APPENDIX (The following material was submitted for inclusion in the printed record :) Hon. WRIGHT PATMAN, CONGRESS OF THE UNITED STATES, Chairman, Committee on Banking and Currency, Rayburn House Office Building, Washington, D.C. DEAR MR. CHAIRMAN: The Housing Subcommittee recently completed its deliberations on the omnibus housing bill pending before your committee, and I would like to take this opportunity to comment on two parts of this bill which relate to nursing home safety. My own congressional district was the scene of a tragic nursing home fire which took the lives of ten elderly patients last January. In view of this tragedy, I feel it would be appropriate for me to offer my thoughts on the provisions of the aforementioned bill which relate to this problem. Section 302 (a) (2) contains a provision which would authorize loans to nursing home facilities to finance the purchase of fire safety equipment in "an amount not exceeding $10,000 and have a maturity not exceeding twelve years and thirty-two days." This provision appears to be based on what previously were considered reliable estimates of the cost for installing fire safety equipment in nursing home facilities. The origin of these estimates, however, do not appear to be based on the most recent evaluations of the cost for installation of fire safety equipment. The Special Studies Subcommittee of Congressman William J. Randall concluded as recently as November 9th of last year that the cost of installing automatic sprinkler systems in nursing home facilities would be approximately $800. per bed. Other estimates were as low as $450 per bed, depending upon the need for an independent water reservoir and other fire protection devices. (See enclosures.) Even if we assume the low figure of $450 per bed to be the most accurate, this means that if the $10,000 loan figure prevails, the only facilities which could provide for the full installation of appropriate fire safety equipment would be those with an average bed capacity of 22 or less. To state the difficulty in its simplest form, therefore, this means that many nursing home facilities are beyond the assistance offered under this provision of the housing bill-even though this unquestionably represents a sincere effort to address the problems of fire safety in the nursing homes throughout the country. Perhaps the best illustration of this problem can be seen by applying these figures to my own State of Ohio. In Ohio, 803 out of 1192 licensed nursing homes (67.4%) are in buildings of wood frame construction. (According to the Life Safety Code, facilities of wood frame construction must have automatic sprinkler systems.) Also, approximately 25,000 of the state's 52,000 nursing home beds (48%) are in wood frame facilities. Finally, there are about 500 nursing homes in Ohio with a bed capacity of 25 or less, and of these, 400 have fifteen beds or fewer. (The large percentage of these smaller homes are undoubtedly of wood frame construction, and are intermediate care facilities.) (See enclosures.) What this means is that even if we still assume the cost estimate of $450 per bed to be the most accurate for the installation of automatic sprinklers, and even if we assume that all 500 nursing homes in Ohio with a bed capacity of 25 or less are of wood frame construction, this still leaves 303 nursing homes of wood frame construction throughout the state which could not cover the cost of installing automatic sprinklers under the $10,000 loan limitation. (See enclosures.) (717) Accordingly, I would recommend that the limit of $10,000 per loan be increased to $50,000. In support of this position, I would like to point out that, based upon a publication entitled Health Resources Statistics, 1970, National Center for Health Statistics, U.S. Department of HEW, a loan limitation of $50,000 would cover approximately 85% of the nursing home facilities in the United States, as opposed to approximately 23% of the facilities under a limitation of $10,000. (See enclosures.) (These figures still assume the low figure of $450 per bed to be the most accurate for the installation of automatic sprinklers. If we assume that a more realistic estimate lies somewhere between the $450 and $800 figures, the rationale for increasing the present limitation becomes even more evident. Further, if we consider that these cost estimates cover only automatic sprinklers, and do not include the many other fire protection devices which may be needed (such as early warning detection systems, smoke detection systems, or core doors, just to mention a few possibilities, the $10,000 appears to be in need of even more revision. Therefore, the basic purpose in proposing a limitation of $50,000 per loan is simply to broaden the coverage of Section 302 (a) (2) of the housing bill to include larger facilities which will require greater funds to install adequate fire protection devices. Finally, Mr. Chairman, even though the $50,000 loan limitation might seem excessive at first glance, there are a few reasons why I believe this is not really the case: (1) Automatic sprinkler systems are required by the Life Safety Code only in those facilities which are wood frame, and since there are very few wood frame structures with a bed capacity in excess of 111 (the number which would be covered under a $50,000 loan limit) there are very few facilities which would likely require the full $50,000; (2) The majority of nursing home facilities are intermediate care facilities, which generally are wood frame and with relatively small bed capacities. This means that most ICF's, the most fire prone nursing homes, would be able to purchase the fire safety equipment needed to comply with the Life Safety Code with substantially less than the $50,000 limit I have proposed. Again, the idea in proposing the $50,000 limit in the first place is only to assure that the largest facilities (which of course handle greater numbers of patients) would be eligible for a loan sufficient to cover the cost of necessary fire protection devices; (3) Those structures which are not wood frame, but which are constructed with, say, fire resistant materials, (about 32.6% of the facilities in Ohio) would not be required to install automatic sprinklers in order to be in compliance with the Life Safety Code. These facilities would only require smoke detection systems to comply with the Code, and these systems are much less expensive than the automatic sprinklers. In summary, therefore, the $50,000 loan figure is, in my judgment, not as excessive as it appears at first glance. My second and final recommendation concerns Title V of the proposed housing bill, which contains an extremely important provision designed to help nursing homes improve their overall plant facilities, and otherwise upgrade the quality of their patient care. Section 504 (e) would add a new provision under "Supplemental Project Loans" which would ensure loans to nursing homes and other health facilities “to finance . . . repairs, improvements, or additions and the purchase, installation, or repair of such equipment to be used in its operation as may be necessary for the facility to meet the applicable requirements imposed by Title XVIII of the Social Security Act and thereby qualify for participation in, or maintain certification under, the hospital insurance program under such title." This provision would further authorize insured loans "without regard to whether such facility is covered by a mortgage (insured or uninsured) ..." and thus make such loan authority available regardless of whether a nursing home facility has an outstanding mortgage. I certainly support this provision of the housing bill and the goal it seeks to attain. However, there is one important omission in this section in that those facilities which participate in the Title XIX program (Medicaid) would not be eligible for insured loans under this provision. Thus, skilled nursing homes which participate under Medicaid, and under new legislation enacted in the last session (P.L. 92-223), intermediate care facilities would not be eligible for insured loans. I should like to point out at this time that the nursing home in my district which was destroyed by fire on January 26th of this year, and in which ten persons were killed, was an intermediate care facility. Therefore, if the appropriate addition can be made, Section 504 (e) would obtain coverage for extended care facilities (Title XVIII-Medicare), skilled nursing homes (Title XIX-Medicaid), and intermediate care facilities, (Title XIX-Medicaid). Finally, the approach outlined herein would therefore allow for the purchase of adequate fire protection equipment for the vast majority of substandard nursing homes throughout the country, while leaving the overall control over the licensing of these facilities in state hands, and the overall control of actually running the facilities in private hands. In my judgment, this is as it should be. In conclusion, Mr. Chairman, allow me to express my sincere appreciation for the efforts made by your committee to improve the fire safety conditions in our nation's nursing homes. I earnestly request your thoughtful attention to the recommendations contained herein. and look forward to working with you in whatever capacity necessary to accomplish the goals I know we both seek. Respectfully, WILLIAM J. KEATING, [Excerpt from the hearing "Problems of the Aging Nursing Home Safety," p. 641, Nov. 9, 1971, Special Studies Subcommittee of the House Government Operations Committee, Hon. William J. Randall of Missouri, chairman] There is, of course, controversy over the efficacy and the cost of fire sprinkler systems as against smoke detection devices, and we will receive some testimony on this subject. It would appear that adding a sprinkler system to an existing home which has to have its own water reservoir, represents a cost of approximately $800 per bed on the average. If amortized at 8 percent per year over 20 years, this would add approximately $80 per year or 21 cents per day, per patient. On a 15-year basis at 8 percent per year, this would be 25 cents a day, or a $91.25 per year increase in patient costs. NFPA LIFE SAFETY CODE, 1967 10-132. Minimum Construction Standards 10-1321. Institutional buildings of 1 story in height only may be constructed of 1-hour protected noncombustible construction, 2-hour fire-resistive construction, 1-hour protected ordinary construction, 1-hour protected wood frame construction, heavy timber construction, or unprotected noncombustible construction. (See 10-136 for automatic sprinkler requirements.) 10-1322. Institutional buildings 2 stories or more in height shall be constructed of at least 2-hour fire-resistive construction. 10-1323. Nothing in this Section removes the requirements in 10-1331 for 1hour corridor walls or 1-hour smokestop partitions called for in 10-1311. 10-1324. All interior walls and partitions in buildings of fire-resistive and noncombustible construction shall be composed of noncombustible materials. 10-136. Sprinklers, Alarm Systems, and Extinguishers 10-1361. Automatic sprinkler protection shall be provided throughout all hospitals, nursing homes, and residential-custodial care facilities, except those of fire resistive or 1-hour protected noncombustible construction. (See 10-132 for construction types permitted.) NUMBER AND PERCENT DISTRIBUTION OF NURSING CARE AND RELATED HOMES, BY SIZE OF HOME, 1969 Sources: Unpublished data from the National Center for Health Statistics master facility census; Health Resources Statistics, 1970, National Center for Health Statistics, U.S. Department of Health, Education, and Welfare, PHS Publication No. 1509. 1 BUILDINGS IN USE AS NURSING HOMES 1 Exact data on the types of buildings in use as nursing homes is not available. Data on the types and extent of fire protection in nursing homes is also not available. It is known that many nursing homes occupy wood frame buildings converted from residences. In general, the converted residences must be considered as sub-standard from a fire safety standpoint unless they have been provided with automatic sprinkler protection and with proper means for confining smoke, heat and toxic products of combustion. On the other hand, there are also many buildings constructed specifically as nursing homes which are also substandard from a fire safety standpoint. A good example is the Harmar House in Marietta, Ohio in which smoke barrier partitions were not provided. Data is available on buildings housing nursing homes in Ohio. Although Ohio may or may not be typical, the data will serve to illustrate the problem. There are 1192 licensed nursing homes in Ohio of which 803 or 67.4 per cent are in buildings of wood frame construction. Total bed capacity is approximately 52,000; 25.000 beds, 48 per cent, are in the wood frame buildings. Automatic sprinkler protection is provided in 143 buildings, 11.9 percent; there is no indication of the number which may be only partial systems. There are also automatic detection systems in 76 of the buildings protected with automatic sprinkler systems; 267 buildings, 22.4 per cent, have automatic detection systems only. The remaining 782 buildings, 65.7 per cent, have neither sprinklers nor detectors. There are 500 homes with 25 beds or less, of which 400 have 15 beds or less. The large percentage of the smaller homes are undoubtedly in converted residences. To some extent, the responsibility for the existence of nursing homes which are sub-standard from a fire safety standpoint must be placed with the state enforcing agencies which have permitted these facilities to continue in operation. In many instances, the enforcing agencies have apparently not required needed improvements because the cost could possibly be used as justification for increased rates for patients. 1 Source: Office of the American Nursing Home Association "The Problems of Nursing Home Fire Safety", June 2, 1972 (Unpublished document). GAGE-BABCOCK & ASSOCIATES, INC., Mount Kisco, N.Y., March 21, 1972. Hon. WM. J. RANDALL, Chairman, Special Studies Subcommittee, Committee on Government Operations, House of Representatives, Washington, D.C. DEAR MR. RANDALL: In accordance with the request made on February 23, 1972 at the hearing concerning the fire in the Green Nursing Home, enclosed are the details on the cost estimates for installing automatic sprinkler systems in nursing homes in Ohio. As mentioned during the hearing, the cost for any specific system will vary depending on the size and physical layout of the building. The $400 per bed estimate is good for an overall estimate, but should not be used for any specific building. One quick guide which is commonly used is $1.00 per square foot of total building area for existing buildings and $0.75 per square foot . . . total building area for new buildings. These unit costs, however, will rise for the smaller buildings. Please do not hesitate to contact us if there are any questions. Chairman, Committee on Banking and Currency, U.S. House of Representatives, Washington, D.C. DEAR REPRESENTATIVE PATMAN: I strongly urge that the Committee on Banking and Currency, in its consideration of the proposed Housing and Urban Development Act of 1972, eliminate the proposed requirement of prior local community approval of housing development proposals to be assisted under Sections 235 and 236 (or their successors). Based on the experience of the Michigan State Housing Development Authority, I believe that here in Michigan we are winning the battle of educating local community leaders and citizens on the benefits of state and federally-assisted housing. In nearly every community in our state, low and moderate income families are finding it increasingly difficult to afford housing at escalating market prices. Clerks, school teachers, semi-skilled workers, young married couples, elderly people on fixed incomes-the bulk of modest income Michigan families-look to Section 235 and 236 assistance, often in conjunction with financing by the Authority, as the means to provide them with decent housing at a cost reasonably related to their limited incomes. There are already a myriad of local controls and approvals which serve to protect adequately local community interests. Unfortunately, these existing controls often slow the process of developing housing for low and moderate income families. To institute yet another approval requirement would seriously cripple programs which are an integral part of the housing effort to which my administration attaches the highest priority. Therefore, I again urge that the Committee eliminate the proposed local approval requirement as to the Section 235 and 236 programs. DEAR CONGRESSMAN BARRETT: On January 7, 1972 the Department of Housing and Urban Development promulgated regulations which established project selection criteria on rent supplement projects and low rent housing assistance applications. |