Editor’s note: This is the first article is a two-part series. The second article will publish on September 21.
Few environments house more medically vulnerable individuals than senior living communities, assisted living facilities, and nursing homes. Across the United States, approximately 32,000 assisted living communities provide housing and supportive services for an estimated 1.3 million residents.
Facilities managers in senior living communities face growing responsibilities that extend far beyond maintaining plumbing systems. Today’s expectations include supporting infection prevention programs, complying with evolving regulations, reducing operational costs, documenting maintenance activities, and ensuring resident safety. Water delivery fittings, showers, and connected plumbing technologies have become important tools that help facilities meet these objectives while improving reliability and reducing maintenance demands.
Many assisted living residents require help with daily activities but remain largely independent. Others are recovering from hospitalization, surgery, or illness and stay temporarily before returning home. While assisted living residents are generally healthier than nursing home residents, advancing age and underlying medical conditions often compromise their immune systems, increasing their susceptibility to infectious diseases.
Residents of nursing homes and skilled nursing facilities typically require more extensive medical, rehabilitation, and personal care services. Because many have chronic illnesses or weakened immune systems, they face an even greater risk of healthcare-associated infections.
Safe water is a critical component of resident care. Plumbing systems must not become a source of infection. Healthcare-associated infections remain a significant concern in long-term care settings. Although this article focuses on senior living communities, these same principles benefit virtually any occupied building where water quality, occupant safety, and operational efficiency are important.
Each year, an estimated 1 million to 3 million serious infections occur among nursing home residents, contributing to approximately 380,000 deaths. Common infections include pneumonia, urinary tract infections, sepsis, COVID-19, and other illnesses that can spread through person-to-person contact or environmental sources.
Waterborne pathogens also pose a growing threat. Cases of Legionnaires’ disease have increased substantially in recent years. Legionella, the bacteria that causes the disease, has an overall fatality rate of about 10%, with mortality reaching 25% or higher among hospitalized patients and residents of healthcare facilities, underscoring the importance of effective water management and infection prevention programs.
Regulations That Create a Safer Senior Living Environment
The release of the Quality in Assisted Living Collaborative’s Infection Prevention and Control (IPC) Guidelines in late 2024 marks an important step toward more formal infection prevention programs in assisted living communities. Although assisted living remains regulated primarily by individual states, the guidelines establish a comprehensive framework to help protect vulnerable older adults from healthcare-associated infections through designated infection prevention leaders, annual program evaluations, staff education, written policies, and evidence-based surveillance and control measures. In doing so, they align assisted living more closely with nationally recognized infection prevention practices promoted by the Centers for Disease Control and Prevention (CDC), ASHRAE Standard 188, and accreditation organizations such as The Joint Commission.
For nursing homes and skilled nursing facilities, infection prevention carries even greater regulatory significance. The CMS Conditions of Participation require Medicare- and Medicaid-certified facilities to maintain an effective Infection Prevention and Control Program. Compliance is evaluated during state surveys, with F-Tag 880 (IPC) remaining one of the most closely scrutinized areas. Surveyors expect facilities to demonstrate systems that identify, investigate, monitor, prevent, and control infections while maintaining a safe and sanitary environment.
Regulatory expectations increasingly extend beyond clinical practices to include building water systems. The CDC recommends comprehensive water management programs to reduce Legionella and other waterborne pathogens, while CMS expects Medicare-certified facilities to implement water management programs consistent with ASHRAE Standard 188.
Although most assisted living communities are not required to comply with CMS Conditions of Participation, many are voluntarily adopting these evidence-based principles to strengthen resident safety, reduce liability, and prepare for evolving state regulations. Likewise, The Joint Commission identifies building water management as an essential component of environmental safety and infection prevention for accredited healthcare organizations.
Water management should be viewed as part of an organization’s overall IPC program requiring coordination among facility engineering, maintenance, environmental services, infection prevention personnel, and administration rather than solely a facilities management function. Documented risk assessments, preventive maintenance, monitoring, and corrective actions support quality improvement initiatives and demonstrate a proactive commitment to resident safety.
Many of these same water management strategies have already become standard practice in hospitals and are increasingly being adopted in schools, universities, hotels, and other commercial facilities where occupant health and building safety are priorities.
Together, these evolving expectations demonstrate that infection prevention now encompasses clinical practices, environmental controls, and water management. Facilities that maintain documented IPC programs, comprehensive water management plans, and plumbing systems designed to reduce water stagnation, support hand hygiene, prevent scalding, and simplify maintenance will be better positioned to protect residents, satisfy regulatory expectations, and maintain survey readiness.
Water Management: A Growing Compliance Priority
Although assisted living communities are primarily regulated by state agencies, these facilities are increasingly expected to adopt infection prevention practices consistent with healthcare settings. Industry guidance and public health recommendations are driving broader implementation of CDC water management programs for Legionella prevention, ASHRAE 188 water management principles, ASSE 1070 and ASSE 1016 scald protection standards, and applicable state plumbing codes. Water management programs aligned with ASHRAE 188 are now a standard expectation in skilled nursing environments.
While CMS F-Tag 880 applies specifically to Medicare- and Medicaid-certified nursing homes, many assisted living providers are adopting comparable infection prevention measures as a recognized best practice. These approaches help reduce the risks of waterborne pathogens, scald injuries, and cross-contamination—hazards that disproportionately affect older adults. Comprehensive water management now extends beyond centralized building systems to point-of-use plumbing fittings, supporting resident safety, family confidence, and a proactive infection prevention program aligned with evolving regulatory expectations.
Digital maintenance records, flushing logs, temperature verification, and documented corrective actions can significantly reduce the time required to prepare for regulatory inspections or accreditation surveys while providing objective evidence that water management activities are being performed consistently.
Infection Prevention at the Sink and Shower
Hand hygiene remains one of the most effective ways to reduce the spread of infectious diseases. Plumbing fitting design plays a critical role in supporting that effort.
In assisted living communities, touchless faucets promote resident wellness, improve accessibility, and reinforce everyday hygiene practices that give residents and their families greater confidence in the safety of the environment. In nursing homes and skilled nursing facilities, these same technologies help reduce the risk of healthcare-associated infections (HAIs), support formal IPC programs, and contribute to outbreak prevention.
Touchless Operation and Accessibility
Touchless faucets eliminate a common source of cross-contamination by removing the need to touch handles where pathogen colonies can reside after handwashing. The touchless actuation enables use by residents with limited mobility or dexterity while supporting staff compliance with hand hygiene protocols. Touchless faucets are designed for high-use care environments, providing reliable sensor activation that minimizes user contact and helps reduce pathogen transmission at the point of use.
Preventing Water Stagnation
Low water use common in resident rooms and infrequently occupied areas can allow water to stagnate, creating conditions favorable for bacterial growth. Features such as automated hygiene flushing, laminar flow outlets that minimize splashing that can spread contamination, and copper supply lines help reduce the potential for waterborne pathogens, including Legionella, E. coli, and Staphylococcus aureus. Connected plumbing technologies can automatically schedule flushing cycles to support building water management programs and maintain water quality.
Reducing Legionella Risk in Showers
Showers represent one of the highest-risk sources of exposure to waterborne pathogens. Self-draining shower systems automatically remove standing water from valves, supply lines, and hoses after each use, reducing conditions that allow Legionellato proliferate without requiring staff intervention. This approach supports CDC recommendations and ASHRAE Standard 188 water management principles for controlling Legionella in building water systems.
For assisted living communities, these plumbing innovations contribute to healthier, more comfortable environments that support person-centered care, resident independence, and family peace of mind. For nursing homes and skilled nursing facilities, they also help reduce HAI risk, strengthen infection prevention and water management programs, improve outbreak preparedness, and address survey expectations related to infection control. By integrating infection prevention directly into plumbing systems, facilities can better protect vulnerable residents while supporting regulatory compliance and long-term operational resilience.
Beyond protecting residents, effective water management also helps reduce organizational liability by demonstrating that recognized industry guidance and documented maintenance practices are consistently followed.
Stay tuned for Part II of this article series to learn more about water management, including scald protection, sustainability and water efficiency, and maintenance and automation.
Greg Hunt is a product manager for Chicago Faucets’ line of commercial products. He’s a certified ASSE 12080 Legionella Water Safety and Management Specialist and an American Society for Health Care Engineering (ASHE) member.