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The 10 common deficiencies in aging healthcare facilities are failures in fire compartmentation, egress, electrical distribution, hazardous-room construction, exit information, rated doors and fire-alarm coverage. They are the findings most often surfaced by healthcare facility assessments, but they sit inside a larger problem: deferred maintenance can also weaken emergency utilities, infection-control protections, accessibility and regulatory readiness.
This list is based on a healthcare facilities assessment published by Building Design + Construction. Its 10-item list dates from 2014, so owners must verify the currently adopted Life Safety Code, state and local building requirements, CMS rules and accreditation standards before designing corrective work.
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The recurring findings are primarily life-safety and building-system defects. Each can be difficult to correct after ceilings, walls and clinical operations are already in place.
- Missing or incorrectly installed fire and fire/smoke dampers. Dampers help preserve rated barriers where ductwork crosses fire- or smoke-resistance assemblies. Older hospitals often conceal them above ceilings, making access, inspection and replacement disruptive and expensive. Verify damper type, location, access panels, installation and inspection records against the current adopted code.
- Lined ductwork. Legacy internal duct liners can complicate inspection, cleaning, maintenance and environmental-risk management. The presence of a liner is not, by itself, a complete remediation specification: determine its condition, the applicable current code and infection-control requirements before selecting removal, replacement or encapsulation.
- Unsealed penetrations in rated walls. Cables, pipes, ducts and other services that pass through fire-, smoke- or combination-rated walls must be protected with an approved, properly installed firestop system. An unsealed opening can compromise the compartment even when the surrounding wall appears intact.
- Incorrectly built rated walls. A wall may look substantial while lacking the tested layers, framing, joints, continuity or firestop details required for its rating. Confirm construction against approved assemblies and survey the full wall line, including above ceilings and at intersections with floors, roofs and shafts.
- Electrical distribution connected to the wrong branch. Hospital electrical systems rely on intended separation and reliability between normal, essential and other designated branches. A load connected to an inappropriate branch can defeat that design during an outage. Trace circuits, labels, transfer equipment and downstream panels rather than relying only on panel schedules.
- Rated stairwell exits that do not discharge directly to the exterior. Protected stairs must provide a compliant path to a safe discharge point. Older layouts may route occupants through intervening spaces or leave the discharge unclear. Check the complete egress path against the currently adopted Life Safety Code and jurisdictional requirements.
- Hazardous rooms with incorrect fire rating or construction. Storage rooms and other higher-hazard spaces require appropriate separation, doors, ceilings, ventilation and construction details. Classify the room by its actual contents and use, then verify that the enclosure and penetrations match the required rating.
- Exit pathways with incorrect signs or drawings. Exit signs, directional information, evacuation drawings and life-safety plans must agree with the physical building. Conflicting information can delay staff response and make it difficult for surveyors or emergency personnel to identify compliant routes. Update posted signs and controlled drawings together.
- Doors in rated-wall construction that are built incorrectly. A rated opening is an assembly: door leaf, frame, glazing, hinges, closer, latching, seals and hold-open or release devices all matter. Inspect the complete assembly, its label and its clearances; replacing hardware alone may not restore the rating.
- Fire-alarm devices placed incorrectly. Detector, notification-appliance and initiating-device locations affect coverage and audibility or visibility. Renovations, room changes and ceiling alterations can leave devices outside the coverage required by the adopted fire-alarm and life-safety rules. Reconcile device locations with current drawings and required testing.
Douglas J. King, a healthcare code and regulatory expert quoted by Building Design + Construction, said these 10 deficiencies emerge “time after time” during healthcare facilities assessments. The list is a practical starting point, not a substitute for a facility-specific survey.
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Why are old hospitals vulnerable beyond these 10 findings?
Age increases the chance that original systems, later renovations and maintenance records no longer align. The Centers for Medicare & Medicaid Services (CMS) requires a hospital to be constructed, arranged and maintained to ensure patient safety, with routine and preventive maintenance, testing and correction of repair needs. Its State Operations Manual Appendix A is the governing reference for survey expectations, subject to current revisions and local adoption.
Deferred maintenance is also a capital-planning problem. The American Society for Health Care Engineering (ASHE) cited a 2021 estimate of more than $390 billion in deferred maintenance across the healthcare sector. In ASHE’s 2024 Hospital Operations Survey, 80% of respondents identified aging facilities and infrastructure as their leading concern; 58% identified lack of funding and staff recruitment or retention as the second challenge. These are survey findings, not a diagnosis of every hospital.
ASHE facility-condition data accurate December 20, 2024, reported approximately 49% deferred life-safety assets, 55% deferred electrical-distribution assets, 57% deferred plumbing assets and 55% deferred architectural assets. Treat these as comparative benchmarks. A local condition assessment, asset inventory and risk analysis must control project decisions.
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How does deferred maintenance affect patient safety and infection control?
Deferred work can reduce the reliability of emergency power, lighting, medical-gas and water systems, while aging finishes and utilities can make cleaning, isolation and environmental control harder. The CDC environmental infection-control guidance warns that aging equipment, deferred maintenance and construction or renovation can provide mechanisms for environmental pathogens to enter high-risk patient-care areas.
Renovation itself creates risk. Dust, pressure changes, vibration, moisture and accidental utility interruptions can affect occupied clinical areas. Before work begins, use an infection-control risk assessment, define barriers and pressure relationships, protect air and water systems, and coordinate shutdowns with clinical leaders. The control measures must match the patient population and the work, rather than relying on a generic construction plan.
How do you assess an aging healthcare facility?
A facilities assessment is essential to establish the full picture before a renovation or capital request. King recommends pairing the assessment with a plan of correction and a master life-safety plan. A practical assessment sequence is:
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- Assemble the baseline. Gather current floor plans, life-safety drawings, fire and smoke compartment plans, electrical one-lines, emergency-power documentation, medical-gas information, equipment inventories, previous survey findings and preventive-maintenance records.
- Confirm the rules. Identify the current adopted building and fire codes, Life Safety Code edition, CMS requirements, accreditation standards and jurisdictional accessibility rules. Do not assume the code in force when the building was constructed is the code governing today’s alteration.
- Walk the building systematically. Inspect above ceilings, shafts, mechanical rooms, electrical rooms, rated corridors, stair discharges, hazardous rooms and representative patient-care areas. Photograph and map each finding with a unique asset or room identifier.
- Trace concealed systems. Verify damper access and operation, firestop continuity, wall assemblies, door labels and clearances, branch-circuit destinations, emergency-power transfer paths and fire-alarm device coverage. Use drawings as a guide, then reconcile them to field conditions.
- Assess occupied-operation risk. Record patient populations, critical services, isolation rooms, operating schedules, shutdown constraints, alternate routes and temporary-capacity options. A technically correct fix can still be unsafe if it removes a required service without a controlled interim plan.
- Rate each finding. Capture location, deficiency, life-safety severity, regulatory exposure, infection-control impact, utility consequence, accessibility effect, clinical disruption, remaining useful life, capital cost and lifecycle cost.
- Apply immediate controls. Where risk is immediate, use measures such as restricted access, fire watch, temporary detection or notification, alternate egress, protected shutdown procedures or relocation—only when approved by the responsible authority and clinical leadership.
- Close the record. After correction, retain revised drawings, product or assembly information, inspection and test results, commissioning records, photographs and accountable sign-off in the facility’s document-control system.
What should a hospital fix first?
Start with conditions that could cause immediate harm or defeat a required life-safety function, then address defects that expose vulnerable patients to infection or utility failure. A risk register makes that order visible and defensible.
| Priority factor | Questions to ask |
|---|---|
| Immediate safety | Could the condition block egress, spread fire or smoke, disable alarm notification, or expose patients or staff to a dangerous electrical condition? |
| Regulatory exposure | Does it conflict with the current Life Safety Code, CMS conditions, accreditation requirements or local accessibility rules? |
| Infection control | Could the defect or proposed work introduce dust, moisture, pathogens or contaminated air or water into high-risk areas? |
| Emergency utilities | Would a failure affect emergency power, lighting, medical gas, water, heating, cooling or essential clinical equipment? |
| Accessibility and security | Can every intended user reach, enter and leave the space safely, including during an emergency? |
| Disruption and cost | What clinical services, temporary facilities, schedule time, capital and lifecycle costs are involved? |
Use the result to create a plan of correction, a master life-safety plan and a phased capital-renewal program. Bundle related work—for example, wall penetrations, rated doors, dampers and ceiling access in one zone—when doing so reduces repeated shutdowns without delaying a high-risk correction.
What other conditions do surveyors review?
The Joint Commission’s Hospital Accreditation Survey Process Guide describes review areas that extend beyond visible construction defects. They include preventive maintenance, environmental risk assessments, accessibility, age-related hazards, security, weather risks, emergency power, emergency water and gas, utility maintenance, testing and inspection documentation.
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That means a compliant project needs an operating system, not just new materials. Assign owners for each asset, set inspection and testing intervals, track overdue work, document exceptions and ensure staff know interim procedures. Reconcile maintenance software, drawings and physical labels after every renovation so future responders are not working from obsolete information.
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How can an older hospital meet current requirements during renovation?
Plan compliance and continuity together. Define the required rating and performance before selecting products; sequence work by compartment or shutdown zone; maintain temporary egress and fire protection; isolate construction air and debris; coordinate emergency-power and utility interruptions; and obtain authority-having-jurisdiction approvals where required.
Accessibility upgrades should be checked across the complete route, not only at a doorway. Life-safety drawings, evacuation maps, room classifications, fire-alarm devices and electrical schedules should be updated as part of the same closeout package. Because state and local code adoptions and accreditation editions change, have the design team verify the requirements at project time.
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What is the practical takeaway for facility owners?
The 10 recurring deficiencies are a focused warning: small-looking defects in dampers, penetrations, walls, doors, signs or devices can undermine a hospital’s compartmentation and evacuation strategy. Aging utilities and deferred maintenance magnify the consequences, while poorly controlled renovation can add infection-control risk. A documented, code-verified assessment followed by risk-ranked corrections, preventive maintenance and disciplined closeout gives owners the clearest path to safer, more reliable facilities.
Frequently Asked Questions
How often should an aging hospital repeat a facilities condition assessment?
Repeat the assessment when major renovations, service-line changes, survey findings or significant utility failures alter the risk profile, and maintain continuous preventive-maintenance and inspection records between formal assessments. The appropriate interval should be set by facility risk, asset life and applicable requirements rather than by a universal calendar.
Who should sign off on a hospital life-safety correction?
The accountable owner should include facilities leadership, the qualified design or code professional, infection-prevention staff and affected clinical leaders, with authority-having-jurisdiction approval where required. Keep the signed decision, test evidence and updated drawings with the permanent asset record.
Can a hospital remain open while rated walls or fire doors are repaired?
Often it can, but only with a documented interim-life-safety and infection-control plan. The plan may require phased barriers, alternate egress, fire watch, temporary detection or relocation, and must be coordinated with the authority having jurisdiction and clinical operations.
What records are most valuable during a CMS or accreditation survey?
Keep current life-safety drawings, preventive-maintenance schedules, inspection and testing reports, emergency-power and utility records, fire-alarm and damper documentation, accessibility assessments, infection-control risk assessments and correction closeout evidence. Records should identify the asset, date, result, deficiency, responsible person and resolution.
