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Many states fail to set or enforce basic fire safety standards for the assisted-living industry
Loopholes in state, local regulations allow operators of assisted-living centers to easily conduct business without basic fire safeguards
By PETER EISLER
USA Today
MOUNT MORRIS TOWNSHIP, Mich. — The first time fire inspectors looked at the assisted-living home on Coldwater Road, a pre-dawn fire had just gutted it.
The blaze killed five of the 12 elderly and disabled residents inside the 1,500-square-foot house, which had no working smoke alarms, no sprinklers and no state license, authorities say.
The burned bodies of four women in their 70s and 80s still lay in their beds. The remains of another lay beneath the dining room table, where the woman had been sleeping on the floor.
“We never even knew this place existed until we showed up and started pulling people out,” Fire Chief Chris Hall says of the 2002 fire. “This place was an accident waiting to happen. ... It seems like anyone can open up their house and call it ‘assisted living.’”
Across the nation, thousands of assisted-living facilities operate without licenses and the oversight that comes with them. And even when facilities are forced to meet state or local fire safety standards, a USA Today investigation shows, the requirements often are weak or rife with loopholes. That makes it easy for operators to go without smoke alarms, sprinklers and other safeguards.
Unlike nursing homes, assisted-living facilities are not subject to federal fire safety standards. That leaves state and local authorities to set the rules.
In many cases, those rules fall far short of where fire safety experts and advocates say they need to be. Assisted-living facilities typically provide 24-hour, supervised care for people who can’t handle all the tasks of daily living but do not require the full-time medical care offered by nursing homes.
With more than a million elderly and disabled people now in assisted-living facilities, the consequences of poor fire safety rules are considerable — and deadly.
A USA Today analysis of federal fire data, news accounts and public records shows at least two fires a day in the nation’s assisted-living facilities, which include everything from converted private homes serving a handful of people to large, supervised high-rises and apartment complexes housing hundreds. About once a month, one of those fires proves deadly.
By comparison, nursing homes average about a half-dozen fatal fires a year; hospitals and hospices average about one, according to data from the National Fire Protection Association, a non-partisan research group.
In 2003 and 2004, at least 30 people died in fires at assisted-living facilities, the newspaper’s analysis shows.
“If you look at who’s living in assisted living, the necessity for more stringent (fire) codes becomes apparent — they’re people who are relatively infirm, not necessarily alert, not necessarily able to move around well, and they’re spending the night there,” says Rick Harris, director of health provider standards for the Alabama Department of Public Health.
“To allow facilities to self-regulate on this issue is ridiculous,” he says.
Alabama is one of few states that set rigorous fire safety standards, including a sprinkler requirement, for all assisted-living facilities. It hasn’t had a fatal fire in an assisted-living facility in a decade.
“Most people who patronize (assisted living) are totally dependent on government regulators to make sure those facilities meet appropriate codes,” says Harris, a former president of the Association of Health Facility Survey Agencies, a national group representing state health care regulators. “It’s the rare consumer who is going to ask whether a place has sprinklers.”
Assisted-living industry officials acknowledge the difficulties consumers face in finding a facility that’s safe.
David Kyllo, director of the National Center for Assisted Living, an industry group, notes that thousands of assisted-living facilities nationwide have excellent fire safety features. But as a practical matter, he adds, states will continue to take disparate approaches in regulating assisted-living providers. That means consumers need to do their homework.
“From the consumer side, if I were looking to move my mom into any type of community, one of the things I’m going to look for are sprinklers and smoke detectors and what plan do they have to get people out if something were to occur,” Kyllo says.
No sprinklers required
Manuel Burciaga picked an assisted-living center in the wrong Arizona community.
According to Bob Kahn, an assistant fire chief in Phoenix, firefighters found Burciaga, 74, on the floor of his bedroom in a blistering haze of smoke and 900-degree heat at The Lodge at 14th Street. The licensed assisted-living facility was home for 40 residents. A man in an adjacent room set fire to a mattress, then fled in his wheelchair as flames tore through their suite, according to the police report. Burciaga and three others who couldn’t escape were rushed to the hospital. Burciaga died from severe burns and smoke inhalation; the others survived.
The October 2004 fire was the second of the year at The Lodge — someone had accidentally lit a mattress on fire while smoking eight months earlier. Built in the late 1960s, the brick building had no sprinkler system. By law, none was required.
Sprinklers “probably would have made the difference” in containing the fire and giving firefighters time to save Burciaga and his neighbors, Kahn says. The state of Arizona sets few fire safety standards in assisted living, leaving the responsibility primarily to counties and municipalities. Some, including Phoenix, demand sprinklers in new facilities, but do not require older ones such as The Lodge to retrofit. Other communities, such as nearby Goodyear, require sprinklers in all facilities.
Kahn says Phoenix’s fire codes give assisted-living providers too much “wiggle room” to avoid installing sprinklers and other safeguards. “It’s a big concern,” he says, because more and more residents are reaching the age where they can’t escape fire themselves. In most buildings, “80% to 90% of the occupants can get out on their own. In these places, it’s more like one in three.”
Nationwide, four states set no fire safety rules whatsoever for assisted-living facilities; about a dozen others have rules that cover some — but not all — facilities. Only one — Colorado — requires that facilities without sprinklers disclose that fact to prospective residents.
In many parts of the country, the scattershot approach to regulating fire safety has yielded a mish-mash of rules from one community to the next.
Tucson Fire Marshal Dan Uthe, a panelist in a 2003 national conference on fire safety in assisted living, says the nation’s growing reliance on the industry makes lawmakers reluctant to impose costly — and uniform — fire safety mandates. “If you require sprinklers retroactively, are the costs going to drive some facilities out of business and displace these elderly people?” he asks. He says sprinkler installation can cost tens, even hundreds of thousands of dollars, depending on a facility’s size. “It’s a real concern.”
But unlike nursing homes, where fees for most services are limited by federal Medicare and Medicaid rules, assisted-living facilities generally can adjust rates to recoup the costs of installing sprinklers and other fire protections. And in states such as Alabama, where all assisted-living facilities must have sprinklers, there’s no evidence that facilities have been forced out of business.
A question of licensing
At the home that burned to the ground in Michigan, operator Esther Johnson took in all sorts of residents, including at least two with dementia so advanced that they couldn’t live on their own, according to fire investigators and friends and relatives of victims. She also provided some services that typically would require a state license for adult foster care, the term Michigan uses for smaller assisted-living-type homes. Some of her charges needed wheelchairs and couldn’t bathe, eat, get out of bed or take their medication without help, according to police and fire reports.
But Johnson had given up her license to run an adult foster care home in 1996 after an investigation by the state’s then-Department of Social Services found her to be “totally disabled due to insanity/imbecility,” state records show. Shortly after, she opened the unlicensed home that burned in Mount Morris Township.
The fire started just after 5 a.m. in a bedroom in a converted garage. Investigators later concluded that the thermostat on an electric heater was disabled — the home’s furnace was broken — and it ignited a bedcover in the room used by Eloise Caldwell, an 88-year-old retired social worker and adult education teacher. She and the four other elderly woman who died all were listed by investigators as “physically disabled.”
Caldwell’s daughter, Darla Caldwell Broden, put her mother in the home because bouts of depression and the onset of dementia had left her unable to take her medication on her own. “I didn’t know at the time whether it was licensed,” she says, noting that she was referred to the home by a social worker.
“My mother was clean and well fed there, she seemed to get good care, and I don’t think I ever thought about the safety issues,” Broden says. “They need to have standards, some type of regulation. ... The safety stuff doesn’t cross your mind until the day after someplace has had a fire.”
Johnson, the operator, did not reopen the ruined home. USA Today could not locate her.
Deborah Wood, head of adult foster care licensing for the Michigan Department of Human Services, says she does not know whether Johnson’s home should have had a license -- and the fire safety checks that come with it. If the residents required significant supervision and care, she says, a license would have been required. But the department never investigated to see if that was the case.
“We have no legal definition of assisted living in Michigan, so basically anyone can call themselves assisted living,” she says.
The department does not know how many unlicensed facilities are operating in the state, she adds, because it only investigates facilities if it gets a complaint. “We don’t find out about them unless somebody tells us.”
No one ever alerted the department about the home in Mount Morris Township, she says.
Enforcement often lax
Even when assisted-living facilities are licensed and subject to safety standards, there’s often no guarantee that they’ll be well protected when fire strikes. Enforcement often is lax. And some care providers slip through gaps in state and local regulations.
Michigan is among at least a dozen states that leave fire safety checks at many assisted-living homes to adult care specialists who are trained primarily to evaluate the quality of care a facility provides. The state has about 50 of those evaluators, and they receive additional training in fire safety. But each year, they’re responsible for inspecting more than 2,000 assisted-living operations across the state, and in the past three years, the number of evaluators has shrunk by almost 40%.
Patient advocates say the problem is common: Many states have cut their enforcement operations sharply as part of efforts to avert budget crises.
“It’s a nationwide problem,” says Lori Smetanka, director of the National Long-Term Care Ombudsman Resource Center, a federally funded group set up to represent and support state ombudsman programs for the elderly and disabled. “Staff (for enforcement) are being cut across the board, and there just aren’t as many people available to do inspections.”
Yet leaving inspections to fire marshals doesn’t necessarily solve the problem. In a survey of state fire marshals by USA Today and the National Association of State Fire Marshals, 15 reported that budget and staffing constraints have hampered their ability to keep tabs on assisted-living facilities.
Several state and local fire marshals also said in interviews that they have run into some regulatory confusion when trying to enforce fire safety standards in facilities regulated mainly by state health departments.
In Florida, for example, state licensing rules allow assisted-living providers to schedule their own fire safety inspections with local fire marshals.
In October, an electrical fire struck a St. Petersburg assisted-living home eight months past due for an annual inspection. Investigators later found an array of safety violations — locked fire exit doors, cigarette butts in non-smoking areas, broken alarms. St. Petersburg Deputy Fire Marshal Rick Feinberg says it was “lucky” no one was killed. Tragedy was averted, he says, because the fire started just after everyone woke up.
Feinberg says a subsequent investigation by fire officials determined that 17 of the city’s 50 assisted-living facilities were overdue for fire inspections, some by almost a year.
Data analysis by Paul Overberg; research by Michael Hartigan, Susan O’Brian and William Risser.