University of Minnesota Long Term Care Resource Center
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Physical Environment

 

Description of Federal Requirements
Comparison of State Requirements
Complete Transcript of State Requirements on Physical Environment (PDF)

Federal Regulations & Related F-tags Applicable Federal Regulation
a) Life safety from fire | F-454
b) Emergency power | F-455
c) Space and equipment | F-455 - F-456
d) Resident rooms | F-456 - F-461
h) Environment (Quality of Life 483.15) | F-252 - F-258
e) Toilet Facilities | F-462
f) Resident call system | F-463
g) Dining and resident activities | F-464
h) Other environmental conditions | F-465 - F-469
483.70 Physical Environment
483.15 Quality of Life

Description of Federal Requirements    (TOP)    (NEXT)

The Federal Regulations on Physical Environment (483.70) deals with an assortment of topics related to life safety from fire, required space and equipment, minimal standards for resident rooms and toilet facilities, resident call system, space designated for resident dining and activities and other environment conditions. Although, not as long as the Federal regulation section on Administration, with its sixteen main parts, the Physical Environment section includes eight main parts, a-h, with the majority of the content devoted to life safety from fire. The umbrella requirement for the physical environment is that “the facility must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public.”

Part (a) pertains to life safety from fire and requires the facility to meet the applicable provisions of the 2000 edition of the Life Safety Code (LSC) of the National Fire Protection Association with the exception of number 2 of Chapter 19.3.6.3.2 which does not apply to long-term care facilities. Copies of the Life Safety Code may be obtained from the National Fire Protection Association. Sections 2 & 3, under part (a), provide conditions for a facility being exempt from meeting the provisions of the 2000 LSC. Under (2), CMS may waive specific provisions of the LSC “which, if rigidly applied, would result in unreasonable hardship upon the facility, but only if the waiver does not adversely affect the health and safety of the patients.” ¬†Under (3), the provisions of the LSC do not apply in a State where CMS finds that a fire and safety code imposed by the state adequately protects residents and personnel in long-term care facilities. Section (4) requires facilities to be in compliance with Emergency Lighting (Chapter 19.2.9) after March 13, 2006. Section (6) allows for the installation of alcohol-based hand rub dispensers if:¬† the use of dispensers does not conflict with any State or local codes that prohibit their placement; the dispensers are installed to minimize leaks and spills that could lead to falls; the dispensers are installed to adequately protects against inappropriate access; the dispensers are installed in accordance with LSC requirements; and the dispensers are maintained according to manufacturer guidelines. Section (7) requires a facility to install, at least, battery-operated single station smoke alarms in resident sleeping rooms and common areas and that there be a program for inspection, testing, maintenance, and battery replacement that conforms to manufacturer’s guidelines and that verifies correct operation of the smoke alarms. Facilities are exempt from this requirement if the facility has system-based smoke detectors installed, maintained and tested in accordance with NFPA 72, National Fire Alarm Code or the facility is fully sprinklered in accordance with NFPA 13, Standard for the Installation of Sprinkler Systems. Section (8) requires that a facility must: install an approved, supervised automatic sprinkler system in accordance with the 1999 edition of NFPA 13, Standard for the Installation of Sprinkler Systems throughout the building by August 13, 2013; and test, inspect, and maintain an approved supervised automatic sprinkler system in accordance with the 1998 edition of NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems.

Part (b) pertains to emergency power with the requirement that an emergency electrical power system must: supply power sufficient for lighting all entrances and exits; supply power to equipment needed to maintain the fire detection, alarm and extinguishing systems; and provide power to life support systems. When life support systems are used, the facility must provide emergency electrical power with a generator located on the premises.

Part (c) pertains to space and equipment and requires the facility to: (1) provide sufficient space and equipment in dining, health services, recreation, and program areas to enable staff to provide residents with needed services and as identified in resident’s care plan; and (2) maintain essential mechanical, electrical and care equipment in safe operating condition.

Part (d) pertains to resident rooms and requires that resident rooms be designed and equipped for adequate nursing care, comfort and privacy. Section (1) requires the bedrooms to: accommodate no more than four residents; measure at least 80 sq. feet per resident in multiple bed rooms and 100 sq. feet in single rooms; have direct access to exit corridor; be designed or equipped to assure full visual privacy for each resident; have ceiling suspended curtains, which extend around the bed in facilities certified after March 31, 1992; have at least one window to the outside; and have a floor at or above grade level. Section (2) requires the resident be provided with: a separate bed of proper size and height; a clean, comfortable mattress; bedding appropriate to the weather and climate; and functional furniture appropriate to the resident’s needs, individual closet space with accessible clothes racks and shelves. Section (3) provides for variations to these requirements in individual cases when the facility demonstrates in writing that the variations are in accordance with the special needs of the residents and will not adversely affect health and safety.

Part (e) pertains to toilet facilities and only requires that “each resident room must be equipped with or located near toilet and bathing facilities.”

Part (f) pertains to resident call system and requires the nurse’s station be equipped to receive resident calls from resident rooms and toilet and bathing facilities.

Part (g) pertains to dining and resident activities and requires one or more rooms designated for dining and activities that: are well lighted; well ventilated, with nonsmoking areas identified; are adequately furnished; and have sufficient space to accommodate all activities.

Part (h) pertains to other environmental conditions and requires the facility to provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public that: ensures water is available when there is a loss of normal water supply; that there is outside ventilation by means of windows or mechanical equipment; handrails are firmly secured on each side of the corridor; and there is an effective pest control programs and the facility is free of pests and rodents.

Comparison of State Requirements    (TOP)

The state regulations on the topic physical environment have been subdivided into the following sub-topics: Resident Room and Bath; Nursing Unit; Facility Wide; Dining and Lounge Space; New Construction Application Process and Waivers. Each of these sub-topics has been further sub-divided into categories within each of the physical environment topics. Categories for Resident Room and Bath include: Resident Bedroom; Storage; Doors and Locking; Windows; Bathroom and New Construction state regulations relevant to the Room and Bath. Categories for Nursing Unit include: Nurse's Station; Specialized Care Units; Resident Call System; Tub and Shower Room and New Construction state regulations relevant to the Nursing Unit. Categories for Facility Wide include: Housekeeping, Laundry and Maintenance; Corridors, Floors and Signage; Lighting, Noise, Temperature, HVAC and Odors; Body Holding Room; Outdoor Space and New Construction state regulations relevant to Facility Wide. Categories for Dining and Lounge Space include: Square Footage Requirements; Lounge Space and Common Areas; Dining Space; Food Preparation and Kitchen Areas (which is also found under the topic Dietary); and New Construction state regulations relevant to Dining and Lounge Space. The Category New Construction Application Process is a comparison of state requirements for applying for new construction permits in all 50 states including the District of Columbia including permissible waivers to the application process. The category Waivers is subdivided into the Waiver Process and allowable waivers for the Physical Environment and also a separate section on state regulations applicable to Care-giving Waivers.

Complete Transcript of State Requirements on Physical Environment    (TOP)