Give 'em a hand

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Give 'em a hand
Give 'em a hand
You know Mary. She moves around noiselessly and unhurried each morning, tidying up residents' rooms, making the beds and emptying the trash. Even though she has been working for you for 25 years, it's easy to forget she's there.

Mary is one of thousands in long-term care who work in the often-overlooked domains of laundry and housekeeping. Whether it is sorting laundry, waxing floors or making residents' rooms more livable spaces, they perform some of the least dramatic but oh-so-essential tasks that keep facility operations humming. 

But, more often than not, higher-ups tend to undervalue these critical worker bees. Continuing to do so is a mistake, experts say. Not only are these employees vital to the workings of the facility, but they  are also capable of providing an often untapped source of resident care and satisfaction.

Role playing

A sad fact is that members of housekeeping and laundry are too often not recognized as playing a valuable role in a facility's operations, observers say. 

“I think from a resident's point of view … they are sort of invisible,” says Dr. Vicki Rackner, a former surgeon and president of Medical Bridges, a business that seeks to improve the doctor-patient relationship. “I think that they are often seen by management as invisible, too. They don't get attention unless there's a problem.”

Those problems could be an outbreak of C.diff or a shortage of bathing towels. In Rackner's case, one time it was a missing wedding ring that she had left tied into the pull string of her scrubs before operating.

“I will forever be grateful to elderly housekeeping staff who went through bins of unwashed laundry and found my ring,” she says.

Despite their role outside the realm of nursing care, they play a key role in the life of the facility, experts say. Beside providing the first defense in an emergency such as an infection control outbreak, they have an impact on the facility's presentation.

“How do people decide about a nursing home?” Rackner asks. “[For] a lot of them it's about how they smell. Housekeeping keeps the place smelling such that, Mom and Dad would be willing to go there.”
Unbeknownst to some, they also have a unique connection to the residents. They know intimate details of a resident that a direct caregiver does not have, experts say. 

“If you really want to know who the resident is as a person, ask the housekeeper,” says Diana Waugh, long-term care consultant and national speaker on long-term care issues.

Because of these employees' non-threatening positions, residents might open up to them in ways that those providing medical care cannot. Also, because housekeepers are in residents' rooms every day, they become familiar with small but pertinent details about the resident—such as what they like to watch on TV, how they like their environment kept and when they might not be feeling well. They also might have more time to spend with the residents than direct caregivers. 

“If you look at residents in nursing homes, probably the closest person to the resident is the housekeeper because they're in the room every day,” according to Ken White, director of environmental health services for Community Care of Rutherford County, a nursing home in Murfreesboro, TN. “They're not invading personal space in terms of doing personal care so, typically, residents are more comfortable talking to housekeepers ...”  

Paying proper attention

Experts in the field say nursing homes are missing out in not paying these employees special notice. Recognizing what these employees have to offer may come back to the facility in terms of improved morale, better retention and, ultimately better resident care. 

“Anything that you do that helps to enrich the life of the staff, I think, plays back in terms of better care for the older person,” says Nancy Bergstrom, a researcher at the University of Texas Health Science Centers' Center on Aging.

Taking time out to emphasize the impact this staff has on housekeeping and laundry services helps bring more value to these positions, according to Jim Keeley, vice president of Healthcare Services Group Inc., which provides contract laundry, housekeeping and food service to approximately 2,000 long-term care facilities. 

“It really needs be a conscious effort,” he says. “It's not necessarily throwing more money at them. It's making them feel more important.”

Eric Bates, regional environmental services manager for Bethesda Lutheran Homes and Services Inc.,  agrees. 

“The money doesn't mean as much to them as being listened to,” says Bates, who oversees the departments of about 80 facilities in the north-central region. “With my old-timers that's especially true. The fact they are being listened to and their opinion is valued means a tremendous amount to them.”
(Of course, small financial incentives don't hurt either. Some facilities offer gift cards and other rewards to show appreciation.)

Educating employees on the products they are using and also empathizing with their challenges outside of work are also motivators, according to Nicolas Valadez, manager of housekeeping at The Menninger Clinic, a long-term psychiatric center, in Houston. 

“Some have had the opportunity to go somewhere else and they have opted to stay here. That tells me they feel appreciated,” he says.

Caring for residents

Incorporating housekeeping and laundry into resident care is a way to generate this important feeling of ownership among the staff, experts say. It also will benefit short-staffed facilities.  

Consultant Waugh believes that because they know so much about residents, housekeepers should participate in care-plan meetings. 

“Knowledge is power. They have power,” she says. “They'll tell you such specific things [about the residents].”

One idea she would like to see nursing homes put into action is sending housekeepers on pre-admission screenings to potential residents' homes. Because of their keen understanding of residents and living areas, those employees could come back with precious details about the potential residents. As an incentive, the facility could consider doubling the salary for the three hours or so that the housekeeper spends at the home, Waugh says.  

“In my perfect world, they'd come back and we'd decide if we're going to bring [the resident] in based on the [housekeeper's] decisions,” Waugh says. “You want to talk about being empowered?”

Some facilities are successfully taking steps to recognize these employees and their importance in residents' lives.

Jewish Convalescent & Nursing Home in Randallstown, MD, is planning to incorporate laundry services staff in what are known as “learning circles.” These are gatherings of residents and staff to discuss concerns.

Such ideas are an integral part of the culture change movement, says Administrator Jennifer Labute.
“The idea is to make the decisions by those who are closest to the residents,” she says.

Mindy Jenson recently helped to incorporate the Customer Service Representative Program at Woodlands at Robinson, a 100-bed skilled nursing facility in Ravenna, OH. Laundry staff and other employees were assigned to resident rooms and expected to see their residents on a regular basis.

The laundry staff most enjoyed these visits–and were able to provide sound feedback, Jensen, former director of nursing there, notes. 

“It seems like the housekeeping and laundry staff are well-received by residents because they're not seen as threatening,” she says. “The residents will tend to talk to [the environmental services employees] a little bit more and will have time to spend.”

Cross-training efforts

Meanwhile, White's facility, Community Care of Rutherford County, is transitioning to smaller households as part of the culture change movement. It has begun to cross-train the environmental services staff as certified nursing aides “so we are in fact recognizing them as being trainable, as being more a part of the lives than most people would like to give them credit for,” White says.

Still, it's the little things that could ultimately make a difference. Kahbir Ashshakur is the supervisor of environmental services at Jewish Convalescent & Nursing Home. He prides himself on running a tight ship, not hesitating to come in during the middle of the night for laundry to ensure there is enough clean linen for the morning staff. 

“I try to be proactive,” says Ashshakur, who typically works from 6 a.m. to 5 p.m. 

He oversees 16 in laundry and housekeeping. His staff likes to earn  what are called LB or LifeBridge points, which allow them to purchase gifts from a catalogue.  He's also planning occasions for the staff each quarter, like a pizza party. 

But a happy resident is one of the best paybacks for him and his staff.

“It goes to show that we are trying ... to do the best that we can to make them happy,” he says. 
There is no substitute for feeling a sense of pride in what you do, agrees Cesare Tapino, administrator of Good Samaritan Nursing Center in Baltimore, a 146-bed skilled nursing facility. At his facility, unlike some others, employees receive full health insurance and differentials. They also have the opportunity to climb a career ladder. 

Stressing housekeeping's place in the overall mission of the facility is the best way to say thank you, Tapino says. Letting them know that they are part of a care team—and thus are responsible for responding to a call light while they're cleaning a room, for example—can reap rewards for the customers (the residents) and for themselves.

“By incorporating them into the holistic approach of what they do here, it makes them feel they have more meaning than cleaning a bathroom or mopping a floor,” Tapino explains.

“They could make much more working in McDonald's,” adds White of Community Care of Rutherford County. They choose long-term care “because they are committed to working with elders in the nursing home.” 


Meet the staff

They do your housekeeping and laundry—and much more

Lori Justman has worked on and off for 34 years at Bethesda Lutheran Homes and Services in Watertown, WI. 

Her love for the residents keeps bringing her back to the intermediate-care facility for people with developmental disabilities, she says. 

“They are my aunts, uncles and grandparents and my kids,” says Justman, 51, a wife, mother and grandmother.

For the last 16 years she has worked in environmental services. Cleaning toilets, vacuuming, dusting and mopping are just a few of the tasks that fill her days. She works a shift from 5 a.m. to 1:30 p.m. 
Because of her skills, Justman has one of the more prized jobs, says her boss, Eric Bates. She cleans the public spaces, such as the lobbies and corridors, as opposed to resident rooms.

He calls her the “cream of the crop.” While she does her day-to-day chores, she also does what is not asked of her–such as keeping an eye on a newly contracted laundry service. 

“She wasn't as confident as I was (about it),” Bates says. 

Since the service started, she has made keen observations and recommendations to Bates. Among them was a suggestion to set up the linen area to make it more organized for the staff.

“Most of my staff are just like that,” he says. “They care.” 

Victoria Coningham knows she can get paid better somewhere else, but she feels content working in laundry services at Community Care of Rutherford County, a skilled nursing facility in Murfreesboro, TN. 

“I love it,” says Coningham, 33. She says her enjoyment in spending time with the residents and working for her boss, Ken White, are reasons for her job satisfaction.  

A 13-year employee, Coningham works with the personal clothing at the facility. After the laundry washes and dries, she sorts articles and delivers them. She is also being trained as a certified nurse assistant, but she is not ecstatic about the prospect of doing nursing care. 

“I don't want to do it everyday,” says the mother of two. 

Her job is not easy—and some people don't recognize that, she says. 

“They just think you're dealing with clothes and stuff, but they don't realize you have to keep up with 131 residents' clothes and if one comes up missing, you have to pretty much search the whole building,” she says. 

Still, she says she does not need a lot of back patting.

“I'm here to do my job whether I get praise for it or not.”

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