Garden Last summer I wrote a post about the practice of disguising doors in memory care units, to help prevent patients from “eloping.”  I included many examples of doors with painted or adhesive murals, disguising doors as bookcases, gardens, wheat fields…basically anything other than an exit that might tempt a patient.  I researched the codes at that time, and there was nothing that would allow the use of murals to disguise exits.  It goes against the familiar IBC requirement:  “Means of egress doors shall be readily distinguishable from the adjacent construction and finishes such that the doors are easily recognizable as doors. Mirrors or similar reflecting materials shall not be used on means of egress doors. Means of egress doors shall not be concealed by curtains, drapes, decorations or similar materials.”

But the other day I found a surprise in the 2015 edition of NFPA 101 – The Life Safety Code (I didn’t find a similar section in the IBC).  Although this code is not widely used yet, it does include a paragraph in both the new and existing health care chapters that would allow murals to disguise egress doors (this section also appears in Chapter 19 for existing health care):* Doors permitted to be locked in accordance with shall be permitted to have murals on the egress doors to disguise the doors, provided all of the following are met:

1. Staff can readily unlock the doors at all times in accordance with
2. *The door-releasing hardware, where provided, is readily accessible for staff use.
3. *Door leaves, windows, and door hardware, other than door-releasing hardware, are permitted to be covered by the murals.
4. The murals do not impair the operation of the doors.
5. The location and operation of doors disguised with murals are identified in the fire safety plan and are included in staff training.

The section above references section, which allows doors to be locked in a means of egress where required for the security or protection of patients, as long as staff can unlock the doors.  Doors must be capable of being unlocked by either a) remote control, b) keys carried by staff, or c) other reliable means available to staff at all times.  According to Annex A,  this method might be acceptable for psychiatric units, Alzheimer units, and dementia units, along with forensic units and detention units.  The annex also mentions pediatric units, maternity units, and emergency departments as examples of areas which might justify controlled egress.

With the addition of the new NFPA 101 section on murals, the same doors that are allowed to have controlled egress may also be disguised by murals.  Patients with mental illness can become fixated on exit doors, so disguising the door may help to create a more calming environment and reduce the chance for elopement when staff members use the door.  (Note: I edited this from the original with the help of one of my readers. – LG)  Annex A notes that murals should not obscure exit signs,vision panels, or operable hardware, or affect the fire resistance rating if the opening is a fire door assembly.  The door manufacturer must be contacted to confirm whether the mural being used is acceptable for fire doors.  Remember, the use of murals in these units is allowed by the 2015 edition of NFPA 101, but is not addressed in the IBC.


There are a wide variety of door mural designs available, including over 100 from an Etsy store called FromEUWithLove.  Given the change to NFPA 101, don’t be surprised if you find what appears to be a brick wall or approaching wildlife the next time you visit a memory care unit.

Basketball  Horse

Photos courtesy of FromEUWithLove on Etsy.

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