The fastest-growing population sector in the United States is that of people between the ages of 65 and 74 years old. This group is projected to grow by 74% by the year 2020, according to the U.S. Census Bureau. The number of Americans reaching the age of 100 is also on the incline. After the 1990 census there were 37,306 centenarians residing in the United States. By the year 2010 it's estimated that there will be 131,000, with as many as 834,000 by the year 2050.

If these projections prove accurate, then it also would be reasonable to expect an increase in demand for small home-style residential care facilities. These are single-family dwellings located within a neighborhood of other family homes that provide a home-style standard of living with assisted care for six or fewer residents in a non-institutionalized setting. These businesses provide communal living with basic room and board along with services such as transportation, laundry, shopping trips, personal hygiene needs, limited medical care and the like. Fire and life safety within residential care facilities will become paramount.

Dwelling problems

Residential care facilities for the elderly are included within the single-family home classification for statistical data collection. Most structure fires occur in single-family homes, which have higher reported fire-related death statistic than any other occupancy. Data collected from the National Fire Incident Reporting System shows about 80% of all fire-related deaths occur in the residential category. Statistically, 41% of all firefighter fatalities occur in residential fires, and on average residential fires injure 3,000 older adults each year. Because these aren't separated by classification, it's difficult to extract from this information how many of these fires involved residential care facilities for the elderly.

These facilities are only required to maintain a minimum in life-safety features. Safety devices normally would consist of a single unmonitored local alarm warning device, using either a bell or horn, activated by a manual pull station centrally located within the home. In general, smoke detectors equipped with an internal alarm would be installed for each bedroom, common area and connecting hallway to the bedrooms. The smoke detectors may or may not be required to be interconnected to sound in all areas of the home if activated. And for every 3,000 square feet of living space, one fire extinguisher would be required to be placed in an accessible location.

Two types of smoke detectors are used in these structures. The smoke detectors may be required to be powered by the house electrical wiring system and provided with a battery backup. These are usually interconnected to one another and would sound an alert to all sleeping areas if activated by any one detector. The second method allowed is to simply provide single-station standalone smoke detectors, which depend on battery power. These are not required to be interconnected and will sound only where the detector was activated.

Research studies have been conducted with smoke detectors in full alarm to test their effectiveness in waking sleeping elderly adults. The studies demonstrated this particular age group may not respond to the alarm sounding or wake up to its warning. In fact, statistics compiled by the National Fire Protection Association indicate that people over age 65 are twice as likely to die in home fires than the population at large.

Many factors contribute to this morbid statistic. Slower evacuation times are to be expected from this type of occupancy. Most of the clients who reside there require some form of assistance with their daily living needs. They may be hard of hearing, sight-impaired or blind. They might require assistance with walking or depend on a walker or wheelchair for their mobility. Taking prescribed medications may have significant side effects, such as confusion and disorientation to their surroundings. Individuals with mental dementia, short-term memory loss, Alzheimer's disease, stroke or Parkinson's are not uncommon in this setting. Even if the residence is equipped with an early warning device, such as a smoke detector, that is maintained in proper working condition, self-evacuation becomes extremely difficult if not impossible without the aid of a rescuer.

At night a single home-care worker may not have the time or the stamina to wake family members and assist elderly clients to evacuate from the residence. Without some immediate intervention, fire will double in size every two minutes once it has reached its free-burning stage. Most residential fires resulting in a death statistically occur in the late evening hours between midnight and 4 a.m. This would be an appropriate scenario to use when analyzing the overall built-in fire and life-safety features within a residential care facility for the elderly.

Immediate intervention

One method with a proven life-saving technology is to require the installation of a quick-response, residential-style automatic fire sprinkler system. This type of fire sprinkler system has been engineered to control or extinguish fires in the early growth stages, thus maintaining a tenable life-sustaining environment for the occupants. By keeping the fire limited to within the area of origin, the occupants will have the much-needed additional time to evacuate safely.

Most fire-related deaths are the result of victims being overtaken by toxic gases such as carbon monoxide, smoke particles and extreme heat. The use of sprinklers limits the rapid spread of all three of these known killers. Fire victims have been found still in their beds indicating they were totally unaware of the growing fire while they slept. Medical examination of these victims shows they had expired long before the fire itself consumed them.

The National Fire Protection Agency has cited statistics that indicate a 95% survivability rate in homes equipped with an automatic sprinkler system. These statistics also show that a quick-response residential sprinkler system will extinguish or control a fire at or near its point of origin 91% of the time. This technology, in conjunction with the use of smoke detectors, would greatly improve the chances of survivability from a fire incident for all its occupants, young and old alike.

Secondary benefits related to the use of sprinklers include the reduction in property damage and of the possible spread of fire to other homes within the neighborhood. For the responding fire personnel, the risk of being injured or killed should decline accordingly.

In 1991, Costa Mesa, Calif., experienced a fire in which three of its non-ambulatory clients perished. In 2002, the City of Torrance, Calif., had a fire in a residential care facility that resulted in the deaths of three non-ambulatory residents. Neither of these home-care businesses were equipped with fire sprinklers. Following these tragedies, the bill AB 2065 was introduced to require residential care facilities in California with six or fewer residents to install fire sprinklers. This requirement would be in addition to the smoke detectors and manual fire alarm pull station with local warning device already required by codes, ordinances and licensing agencies.

This bill has passed through two house committee votes, but it has not been heard by all the levels of government necessary to receive a final vote. The bill is gaining momentum and the list of supporters is growing daily, but the debate continues and it has not been signed into law. The long list of those favorable to the bill includes fire departments from the northern, central and southern portions of the state including several fire marshal and firefighter associations. Other agencies have seen the benefit of this initiative and have signed on as supporters, including the California Advocates for Nursing Home Reform and the California Assisted Living Association.

Sprinkler barriers

The expenses associated with the installation of a residential sprinkler system have raised concerns among the opponents of this bill. This is a valid concern, but not one without solution.

In April 2003, the U.S. Fire Administration hosted the National Residential Fire Sprinkler Initiative. The coalition members consisted of fire protection representatives and USFA staff. Their mission was to identify their goals and national strategies. One portion of the goals and strategies was to research and propose methods to encourage the installation of residential sprinkler systems nationwide.

Recognizing cost as a significant impediment to gaining the acceptance of the coalitions nationwide goal, it listed possible ways to reduce these installation costs. The coalition proposed the use of incentives as a method to help lower the financial impact on the end user. Some incentive ideas that were brought forward included a reduction in insurance premiums, tax credits, lowered interest on loans associated with the installation of the sprinkler system, and reduction of property taxes.

In 2003, Reps. Curt Weldon (R-Pa.) and Jim Langevin (D-R.I.) introduced H.R. 1824. The body of this bill is to amend the Internal Revenue Code of 1986 to classify automatic fire sprinkler systems as five-year property for purposes of depreciation. By allowing the owners to claim the depreciation on the system, they are able to recapture some of their initial investment. H.R. 1824 still remains in the House Ways and Means Committee.

The cost of installing a residential fire sprinkler system has been compared to the cost of installing wall-to-wall carpets. This type of analysis leads to an apples-to-oranges comparison and fails in providing enough information to effectively demonstrate what an average typical installation requires in labor, time and money. The National Fire Sprinkler Association is conducting field case studies and data collection pertaining to installation costs. The results of this experiment are not yet available, but should help to establish a baseline of information that could be used as a guideline when comparing actual cost.

The type of care provided by residential care facilities for the elderly is preferred by many people not wishing to be institutionalized and who desire that at-home feeling. They move in with this expectation and create a safe haven — it is their home. They pay for this privilege and all other services rendered to them. They have the right to feel safe in their homes. They have the right to expect the owner and care provider to take all measures to ensure their safety while in their care. These homes may or may not be required to be equipped with wall-to-wall carpets, but they should be required to be equipped with wall-to-wall safety.

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Tom Horton has 14 years of fire service experience, currently serving as a senior fire inspector for the Sacramento (Calif.) Metropolitan Fire District. He previously had served as a firefighter/engineer, EMT and hazmat technician. Horton has an associate's degree in mechanical electrical technology and engineering, a bachelor's degree in fire science, and a certificate in fire protection engineering from the University of California at Davis. He serves as a member of an ad-hoc committee for fire prevention for the California State Fire Association and is a member of the California Fire Prevention Officers Association, Northern Division. Horton also consults independently on fire and life safety issues.