"The court decided to impose the death sentence on Lin Chi-hsiung because of the large number of casualties he caused and because he showed no remorse for his crime," a spokeswoman for the Tainan district court in south Taiwan said.
Lin, 67, a patient at the nursing facility in Tainan city, was found guilty of last year triggering the fire by lighting tissue paper and throwing it into a storage room full of clothes.
He was arrested hours after the incident and has claimed he started the blaze because he was upset about suffering from cancer and other chronic illness.
The fire erupted before dawn at the nursing facility, whose 115 patients included people in their 90s, with several left on their own to escape dense smoke that filled the building.
Closed-circuit TV footage taken moments after the blaze broke out showed hospital staff scrambling to put out the fire, while some elderly patients struggled to escape in their wheelchairs.
The government has ordered hundreds of hospitals and nursing homes across the island to complete fire safety checks and enhance fire drills in the wake of the incident.
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