NFPA 101 Relevant to Health Care Occupancies
By Ron Coté, P.E.
NFPA 101®, Life Safety Code®1
focuses on the protection of building occupants' lives in fire and
similar emergencies, and it does not address property protection. The
Code is revised on a three year cycle. It is a mature document that is
kept current, sometimes changing in response to a tragedy. For example,
the 2006 and 2009 editions of NFPA 101 introduced new requirements
addressing the problems identified after the World Trade Center attacks
of September 2001 and The Station nightclub fire of February 2003. The
major changes to the recently published 2012 edition do not reflect
reaction to tragedy but proactively help to promote a more-homelike and
less-institutional health care occupancy setting.
Health care occupancies provide patient and resident
care on a 24 hour basis. These occupancies include hospitals, nursing
homes, and limited care facilities. They are heavily-regulated by NFPA
101 via a protect-in-place strategy intended to lessen the need to
evacuate a facility. This approach recognizes that complete building
evacuation introduces threats to patient and resident safety.
Health care occupancies are also heavily regulated by
government licensing groups, accreditation agencies like The Joint
Commission, the Centers for Medicare and Medicaid Services (CMS), fire
and building officials, and insurers. The degree of regulation imposed
on health care occupancies has led to a stringent set of requirements
for fire and life safety. The requirements adequately address fire and
life safety concerns but leave facilities with an institutional look and
For example, new hospital and new nursing home corridor
width is required to be minimum 8 ft (2.4 meters). The minimum width is
then required to be maintained clear and unobstructed over the life of
the facility. Figure 1 shows a nursing home where required corridor
width is not encumbered in compliance with Code requirements.
Figure 1. Nursing home where required corridor width is not encumbered.
Figure 2 shows a hospital where required corridor width
is encumbered. Equipment, like the bed and tray table stand, appears to
be in storage – a violation of Code requirements. Other wheeled items
are at-the-ready should they be needed, yet violate the corridor clear
Figure 2. Hospital where required corridor width is encumbered.
The 2012 edition of NFPA 101 addresses corridor clutter
and the functional need for seating in corridors via new provisions. The
provisions clarify what items are permitted to encroach on corridor
width and the degree of permitted encroachment. The new provisions add
flexibility to existing requirements that are difficult to enforce and
helps to make the health care occupancy setting, particularly that for
nursing homes, more homelike. It is part of the nursing home industry
move away from institutional models to a new household model. A lengthy
corridor that provides no place to sit makes the task of traveling to
the other end of the corridor, as might be done to visit someone, an
arduous task for many nursing home residents.
One provision permits wheeled equipment in the corridor
provided that the unobstructed corridor width is at least 60 in. (1.5
meters). Another provision permits fixed furniture in corridors that are
at least 8 ft (2.4 meters) wide. Many existing health care occupancies
have 8-ft (2.4 meter) width corridors, as they were built to the
requirements of the code applicable to new construction. However, at
time of construction, there was no forethought to providing seating
alcoves outside the required corridor width. This new provision for
fixed furniture should be particularly useful to such existing
facilities. However, use of the provision is also permitted for new
Figure 3 illustrates the combined use of the provisions
for fixed furniture and wheeled equipment. The fixed furniture is
located only on one side of the corridor. The wheeled equipment can be
positioned at both sides. The wheeled equipment is portable and is
something brought into place after the furniture has been fastened in
place. The provision that prohibits the wheeled equipment from reducing
the clear unobstructed corridor width to less than 60 in. (1.5 meters)
has the effect of prohibiting any wheeled equipment from being
positioned on the opposite side of the corridor from the fixed furniture
unless the corridor width exceeds 8 ft (2.4 meters) to the extent
necessary to provide the required clear corridor width.
Figure 3. Combined effect of corridor width projections for fixed furniture and wheeled equipment.
Another major change to the code permits small kitchens
for resident use to be open to the corridor. The technical committee
that developed this portion of NFPA 101 again acted in response to
requests for moving nursing home care away from an institutional model
to a household model. Decentralized kitchens and small dining areas help
to create the feeling and focus of home.
For residents with dementia, it is desirable to have
spaces that look familiar to increase their understanding and ability to
function at their highest level. For this reason, it is important that
nursing homes have the choice of using residential appliances in
decentralized kitchens. The provisions allow residential equipment to be
used, without requiring a commercial-grade vent hood, and include
appropriate safeguards for the maximum 30 persons affected. The
safeguards include automatic fire suppression, smoke alarms, a
prohibition on deep fat frying, adequate exhaust and filter system
airflow, interlocks for shutting off the fuel supply and electricity to
the cooktop or range, and a host of other features.
Permitting kitchens to be open to common spaces and
corridors enhances the feeling and memories of home for older adults.
This allows residents to see and smell the food being prepared, which
can enhance their appetites and evoke positive memories. Some residents,
based on their abilities and cognition level, might even be able to
participate in food preparation activities such as stirring, measuring
ingredients, peeling vegetables, or folding towels. This becomes a
social activity, where they can easily converse with the staff member
cooking, as well as a way for the residents to maintain their functional
abilities and to feel that they are important contributing members of
Figure 4 shows a resident living area open to a
corridor. Figure 5 shows a kitchen that is open to a dining area and
open to the resident living area shown in Figure 4. Thus, the kitchen is
open to the corridor. The kitchen is without a cooktop or range as the
photograph was taken before the new provisions were added to the code.
Figure 4. Resident living area open to corridor.
Figure 5. Kitchen open to resident living area which is open to corridor.
The numerous criteria that must be met to permit the
kitchen to be open to the corridor are clearly delineated, and many of
the items are accompanied by advisory annex text. The criteria related
to smoke alarm placement might benefit from further explanation. The
minimum 20 ft (6.1 m) placement from the cooktop or range is permitted
to be accomplished by locating one or both smoke alarms in the adjoining
corridor. Exhibit 6 shows one smoke alarm placement strategy that could
Figure 6. Smoke alarm placement providing the required minimum 20 ft (6.1 m) clearance from cooktop.
Additional changes to the 2012 edition of the code help
to make the health care occupancy more homelike by offering new options
for attaching decorations, like photographs, paintings, and other art,
directly to walls, ceiling, and non-fire-rated doors. Figure 7 shows
limited decorations on the door to a nursing home resident's room. Note
the furniture and furnishings that the resident has interspersed among
the institutional-like furniture provided by the facility.
Figure 7. Limited decorations on nursing home resident's room door.
Ron Coté is with National Fire Protection Association (NFPA).
NFPA 101®, Life Safety Code®, National Fire Protection Association, Quincy, MA 02169, 2012.
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