In healthcare today, short hospital stays are normal, and recovery at home or at a rehabilitation facility is common. When I was still at the NFPA, I heard a lot of concern about durable medical equipment (DME) installed in homes, because codes or standards only addressed medical equipment used healthcare facilities.
Requirements for electrical systems in healthcare facilities are found in Article 517. This includes “hospitals, nursing homes, limited care facilities, clinics, medical and dental offices, and ambulatory care centers, whether permanent or movable.” The informational note for 517.2 also states that the list isn’t limited to those facilities, but the home is not included in this list.
Many of these requirements are extracted from NFPA 99, the Health Care Facilities Code, which provides the electrical systems’ performance requirements. It also includes other critical aspects of healthcare facilities, including construction and fire protection. These details are important to ensure that patients can be treated successfully without events that can endanger them.
Treatment in the home often involves the use of DME. Medicare and private insurance companies use this term to refer to a wide variety of nonelectrical medical equipment with a useful lifetime of at least three years, such as canes, walkers and some wheelchairs. Nondurable medical supplies have a limited lifetime, and most are disposable.
Electrical DME is also referred to as medical electrical equipment (MEE). MEE includes nebulizers, ventilators, oxygen generators, dialysis machines, various types of monitors and electric hospital beds. According to Medicare requirements, DME must be used for a medical reason, must not be useful to someone who is not sick or injured and must be needed for use in the home.
MEE is used for patient diagnosis, monitoring or treatment. It is usually cord-and plug-connected and usually does not involve continual on-site supervision by trained healthcare personnel. Modern technology does permit off-site monitoring.
Because of the growing use of MEE, the healthcare community within NFPA brought this issue to the attention of NFPA staff, who brought it to the attention of the NEC Correlating Committee to determine if Code changes were needed to facilitate the reliable use of MEE. The NEC Correlating Committee formed a task group “to identify any gaps that are created by the increased use of DME within the individual dwelling unit and multifamily dwelling electrical infrastructure including but not limited to increased loading, compatibility of DME with required circuit protective devices, compatibility of DME with the typical residential wiring methods, and standby power considerations.”
There is no one-size-fits-all solution, but some general needs would help most patients. Some patients require a higher level of reliability than others.
New Section 210.16
For the 2023 cycle, the task group submitted two public inputs. The first one proposes a new Section 210.16, Branch Circuits of Medical Electrical Equipment. This section would apply to dwelling units and residential board-and-care occupancies. It doesn’t require infrastructure to supply MEE in every new or existing home. It proposes to provide requirements that such systems must meet if they are installed.
The proposed requirements apply to 15A, 20A and 30A branch circuits intended to supply cord-and-plug-connected MEE. Because power supply reliability is important, the circuit loading would be limited to 50% of the branch-circuit rating.
Some MEE has a built-in alarm to indicate loss of power. If the equipment does not have an alarm feature, one must be provided. To differentiate between receptacles for MEE and others, labeling would be required. The proposed marking would indicate: “Warning—power loss risk to life-support and medical equipment on same circuit. Do not overload.”
Informative Annex K
The second public input from the task group proposed a new informative Annex K, Use of Medical Electrical Equipment in Dwellings and Residential Board-and-Care Occupancies. It provides some perspective on the trend of this equipment showing up in the home. It points out the two classes of equipment and the need to consider reliable backup power. It also provides some factors to consider for analyzing an installation, and it recommends labeling receptacles on circuits used for MEE.
Not all medical needs are alike. For some medical conditions, loss of power would be an inconvenience. For others, it could mean loss of life. The proposed new Annex K provides what to consider in an analysis of installation needs.
Disposition of public inputs
Code-Making Panel (CMP) 2 was assigned the public input for 210.16 and Annex K. The panel chose to not move forward with the proposed new Section 210.16 because it “includes language that would make enforcement difficult.” While it was written in mandatory language, as is required by the NEC Style Manual, the section would only apply if a decision had been made to provide the infrastructure to support MEE.
The National Electrical Manufacturers Association (NEMA), Arlington, Va., also submitted a public input proposing a new Section 210.11(C), which would require at least one 20A, 120V branch circuit for each bedroom. NEMA also cites the need to supply MEE such as dialysis equipment, CPAPs, oxygenators and infusion pumps.
CMP 2 created a first revision based on this public input. This change recognizes that the loads in bedrooms are increasing, which may accomplish some of what the task group was attempting to do by improving the reliability of the circuits in each bedroom. CMP 2 also created a first revision based on proposed Annex K. This will provide valuable information to help assess the needs for providing MEE with the necessary level of reliability for installation in dwellings and residential board-and-care occupancies, including assisted living residences.
Health insurance companies are usually in a hurry to get patients released from the hospital because of the high cost. This is not necessarily bad. We all tend to be happier at home and can recover better there. Patients may also be released to a rehabilitation facility or a nursing home. Insurance coverage for the cost of the facility is usually for a limited time. My father and father-in-law spent the last years of their lives in nursing homes. The financial toll on the patient and the family is staggering.
Configuring an older home for healthcare, though, can be expensive. Medicare or Medicaid probably would not cover the necessities to make a home ready to care for someone needing MEE. However, according to Virginia-based Genworth Financial’s Cost of Care Survey, the average cost of a private room in a nursing home is $275 per day or $8,365 per month. The average cost of a semi-private room is $245 per day or $7,441 per month. On an annual basis, that amounts to a staggering $100,380 for a private room or $89,292 for a semi-private room. Most of that cost will be borne by the family, quickly wiping out savings. The cost of improvements to create a supportive electrical system for a family member begins to look like a real bargain in comparison.
Health insurers don’t normally cover the cost of home renovations for MEE. However, they will cover some aspects of at-home care—such as adult daycare and visiting nurses—which may make it practical. Long-term insurance usually covers in-patient services in nursing homes. It also tends to cover some outpatient services, such as visiting nurses, because it is less expensive than in-patient care. Whether they will ever cover some renovations is unknown. Insurers may eventually find that it could be more cost-effective to fund changes that make at-home care a more practical option.
This is the first time the NEC has ever dealt with at-home healthcare. The CMPs have concluded their first draft meetings, and balloting and correlating committee review are upcoming. The first draft report of the NEC will be published online by July 2, 2021, at www.nfpa.org/70next. I expect there will be public comments on the first revisions and public inputs, which could result in some reworking of the issue.