About 98 percent of North Dakota's nursing homes had fire-safety violations in the last year, the highest in the nation, according to a report released this week by the U.S. Government Accountability Office.

The report - prompted by fatal fires in Nashville and Hartford - looked at fire safety in nursing homes nationwide, and found lagging federal regulations that don't require homes to have sprinkler systems or fire detectors in every room. It also said nursing homes are poorly monitored by the state and federal agencies that are required to make sure regulations are followed.

"We had never looked at this facet before," said Kathryn Allen, who was in charge of the report. "What made an impression upon us was how little attention was being paid to fire safety."

North Dakota's ranking doesn't necessarily mean the condition of its nursing homes are the worst in the country. The high incident rate reflects the state's diligence in surveying buildings to ensure they are complying with regulations, Allen said.

"If we sent out our health department to other states they would have the same compliance record we do," said Shelly Peterson, president of the North Dakota Long Term Health Association, an advocacy group for nursing facilities in the state.

The health department inspects the state's 83 nursing homes once a year for violations. Officials from the federal Centers for Medicare and Medicaid are required to reevaluate a portion of those buildings yearly to make sure the state's inspection is thorough.

Deficiencies mentioned in the report ranged from storing empty oxygen tanks in hallways to not recording when fire drills took place to having openings in fire barriers where smoke or fire could get through.

"We are doing a good job of monitoring compliance with the existing requirements," said Monte Engel, who works with the North Dakota Health Department and is the manager of building standards and life safety codes. "I'm not in a position to say if those requirements are inadequate or not."

Unlike many states, about 75 percent of North Dakota's nursing homes have full sprinkler systems. The other one-fourth have smoke detectors in every room that are checked every week by staff members, Peterson said. Buildings without full sprinkler systems are looking at the possibility of installing them because of their effectiveness.

"There was a fire in the Walhalla nursing home," Peterson said. "She (the director) believes if they hadn't been fully sprinkled there would have been a death."

The federal government is looking at requiring all nursing homes to have sprinkler systems by 2006, which also is pushing North Dakota facilities to seriously look at installing them. In some cases, that would cost almost $1 million. Peterson said the Long Term Health Association is working with state officials to provide financial assistance to those buildings.

"It's so hard to lay out the cash then wait to be paid back," she said. "But it's better to be safe than sorry."

(Reach reporter Sheena Dooley at 250-8225 or sheenadooley@ndonline.com.)