Oxygen Therapy and Beauty Salons

Q: I am curious if you know of any regulations that deal specifically with LTC residents with oxygen supply and beauty salons. We have a salon in house, and the beautician comes twice a week and I have a sign up that says no oxygen allowed in salon. Do you know of any specific regulations that relate to the use of oxygen in a salon?

A: After reviewing sections and of NFPA 99-2012, I believe oxygen therapy would not be permitted to be administered around hot appliances. While beauty salon heating devices such as hair dryers and curling irons typically do not get much attention from surveyors, NFPA 99-2012 does prohibit the administration of oxygen therapy around hot appliances… and hair dryers and curling irons are hot appliances. I would recommend that you not allow the use of O2 therapy equipment in a beauty salon.

Fire Damper Testing Frequency for LTC Facilities

Q: I work in a long-term care facility. It used to be that fire dampers had to be tested/inspected every four years, but I’ve heard that has changed with the new 2012 LSC. Now fire dampers are only required to be tested/inspected once every 6 years. I am perplexed because I cannot seem to locate where in the LSC it is written. Can you please tell me where it is written that we can now test fire dampers once every 6 years?

A: You seem to have it backwards. Section of the 2012 Life Safety Code requires compliance with NFPA 80 for all openings (i.e. doors, ductwork, windows, etc.) in fire-rated barriers. Section of NFPA 80-2010 says fire dampers in hospitals are required to be tested and inspected every 6 years; for all other facilities the test and inspection frequency is every 4 years.

Since Long-Term Care facilities are not hospitals, you would be required to test and inspect your fire dampers once every 4 years. The same holds true for smoke dampers.

Nursing Home Temperatures

Q: My loved one is in a nursing home and needs additional heat in the winter time, what do I do? The building seems to be at a comfortable temperature, but my family member needs extra heat. Is there a heating blanket that passes code? 

A: The CMS State Operations Manual for Nursing Homes, sub-parts 483.70(c) and 483.70(h) requires a ‘comfortable’ environment for the resident. However, CMS does not define what temperature dictates a comfortable environment. Check with the state that the nursing home is located and determine if they have temperature limits for nursing homes. Enter “state regulations for nursing homes” in your internet search engine and include the name of the state the nursing home is located. They may have their state licensing requirements available for download and you can see if they have temperature ranges specified for the residents.

The temperature of the facility is typically set and controlled by nursing home staff, who are active and walking about, performing duties. The residents of the nursing home are typically sedentary and therefore inactive. This difference can cause the workers to be over-heated when the temperature is raised to satisfy the residents, or the residents are uncomfortable when the temperature is set to satisfy the workers. It is a problem that is not easy to resolve. 78° may be a comfortable temperature for residents who are inactive, but would be too warm for workers who are scurrying about. Likewise, 72° may be a comfortable temperature for workers but may be too cool for residents. If you set the temperature in the middle at 75°, you may have a better chance of satisfaction, but ultimately, someone will be uncomfortable. It is not uncommon to see workers wear summer clothing in the middle of winter.

Portable heating devices, such as a space heater are not permitted in patient care areas, according to CMS rules and the NFPA Life Safety Code section 19.7.8 (2000 edition). Electric blankets are not directly addressed by NFPA codes and standards, but it is a good bet that the nursing home would not (or should not) permit them, as they can be dangerous in an institutional setting. Cords can become easily and quickly damaged from moving beds and rolling carts, creating the potential for sparks from electrical shorts. Temperature settings on the control can be fixed too high, or accidentally increased by the resident causing epidermis damage. Hospitals that I consult with typically do not allow electric blankets, and I would not recommend their use in a nursing home. Perhaps warm blankets from a blanket warmer may be a temporary solution to the problem.

The nursing home has an obligation to provide a comfortable environment for your loved one. If you feel there is an inadequate response to your concerns by the nursing home, you can file a complaint at CMS for conditions that you believe are sub-par based on the State Operations Manual for nursing homes:   http://www.medicare.gov/claims-and-appeals/file-a-complaint/complaints.html

I’m sorry if this is not the answer that you are looking for, but I do not believe there are portable heating devices for a nursing home resident that would be permitted under CMS rules and NFPA Life Safety Code standards.

Nursing Home Sprinklers

Q: Can you clarify for me if the elevator equipment room is required to be sprinklered and have a shunt trip installed in our nursing home.

A: Yes, elevator equipment rooms are required to be sprinklered in all new and existing nursing homes, as per the CMS S&C memo 09-04 issued October 3, 2008. The S&C memo requires all existing and new nursing homes to be fully protected with automatic sprinklers. The CMS memo refers to NFPA 13 (1999 edition) as the standard to be used for the installation of sprinklers, and unfortunately for you, neither NFPA 13 nor the CMS S&C memo has any exemptions for elevator equipment rooms to be protected with sprinklers.

Section 5-13.6.2 of NFPA 13 very clearly states that sprinklers are required in the elevator hoistways and mechanical rooms. However, the Annex section for 5-13.6.2 refers to ASME A17.1 Safety Code for Elevators and Escalators which requires shunt-trip shutdown of the electrical supply upon or prior to the application of water in the elevator machine room or hoistway. The intent is to interrupt the power supply before significant sprinkler discharge.

So, it looks to me that you need to have those sprinklers installed. If you have a local authority telling you not to install sprinklers in the elevator hoistway or mechanical rooms, you need to inform them that you are under federal direction and they need to allow you to do so.