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Changes to NFPA 101 Relevant to Health Care Occupancies
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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 feel.

 

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 width requirement.


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 construction.

 

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 society.

 

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 be utilized.


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).

  1. NFPA 101®, Life Safety Code®, National Fire Protection Association, Quincy, MA 02169, 2012.

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