Senior living properties, including those providing assisted living services and memory care support, are being integrated into the greater community all around the nation. No longer are senior living communities confined to the outskirts of town; they now are being developed in local neighborhoods, downtown urban areas and even on college campuses, such as an innovative project on the campus of Arizona State University known as Mirabella at ASU.

Regardless of where those communities are located, senior living providers are compelled to develop plans for emergencies and disasters that can affect their operations. The development of an “all hazards” emergency management plan will help you identify the wide variety of threats and perils that you must be prepared to manage.

One threat that every senior living community, as well as every type of occupancy, must prepare for is the presence of an armed intruder or active shooter on campus. Whether the cause is civil unrest — including violent protests, criminal activity, domestic violence or armed robbery — or a mass shooting, there are ways that senior living communities can prepare, respond and recover from the unthinkable.

Unlike other occupations where, for the most part, individual employees simply can focus on their own personal safety in the workplace, the senior living environment clearly is different. Members of the workforce in senior living communities become connected with residents and, in times of peril, will not leave them to fend for themselves.

Security experts have developed protocols that focus on the nuances of the senior living “careforce.” Those simple protocols provide practical solutions and the options that can be considered, including a life-saving strategy known as the Four Outs, to effectively respond to fast-moving and unpredictable incidents.

Senior living communities are uncommon in the way they must approach preparedness for an armed intruder or active shooter. In most industries with an adult workforce, workers are trained in survival techniques based on “me focusing on me”; in other words, each adult takes care of himself or herself. In senior living, much like elementary schools, workers not only have themselves to worry about; they also have to worry about others who can’t take care of themselves and rely on them.

The Four Outs is a program that addresses this factor as it applies to senior living communities. Often compared to the Run-Hide-Fight protocol promoted by the US Department of Homeland Security, the Four Outs was developed by the team at Sorensen, Wilder & Associates as a program based on practical choices for those situations when one has to think about more than just himself or herself. The Four Outs must be applied with both the resident and the caregiver or other staff members in mind.

Broken down, the key elements of the Four Outs are as follows:

1. Get out. Move residents and staff members out of and away from the building to a designated reunification point. Remember, the Occupational Safety and Health Administration, as well as licensure regulations, require a senior living community’s emergency evacuation plan to identify a designated reunification point(s) and provide for an immediate accountability of all employees and residents during an emergency evacuation.
2. Hide out. When getting out isn’t possible, then Plan B is to hide out. Seclude yourself in a room, preferably with a locked door, where you can hide without being seen or heard. This includes taking steps such as covering interior windows and turning out lights.
3. Keep out. Not all rooms have locks on the doors, and in some cases, locks even may be prohibited by regulatory standards. In those cases, such as in a resident’s room in a memory care unit where the door does not lock, you will have to create your own barriers. Doing so may include barricading the room’s door with a resident’s bed (remember to lock the wheels) as well as other furniture in the room. The more material barricading the door, the better. In other areas, you can use anything and everything available to create a wall of obstruction, such as in front of hallway smoke doors. Those temporary barricades are not intended to prevent the door from being opened (many swing in opposite directions). Rather, they are intended to create such an obstruction that the offender, who is looking for targets of opportunity, will choose to move on rather than set down his weapon and waste time trying to move all of the obstructions. 
4. Take out. As a last resort, and only as a last resort, you may have to fight back. This fight against the offender is truly a fight for your life. There are no rules; there is no “fair fight,” and your focus is on your survival by stopping the offender by incapacitating him or her. Use any weapon of opportunity available — such as scissors, a stethoscope, a fire extinguisher, a chair or a trouser belt — and be prepared to do whatever you must do to stop the offender and save yourself, up to and including the use of lethal force.

When someone is in a position of relative safety, as quickly as possible, the authorities should be called through the 911 system. A concept taught by the team at SWA and other security professionals is that there is no such thing as too many calls to 911 during those types of violent and fast-moving emergencies.

Additionally, many jurisdictions now have 911 texting capabilities, so emergency text messages, instead of voice communications, can be sent to the 911 center when hiding out. It is important to know whether this service is available in the jurisdiction where your senior living community is located. Once you have confirmed whether this option exists in your area, all members of your team should be trained on proper 911 procedures, including text messaging, if available.

The program developed by SWA also focuses on making the most difficult decision that may need to be considered in times of peril: whether to focus on yourself or your residents.

Identified as the Safety Transition Adjustment Formula, or STAF, protocol, caregivers are trained in what to look for in the initial moments of an event, to guide themselves to making the right decision based on personal and resident safety.

When a shot is heard, the normal (and expected) reaction is anxiety. That is understandable. But when that moment occurs, your first question needs to be, “Where am I in relationship to where the shot came from?”

If you are close to the shooter, then your personal safety comes first. If the shooter is a distance away from you — perhaps on a different floor or in a different building — then you can then focus on resident safety first, using the Four Outs to evacuate residents or secure them in place.

And remember, when the best option is placing yourself first, you aren’t being a coward or being selfish. If something happens to you, who will take care of residents and others?

The recovery aspect of a shooting incident often is the part of the preparedness continuum that is overlooked, considering that no organization or individual thinks that such an event really will happen to them. But if you are willing to accept the fact that an incident involving an armed intruder or active shooter really can occur at your senior living community, then you also must realize that when the initial incident ends, you must initiate the recovery process to eventually return to a state of normalcy.

For those who have experienced the unthinkable, they know that this is not as easy as it sounds. The recovery process must be addressed long before the first shot ever is fired. It requires the development of relationships with outside providers who likely will be needed to provide support after the incident. This support includes the restoration resources that may be needed to address physical damage to the community, as well as the emotional support that will be needed from mental health professionals to address the psychological trauma associated with this type of adverse incident.

Training, both in the didactic mode and the practical skills mode, are essential elements of an effective armed intruder / active shooter awareness program in a senior living community.

Although both authors of this article are strong supporters and allies of law enforcement, relying on your local police department or sheriff’s office for training may not give you the results you need. Law enforcement training focuses on law enforcement’s response to the threat. Your community’s training must focus on how to minimize casualties and maximize survivability from the moment the first shot is fired until the time police arrive on the scene. To do this, your community’s training should be provided by a qualified person who is intimately familiar with the senior living environment and the unique challenges you face.

The thought of an armed intruder or active shooter in a senior living community is difficult to imagine. Providers, however, must prepare their staff members for the unexpected by empowering them with the knowledge needed to exercise one of the Four Outs or take other appropriate action to protect themselves and those in their care should this type of emergency occur.

Stan Szpytek is the president of Fire and Life Safety Inc., a national consulting firm based in Mesa, AZ. He is a consultant for the American Assisted Living Association and is the life safety/disaster planning consultant for the Arizona Health Care Association, the California Association of Health Facilities and the Utah Health Care Association. Szpytek is a former deputy fire chief and fire marshal, with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Stan@FLSafety.org.

Steve Wilder is president and CEO of Sorensen, Wilder & Associates, a nationally recognized healthcare safety/security consulting group based in Bradley, IL. Since 2014, SWA has been the recognized leader in active shooter preparedness in the senior living and care industry. A retired fire chief in the suburbs of Chicago, Wilder was the 2019 recipient of the Leadership in Emergency Preparedness Award from the Illinois Security Professionals Association, for his leadership role following the murder of two residents in an assisted living community in Pennsylvania. For more information, visit www.swa4safety.com or contact Wilder at swilder@swa4safety.com.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

State and local codes primarily regulate senior living communities that provide assisted living, memory care and independent living options. To achieve optimal safety conditions, several fire protection and life safety systems are integrated into such properties.

Although a great deal of oversight is in place to help ensure the reliability of fire protection systems, there are times when mechanical and electrical systems are vulnerable. For example, fire protection systems such as wet sprinkler systems can be exposed to environmental conditions, including freezing temperatures, that can impair operation. When frozen pipes thaw, they typically break, rendering a critical fire protection and life safety system inoperable.

A devastating fire in a Tennessee assisted living community in late 2022 ignited while a fire watch was in place in the building, due to unexpected frigid temperatures. Those temperatures caused the fire sprinkler system to freeze and placed it out of service until repairs could be initiated. The facility initiated a fire watch while the system was impaired, but a fast-moving fire occurred during the period of time that the fire sprinkler system was inoperable, and a resident died.

A fire watch procedure is designed to monitor a building for smoke and fire conditions when fire protection systems are compromised, but it was not enough to prevent a tragic loss in this particular situation.

Senior living communities should train staff members to understand the significance of fire protection systems and the vulnerabilities that exist when they are out of service. Informed decisions need to be made when a system goes out of service to determine if a Fire Watch is appropriate or if a building should be evacuated when fire protection systems are compromised.  When one of these critical systems goes down due to a mechanical or electrical malfunction, facilities should activate their emergency operations plan and establish an incident management team to effectively manage the situation just like any other emergency incident or disaster.

In addition to fire protection systems such as fire sprinkler and fire alarm systems, there are other safety systems integrated into the built-environment designed to safeguard residents, and those systems rely on technology and electrical power. When those systems are compromised, life safety can be at risk.

Many senior living communities that provide assisted living and memory support services are equipped with sophisticated electronic safety systems, including door alarms, wander management solutions and delayed egress locks. Those systems are designed to keep residents safe and secure under normal conditions, as well as to provide them with an unimpeded path out of the building when evacuation is required during an emergency.

There are times when these systems are compromised, representing a significant life safety vulnerability. For example, when the building’s fire alarm system activates, or a power failure occurs, some of those systems are designed to disengage to allow safe egress during an emergency. Fire drills as well as scheduled and unscheduled power disruptions can disengage some of these systems as well. 

Once again, it is essential to train senior living staff members to understand the security and elopement risks that exist when those systems are disengaged either during a real-world emergency or drill. Appropriate measures need to be in place to reset or re-arm those critical systems as quickly and efficiently as possible, to reduce the risk of elopement or unauthorized entry into a facility.  

Fire and life safety compliance does not happen by accident in a senior living community. Ensuring a safe and secure environment of care requires the integration of fire protection and life safety systems into the built environment. All staff members should be trained on a regular basis to be aware of the consequences when fire protection or life safety systems are compromised to help them understand what measures are needed to restore those systems in the quickest possible manner and reduce the potential for an adverse incident.

Stan Szpytek is the president of the national consulting firm Fire and Life Safety Inc., based in Mesa, AZ. He is a consultant for the American Assisted Living Association and is the life safety/disaster planning consultant for the Arizona Health Care Association, the California Association of Health Facilities and the Utah Health Care Association. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Stan@FLSafety.org.

As power sources for electronic equipment, appliances and devices used in senior living communities and nursing homes become more sophisticated and battery technology advances, the threat of a lithium battery fire is always a possibility.

Equipment used by the maintenance crew, environmental services department and clinical teams for sanitation and infection control purposes, as well as the delivery of medical therapies, often uses tools and equipment that require the use of lithium batteries. 

It is essential for community and facility operators to be aware of the risks associated with those types of power sources and charging protocols. Walk into the bio-med department, housekeeping office, maintenance department or any number of other areas in just about any senior living community or healthcare facility and you likely will find batteries charging.

Proper charging and discharge requirements typically are included with the instructions that come with electronic equipment and batteries. It is important to be thoroughly familiar with those protocols to safely handle, store, charge and use electrical devices that use lithium batteries.

If a lithium battery fire were to occur, it is important to understand that it is possible that the building’s fire sprinkler system in the area where the batteries are burning may not extinguish the fire due to the intense heat and reaction that occurs when those power supplies explode and cook-off. The fire sprinkler systems likely will control fires involving common combustibles that may ignite in the area as a result of the burning batteries. It is important to provide appropriate clearance around battery chargers and to consider reducing the amount of combustible material near charging stations as a best practice.

Educate your team about the risks associated with lithium battery fires by watching the short, informative video below, produced by Clark, Seif, Clark (https://csceng.com/), an environmental health and safety company.

Here are some other resources:

NFPA- Lithium-Ion Battery Safety

OSHA- Preventing Fire/Explosion Injury from Small and Wearable Lithium Battery Powered Devices

Stan Szpytek is the president of the national consulting firm Fire and Life Safety, based in Mesa, AZ. He is a consultant for the American Assisted Living Association and is the life safety/disaster planning consultant for the Arizona Health Care Association, California Association of Health Facilities and Utah Health Care Association. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

A ruthless pandemic, raging wildfires, catastrophic hurricanes and the threat of civil disturbance in cities across the country are just a few of the emergencies and disasters that senior living communities have had to confront over the past several years. Not to mention frequent power failures, small fires, smoke scares, staffing shortages and supply chain disruptions that occur regularly in all types of occupancies that provide services to our nation’s older generations.

The question that must be asked is this: How should senior living communities prepare for every conceivable type of emergency or disaster that they may face on any given day? The answer starts with getting back to the basics.

A colleague with the American Assisted Living Nurses Association who regularly works with senior living communities to identify and reduce risk as well as enhance quality told me that she was amazed at how many employees she interviews who have never had the experience of discharging a fire extinguisher. This begs the question: How comprehensive are emergency preparedness training regimens in senior living communities if training is limited to the classroom? 

As a life safety and emergency preparedness consultant, I regularly review emergency protocols in senior living communities and healthcare facilities. I often find that although many providers use robust training programs that are delivered in a virtual or video format by reputable training organizations, very limited hands-on training occurs in these occupancies. 

Even when it comes to the basics of the R.A.C.E. (rescue, alarm, confine, evacuate / extinguish) and P.A.S.S. (pull, aim, squeeze, sweep) procedures, employees often watch videos on those subjects but are not given the opportunity to actually practice those functions. Similarly, procedures such as evacuation, sheltering-in-place and lockdown are presented in the classroom but not necessarily exercised in a hands-on capacity.

For senior living community owners and operators to have realistic expectations that their team will perform well when the “big one” occurs, they must prepare their staff members through a variety of processes that include hands-on training, drills and exercises to properly manage the day-to-day emergencies that undoubtedly will occur.

A few tips to consider:

• Identify a person to be your community’s emergency preparedness “champion” to coordinate training, drills and exercises; this person should possess a passion for safety and preparedness.
• Work with your community’s fire extinguisher vendor to coordinate hands-on fire extinguisher training for all staff members.
• Invest in a fire extinguisher training simulator that uses laser technology to provide employees with a realistic experience on how to extinguish a fire without starting a real fire.
• Contact your local fire department or emergency management agency to see whether it will help you coordinate a disaster drill or other emergency exercises at the facility.
• Conduct an emergency lockdown drill where staff members practice the process of securing residents and the perimeter of the entire building or campus.
• Coordinate an emergency preparedness fair where several interactive activities are available so that staff members can practice things such as evacuation carries, first aid, CPR and fire extinguisher use.
• Host a Stop the Bleed (www.stopthebleed.org) class at your community.
• Encourage staff participation with the local community emergency response team program.

Emergency preparedness does not happen by accident. Always remember: It’s a normal day — until it isn’t. Crisis can strike in a blink of an eye, and now is the time to level up readiness at your senior living community to help ensure positive outcomes when emergencies and disasters strike.

Stan Szpytek is the president of the national consulting firm Fire and Life Safety Inc., based in Mesa, AZ. He is a consultant for the American Assisted Living Association and is the life safety/disaster planning consultant for the Arizona Health Care Association, the California Association of Health Facilities and the Utah Health Care Association. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

The National Fire Protection Association created Fire Prevention Week to commemorate the Great Chicago Fire of 1871 as well as to promote fire safety at home and in the workplace each year during the second week of October.  This year will mark the 100th anniversary of the observance and may be a good time to put some extra emphasis fire safety with both staff members and residents in your senior living community.

It is likely that children at elementary schools around the nation will be visited by their local firefighters, who will teach them about fire prevention and fire safety, during the week of Oct. 9 to 15. Wouldn’t it be a great time for your senior living community to focus on fire safety, too?

Although senior living communities are required to conduct fire drills and fire response training on a regular basis in accordance with state and local requirements, it is not uncommon for a concept known as “drill fatigue” to set in due to the redundancy that comes with the frequency of those requirements. Think about how many times a long-time employee at your property has participated in training regimens and drills. The curriculum essentially is the same, and the drills follow a typical format but can be perceived as routine and boring — that is, until a real emergency occurs and those drills reveal their true value.

Fire Prevention Week represents a good opportunity for a senior living community to step up its focus on fire safety with both staff members and residents by developing creative ways to promote this essential element of community operations. The theme that the NFPA developed for this year is “Fire Won’t Wait, Plan Your Escape.”

For staff members, a good starting point is to consider conducting a special in-service on each shift focused on fire safety and emergency response procedures during FPW. Reviewing the common protocols associated with fire response, including the R.A.C.E. (Rescue, Alarm, Confine, Extinguish) and P.A.S.S (Pull, Aim, Squeeze and Sweep) procedures will remind your team of the critical sequence of response to a fire or smoke condition in a building.

In addition to reviewing emergency response protocols, consider doing something a little more creative to promote fire prevention and response with your team. When was the last time your facility provided “hands-on” fire extinguisher training with your fire extinguisher contractor? FPW is a great time to conduct this type of training.

Another thing to consider is creating an interactive display that showcases the community’s fire protection features along with some fire prevention tips. An example: Create a table display that includes a mock-up of a fire alarm pull station that everyone can actually “pull” as well as other fire protection features that staff can see up close, such as fire sprinkler heads and smoke detectors. In the same display, you also can have examples of items that cause fires, such as candles, extension cords and power blocks that should be prohibited in a senior living community.

Independent living residents need to be reminded about fire safety, and FPW is an excellent time to spotlight this important topic. Conducting a resident meeting focused on fire safety and personal preparedness during FPW usually is a very popular activity. Aligning the fire safety presentation with the NFPA’s annual theme often is received very positively by senior living community residents.

Setting up a separate FPW display for independent living residents promoting fire safety within their own apartments is a great idea. Illustrating common fire hazards and demonstrating safe practices likely will be a hit with residents. Considering that most fire deaths and injuries occur in the home, promoting fire safety in your residents’ “homes” is an excellent way to help reduce the potential for fire-related injuries or death as well as prevent fire losses in your senior living community.

Another popular activity that you also may want to consider for both residents and staff members is hosting a meal that aligns with the annual NFPA theme at the community sometime during FPW. Serving cupcakes, cookies, a sheet cake or some type of sweet treat decorated to promote fire safety can help enhance levels of safety and preparedness within your community. 

You also can consider specifying a specific day during FPW where everyone wears a “red” shirt or similar clothing article to promote fire safety awareness.

Trying to engage the assistance of your local fire department always is a good idea but likely will be a challenge during Fire Prevention Week this year. Most fire service agencies are booked solid with visits to schools and other organizations within their jurisdiction to promote fire safety during this week in October. Don’t let that stop you from contacting the fire department to see whether you can schedule time for members to come to your community next year during FPW to enhance your property’s focus on fire safety.

One final tip: Tap into the creative minds of your activity directors and life enrichment departments to come up with some fun and innovative ways to promote fire prevention and fire safety within your senior living community during Fire Prevention Week 2022.

The NFPA’s website has more ideas for Fire Prevention Week 2022.

Stan Szpytek is the president of the national consulting firm Fire and Life Safety Inc. based in Mesa, AZ, and is the life safety/disaster planning consultant for the Arizona Health Care Association, the California Association of Health Facilities, the Utah Health Care Association and the American Assisted Living Nurses Association. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

A series of fires occurring in senior living properties recently have made the headlines. One such fire occurred in the basement of a retirement community in Manhattan, KS, at 1 p.m. on a Saturday and was controlled by the building’s fire sprinkler system. According to published reports, the fire caused damages estimated at $12,000 to the building and its contents, with no injuries reported. The cause of the fire was listed as “accidental due to overheating of material in the dyer.”

Building codes, fire prevention standards and life safety regulations for senior living communities enforced by local and state agencies are designed in part to help ensure safety and prevent fires. Those rules are highly effective when building operators abide by them specifically to prevent fires. Adverse incidents such as fires happen when operational deficiencies create unsafe conditions that ultimately lead to the ignition of combustible materials.

As a retired deputy fire chief, I responded to several fires in commercial laundry rooms in senior living communities during my 26 years with the fire department in a major metropolitan area. Every one of those fires had one or two common denominators: improper use and lack of maintenance. Those same factors are the cause of the majority of fires that occur in the commercial laundry rooms today.

Most commonly, fires in the laundry room are caused by improper use of commercial clothes dryers. This typically means that items that should not have been placed in the dryer were indeed placed in the dryer barrel and caught fire. Some of those items include micro-fiber mop heads and mixed loads of materials such as rags that previously were saturated with grease, oil or cleaning solutions. The temperatures produced in commercial clothes dryers can bring these combustible materials up to their ignition temperature and subsequently cause a fire within the dryer barrel.

The other common denominator is lack of maintenance. As a former fire marshal and currently as a fire/life safety consultant, it is not uncommon for me to observe lint traps full of combustible material such as highly flammable lint. Additionally, the mechanical areas in the rear and inside of the clothes dryers — including motors, electrical components and piping near the open flame of a natural gas-powered machine — often are covered in lint when not regularly cleaned and maintained. Imagine the area around the gas cook top in your kitchen at home covered in combustible lint. At some point, a fire is quite possible, as heat from the cooking flame eventually will cause the lint to catch fire.

The laundry room is an area of your senior living community that, similar to your commercial kitchen, requires vigilance and a strong operational commitment to prevent fires. Policies, procedures and safety protocols should be developed in accordance with manufacturer’s guidelines to help ensure the proper operation of laundry equipment. Staff members should be continuously trained on those procedures to help reduce the potential for fires.

Lint traps should be emptied regularly, and all interior and exterior surfaces should be maintained in a condition that is free of combustible materials such as lint. Again, follow the information contained in the equipments’ operating manuals and safety guidelines to help ensure proper operations and a reduced risk of fire.

Some senior living communities have developed a log to document the frequency of lint trap cleaning on a daily basis. Although there is no standard for lint trap cleaning, more frequently is better than less frequently. Most commonly, lint traps are cleaned out every one or two hours. In some cases, senior living providers have a protocol to clean out the lint trap after every load has been dried.

Maintenance and cleaning of other elements of commercial laundry equipment, including the clothes dryers, should be on your community’s preventive maintenance schedule. This type of equipment typically is inspected and comprehensively cleaned at least monthly, or more frequently depending on use. The more active the equipment is, the more frequently it should be cleaned.

Remember that dryer fires don’t only occur in a senior living community’s commercial clothes dryers. They also commonly occur in residential homes. Make sure that laundry equipment that may be installed in the single family homes or townhomes that are part of your senior living campus are properly maintained as well. The National Fire Protection Association has produced a one-page fact sheet that can be referenced to ensure fire safe conditions for residential-grade clothes dryers on your campus. (Note: This information from the NFPA also can be considered to help ensure fire safety in your own home, where fires often occur in single family residences, townhomes and apartment buildings due to lack of cleaning and maintenance of clothes dryers.)

Although the fire sprinkler system saved the day at the retirement community in Manhattan, KS, where no one was injured and property damage was not catastrophic, it is important for your team to learn from such unfortunate incidents and institute the measures presented in this article to reduce the risk of fire in your senior living community’s laundry room.

Stan Szpytek is the president of the national consulting firm Fire and Life Safety Inc., based in Mesa, AZ, and is the life safety/disaster planning consultant for the Arizona Health Care Association, California Association of Health Facilities, Utah Health Care Association and American Assisted Living Nurses Association. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.

The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.

Have a column idea? See our submission guidelines here.

Of course, part of the challenge starts during the design phase of the communities, where a major objective is to build as much revenue-producing residential space as possible, oftentimes within a limited footprint. Due to capacity restrictions, storage sometimes is being placed in areas that represent safety hazards, risk exposures and potential compliance issues.

Building construction standards and life safety compliance in assisted living facilities are generally regulated by state and local authorities.  Senior living communities typically are regulated by local codes unless they have specific levels of licensure on campus (ALF, skilled nursing, memory care, etc.) where other regulations apply.  Although there are variances from jurisdiction to jurisdiction, storage typically is required to be in a protected space that has a hazardous area designation. This means that walls and ceilings in storage areas usually are constructed with materials having a specific fire-resistance rating (minimally one hour) along with rated fire doors that include self-closing devices. In new construction, fire sprinkler protection also is part of the requirements, the concept being that large volumes of combustible material represents a higher fire risk, so the material (equipment, supplies, etc.) needs to be separated from other areas of the building, especially the means of egress.

Emergencies require more equipment, supplies

The COVID-19 public health emergency, along with other emergency scenarios that may require a facility to “shelter-in-place,” obviously dictates the need for additional equipment and supplies. Professionals such as architects responsible for designing those types of properties likely did not anticipate the overwhelming amount of material needed to manage a public health emergency or potential disasters such as hurricanes or prolonged power disruptions in an assisted living community. It is not uncommon for code enforcement officials, risk managers and others who provide safety oversight to observe unauthorized storage in service corridors, resident hallways, unoccupied resident rooms, stairwell landings and other places where storage is strictly prohibited.

Simply using the rationale that your facility or buildings on campus do not have enough space in protected storage rooms for necessary infection control supplies (boxes of masks, gowns, sanitizers, etc.) or other disaster-related supplies is not an acceptable reason to place storage of any type within an unprotected area. Beyond the potential citations or deficiencies an operator may receive, a hazardous condition is being created that may not only compromise evacuation capabilities but also may represent a direct safety hazard to residents and staff members. Improper storage practices can reduce clear exit width as well as create a situation where items can topple onto building occupants.

Strategies to consider

One strategy to consider is having your procurement team work closely with the logistics professionals at the different vendors your community engages to develop supply chain schedules, to positively address this important matter. Alternate delivery schedules for supplies, equipment and materials needed for infection control measures and disaster management can be considered to help optimize the delivery pipelines so a facility can manage storage practices in a safe and compliant manner. Simply adding extra deliveries and reducing the amount of material at the facility may be one solution to this problem.

Another remedy may be to re-organize your storage rooms to accommodate equipment and supplies more efficiently. It is not uncommon to observe inefficient use of storage space within a facility.

Of course, storage practices always must be mindful of required clearance zones around fire sprinkler heads (18 inches) and electrical equipment including circuit breaker boxes (36 inches). Where allowed by local codes and ordinances, obtaining portable storage containers that can be placed on the property also can provide temporary storage solutions. 

Additional storage capacity may be obtained in senior living communities by assessing the available space that may be present in designated resident storage areas. Some assisted living communities, such as those associated with independent living campuses, have storage capacity for residents’ personal storage needs beyond the space within their residential units. Although those particular storage rooms are specifically designed for residents’ use, they may be considered during times of emergency. Often times, there is a considerable amount of available storage capacity within resident storage rooms. Engaging the cooperation of residents and their families to use under-used storage areas during an emergency may represent a safe and compliant temporary solution. 

Finally, senior housing communities may want to contact their professional associations or purchasing groups to see whether they can provide perspective or direct support on this specific logistical matter. In consideration of other infectious disease outbreaks, disasters or supply chain issues that may be on the horizon, in-house storage and supply chain management should be part of every senior living community’s emergency preparedness program.

Stan Szpytek is the president of the national consulting firm Fire and Life Safety Inc., based in Mesa, AZ. He is a consultant for the American Assisted Living Nursing Association and is the life safety/disaster planning consultant for the Arizona Health Care Association, the California Association of Health Facilities and the Utah Health Care Association. Szpytek is a former deputy fire chief and fire marshal and has more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.

In response to major disasters that have affected our nation since Hurricane Katrina to last year’s devastating wildfires in California, senior living providers have gotten quite sophisticated when planning for emergencies and managing real-world adverse events. A good emergency operation plan uses a process known as hazard vulnerability assessment, or HVA, to assess all of the potential threats and perils that could affect a senior living community, both internally and externally. For example, hospitals and nursing homes use a standardized tool made publicly accessible to all healthcare providers by Kaiser Permanente to conduct a comprehensive HVA (downloadable here). If this process currently is not part of your senior living community’s emergency management program, it is highly recommended that you implement it.

Once all potential internal and external threats have been identified, including the emergence of an infectious disease outbreak, your emergency operation plan should provide guidance on how to appropriately respond to these emergency situations and disasters with an “all hazards” approach. To help ensure an efficient and standardized all hazards response, senior living communities should consider using the same emergency management model used by first-responders (fire, police, EMS, emergency management agencies, health departments, etc.), nursing homes, hospitals and other similar organizations, known as the incident command system.

An incident command system is a standardized system of command and control that should be included in a comprehensive emergency operation plan and is designed to provide clear leadership, delegation of authority and appropriate support functions for all types of emergencies and disasters. One of the main benefits of the incident command system is that it provides a standardized framework of incident management across all disciplines through the use of a common language and common practices.

The American Assisted Living Nursing Association, in partnership with the Emergency Management Alliance, has developed and published a version of an incident command system, known as the Assisted Living Incident Command System, that is applicable to assisted living facilities and senior living communities. These two organizations currently are providing all senior living providers with complimentary access to the ALICS and the other resources posted in its resource center. Simply follow the registration instructions and your access will be reviewed and approved.

Clearly, the focus of majority of activities currently underway at senior living communities pertains to the prevention of virus spread. To help meet this objective, using your senior living community’s emergency operation plan will help your team manage this emergent situation with the same level of proficiency that it operates at during other common emergency situations to help protect the health and safety of your residents, staff and visitors.

As a life safety and disaster planning consultant working with several senior living providers around the nation, I have seen first-hand how the dedicated employees of senior living communities have used their emergency operations plan to successfully manage emergencies and disasters regardless of the scope, severity and duration of anticipated incidents such as hurricanes and emergent infectious disease outbreaks as well as unexpected adverse events like earthquakes and fast-moving wildfires.

Named after Arizona’s Emergency Preparedness Program for long-term care facilities, the “Disaster Ready” video provides an excellent overview of what providers in every state should be doing to make sure that they are ready for emergencies and disasters. The video is posted on YouTube.

Senior living and other long-term care providers in states across the nation continue to emphasize emergency preparedness. Comprehensive regulations now enforced by the Centers for Medicare & Medicaid Services are requiring many healthcare facilities to be prepared for emergencies and disasters in accordance with a risk analysis or hazard vulnerability assessment. States often look to CMS when crafting regulations that affect assisted living as well.

The Arizona Health Care Association administers the Disaster Ready program in partnership with the Arizona Department of Health Services. The program, funded through a grant from the Hospital Preparedness Program, has been providing resources to long-term care facility operators since 2012 to help them be ready for emergencies and disasters by promoting the “all-hazards” approach of preparedness, response and recovery to help ensure continuity of operations during a crisis.

In addition, a website offers a full complement of tools for long-term care facilities around the state following this all-hazards approach. Some of those tools include the Nursing Home Incident Command guidebook and evacuation procedures, just to name a couple.

Watch, read and get inspired to be ready for emergencies and disasters.

As long-term care providers around the nation, including assisted living communities and skilled nursing facilities, continue to optimize their emergency preparedness programs according to regulatory requirements and best practices, they have become very familiar with the concept of hazard vulnerability assessment, or HVA.

Common emergency management practices require individual facilities as well as entire communities and regions (county and state) to identify all of the potential threats and perils that potentially could affect their operations. Although the majority of these recognized hazards can be considered static or remain unchanged once they have been identified through a formal HVA process, a dynamic element of hazard recognition must be addressed when things do, in fact, change.

One such change includes the presence of construction within a facility or outside of the facility in the general community. Recent emergencies, including two devastating incidents that occurred during construction at both a healthcare facility and a non-healthcare facility, highlight the risks associated with “routine” construction projects.

In the incident involving a healthcare facility, in Texas, an apparent explosion during a construction project resulted in significant damage to several buildings and caused injuries as well as two fatalities. In the non-healthcare related incident, in Wisconsin, a massive explosion occurred on a city street when an excavating machine apparently ruptured a gas line, killing a responding fire captain and injuring several other firefighters, police officers and civilians.

External construction projects on or near a senior living community, as well as internal construction projects within a building, should be recognized as potential hazards. The presence of heavy machinery on the outside of a facility and associated excavating represents a potential hazard that must be recognized. Construction sites where foundations, walls, support beams and roofing elements are being installed should be considered hazardous during the various phases of completion. Unsupported building elements such as block walls can collapse in high winds, and structures in the early phases of construction that are not yet protected by a fire suppression system can burn.

Remodeling, renovation or new construction occurring on the inside or on the grounds of an existing healthcare facility also should be identified as a potential hazard. Fire suppression systems that have to be turned off during construction, electrical hazards and the potential need for any “hot work,” including the use of torches for plumbing component installation, should be recognized as potential hazards that must be addressed in the facility’s emergency operations plan. In the case of regulated long-term care facilities, in-patient hospice and hospitals, interim life safety measures may be required by regulations to address the presence these hazards. Be sure you and those involved with your project are familiar with applicable regulations.

Construction projects occurring near the facility, such as water and sewer projects where excavation is required, also represent a potential threat that must be acknowledged and accommodated. For example, if a primary or secondary emergency exit route out of a facility leads right into a construction zone, then alternate measures must be developed for the times when normal provisions of egress may be compromised. From another perspective, it is not uncommon for major construction projects to be occurring on an adjacent property, where the risks associated with a high volume of combustible material, such as wood framing, will present an extreme risk to the neighboring buildings if those building components should catch fire during the construction process.

The main take-away point from this article should be that HVA must be considered a dynamic process, not just a “one-and-done” deal. New emergency preparedness requirements from the Centers for Medicare & Medicaid Services mandate that regulated healthcare facilities conduct a risk analysis or HVA that is reviewed on an annual basis. In addition to annual review, an analysis of new risks must be completed when they emerge in or near a senior living property or healthcare facility.

Kaiser Permanente has developed a tool that is commonly used to conduct an HVA. The tool can be accessed at multiple sites online or can be downloaded here.

Potential threats and perils to your senior living community or nursing home are constantly changing. Make sure that your emergency preparedness efforts are dynamic and account for these changes when they occur. Once identified, adjust your emergency operations plan, even on a temporary basis, to provide appropriate emergency response protocols and contingencies to address all potential threats and perils.

Stan Szpytek, a regular contributor to McKnight’s Senior Living, is the president of consulting firm Fire and Life Safety Inc., in Mesa, AZ, and is the life safety / disaster planning consultant for the Arizona Health Care Association and California Association of Health Facilities. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at Firemarshal10@aol.com.