Many victims had been restrained to their beds or trapped behind wheelchairs that were too wide for the exits. Investigators later blamed faulty wiring and found the nursing home didn't have an evacuation plan.
Overshadowed by the shooting in Dallas 50 years ago and largely forgotten today, the deadly fire along with a string of other nursing home fires in the 1960s helped bring about better federal and state oversight and uniform safety rules for the industry.
Until then, inspections and regulations left to the states were inconsistent, and there were no requirements for sprinklers, fire drills or safety plans.
The result was a series of multiple-death nursing home fires that killed an average of 15 people per year during the 1960s and early 1970s, said Tom Jaeger, of Great Falls, Va., a longtime consultant to the nursing home industry.
Now, with stricter safety codes and sprinklers in nearly every nursing home, the number killed in multiple-death nursing home fires is less than two each year, Jaeger said.
The industry has made great strides in reducing those fires, but health experts and regulators warned just this year that many nursing homes are ill-prepared for natural disasters after examining responses to Superstorm Sandy and Hurricane Katrina.
Some of the warnings being sounded today about evacuation plans are similar to the complaints that came up after the Nov. 23, 1963, fire, which killed all but 21 of the residents at the Golden Age Nursing Home in Fitchville, a village between Toledo and Cleveland.
The fire began just before 5 a.m. ET, in the attic of the one-story building, burned through the phone lines and spread before anyone knew what was happening. By the time firefighters arrived 10 ! minutes later, the building was burning from one end to the other.
Passers-by and employees managed to get a few residents out. Steve Pierce said his father went in four or five times before the roof collapsed.
"I remember his clothes smelled so bad I think mom said she had to bury them," said Pierce, who still lives nearby.
Jerry Earl, who was 18 at the time, said the flames were shooting through the roof when he arrived with his father, a fire chief in a neighboring village.
"The heat was so intense it melted a glass-block window into one big teardrop," he said.
Earl said he found one of the exits blocked by a wheelchair with a charred mass behind it.
Investigators said some of the victims died steps away from exits, adding that the large loss of life was caused by the lack of a plan for prompt evacuation.
Many of those who died suffered from dementia and were wards of the state and not from the area.
Henry Timman, a local historian in nearby Norwalk, remembered hearing about the fire on the radio amid coverage of Kennedy's assassination.
"You were just stunned at all that was happening," he said.
Even though the fire was so close to home, almost all thoughts remained focused on Kennedy, he said.
"We kind of put the nursing home aside until the president's funeral," Timman said. "It was overshadowed in a way, but its effects were far-reaching."
After the fire, which made the front pages in northern Ohio but wasn't carried on the covers of many major U.S. newspapers, Ohio's governor's ordered beefed up inspections of wiring in nursing homes. State lawmakers later established regulations that required sprinklers, fire exits and extinguishers while also giving the state more authority over nursing homes.
Congress instituted new safety codes that went into effect in 1970 and spelled out rules for building construction and fire safety. But it wasn't until this year that all nursing homes were required to have automatic sprinklers! if they ! wanted to qualify for Medicare and Medicaid reimbursements.