Nurse handing a glass of water to a smiling elderly man
August 29, 2019
By Reid Hutchison

3 Water Safety Challenges in Skilled Nursing Facilities

Nurse handing a glass of water to a smiling elderly man

Most people will require some form of assisted living or long term care support in their lifetime. The United States alone has roughly 28,000 assisted living facilities (ALFs) and skilled nursing facilities (SNFs), housing more than one million people, many of whom are in frail health. Building managers for skilled nursing facilities and long-term care centers with complex water systems face specific water safety challenges.

Knowing these challenges and what you can do about them will help you keep your building safe and stay compliant with current water safety standards like ASHRAE 188.


1. Contamination At The Source

If your facility is in a rural area, you may be on a well system which can be at risk for lead contamination. Those on a municipal system have the benefit of more stringent quality controls. However, any water supply can be compromised by multiple variables like construction in the area, water main breaks, stormwater and/or agricultural runoff, and environmental disasters such as a hazardous materials spill.

What To Do:

No matter your water source, you’ll need to conduct regular water testing with the help of a professional water treater. The more data you collect about your on-premises water, the more chance you’ll have at preventing contamination or an outbreak of disease.

water management program

2. Aging Water System Infrastructure

Many facilities around the country are facing aging equipment and pipes. This can cause equipment failure and lead to contamination of your water supply.

What To Do:

A site visit from your water treatment partner to assess the current health of your infrastructure and equipment can head off problems before they become expensive emergencies. A professional water treater can also help you develop a water safety management plan so you can be more proactive overall.

3. Compromised and At-Risk Populations

Residents and patients of hospitals, SNFs, and ALFs often have existing health conditions that make it hard to fight respiratory illnesses and injuries. Opportunistic pathogens, such as Legionella can cause illnesses that quickly become life-threatening.

A CDC study done in 2015 found that 533 (19%) of the Legionella cases that occurred that year were reported in a health care facility, such as a hospital or nursing home. And the risk for death jumps to 25% for residents of nursing homes, SNFs and ALFs.

What To Do:

Develop a Legionella prevention plan that keeps you compliant with ASHRAE and other industry water safety standards. You’ll also need a water safety program and a water safety team to monitor your water and its systems and equipment.

Water Temperature and Legionella

Maintaining safe water temperatures in nursing homes and similar facilities is important for two reasons:

  1. Burn prevention
  2. Legionella prevention

For burn prevention, federal guidelines advise that you keep domestic water temperatures below 120 degrees Fahrenheit, although this temp can still cause burns if exposure reaches five minutes. Many states have even stricter standards that set maximum temperatures lower than 120 degrees Fahrenheit. Although 100 degrees Fahrenheit is considered a safe water temperature for bathing.

However, Legionella thrives in temperatures between and 77 and 100 degrees Fahrenheit, so the CDC advises that you keep your hot water hot and your cold water cold. (Some states’ recommended limits for maximum temperatures may even be too low to limit Legionella growth.)

The optimal way to prevent both burns and Legionella growth is to run domestic hot water at 135-140oF at point of generation immediately followed by mixing valves that lower the temperature to below the maximum legal temperature in your location. If that is not practical for your facility, it is recommended that you set your hot water temperature at 105-110oF (lower the range if 110 degrees Fahrenheit is above the legal limit in your location) and then mix cold and hot water at the point of use.

Water Management Advice For Long-Term Care Facilities

The CDC recommends that building managers of long-term care facilities follow these best practices for water management:

  • Maintaining water temperatures outside the ideal range for Legionella growth
  • Preventing water stagnation
  • Ensuring adequate disinfection
  • Water monitoring and quality testing

Protecting Your Medicare/Medicaid Status

In addition to ASHRAE compliance, having a water management plan will also help you protect your Medicare/Medicaid status.

The Centers for Medicare and Medicaid Services (CMS) requireMedicare-certified healthcare facilities, including nursing facilities, to have water management policies and procedures in place to reduce the risk of Legionella and other pathogens in building water systems. Accrediting organizations will review your facility’s policies, procedures, and reports documenting water safety management practices. They will verify that you’ve done the following:

  • Conducted a facility risk assessment to identify where Legionella and other pathogens could grow and spread in your water system
  • Implemented a water safety management program informed by ASHRAE Standard 188 and the CDC toolkit, including control measures such as physical controls, temperature management,disinfectant level control, visual inspections, and environmental testing for pathogens
  • Specified testing protocols and acceptable ranges for control measures, and document the results of testing and corrective actions taken when control limits are exceeded

If you’re a building manager for a senior living center and need help creating a water safety program, or pricing, contact us to schedule a site visit.

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