It is the statement that every administrator in the highly competitive skilled nursing environment dreads hearing: “I don’t want my mom to stay here … this place smells.”

Enough of those bad impressions and a facility will quickly become history. Yet all too many provider organizations cut corners on laundry and housekeeping, putting themselves at a high risk of getting rejected by prospective clients due to an odor complaint.

“Most family members don’t know whether the nursing staff is competent, whether the therapy staff is qualified or if the administrative staff is caring, but they trust that those elements are in place,” says Jim Keeley, vice president of Healthcare Services Group. “But every visitor knows if there are odors in the building, if the rooms are dirty or if the linen is stained, and it is a major influence on their decision about whether Mom or Dad will stay there.”

Keeley’s says there are still a number of facility administrators who don’t understand that the facility environment is one area that visitors feel comfortable evaluating, and that it is the environment that is often what makes or breaks a facility’s reputation. Even if a facility recognizes that it has an odor problem and takes steps to improve it, Keeley says by that time, it is usually too late.

“There is an old housekeeping expression: ‘You will never get a facility clean enough to overcome a bad reputation,’” he says.

Kim Shady, senior vice president of on-premises laundry sales for Laundrylux, sees a lot of laundry rooms and says his impression is formed in the first three seconds of stepping inside.

“You can immediately see what expectations they set for themselves,” he explains. “High expectations are contagious. The best ones are clean, their equipment shines and they demonstrate proper linen handling. These may sound like simple things, but they don’t happen everywhere.”

While a bedbug infestation may not be as readily apparent to visitors as stains and smells, negative word-of-mouth can spread faster than the insects. After decades of dormancy, bedbug infestation has become an enormous problem across the United States, both the Centers for Disease Control and Prevention and the Environmental Protection Agency report.

In a joint statement, the CDC and EPA recently concluded that the current national problem with bedbugs “is likely due to the convergence of three human behaviors: lack of awareness of the historical and biological link humans have with bedbugs, increased international travel and past over-reliance on pesticides.”

Long-term care facilities are fertile ground for bedbugs, more than any other healthcare environment, says Patrick Copps, technical services manager for Orkin Commercial Services’ Pacific Division. A recent three-year Orkin study found a year-over-year escalation in bedbug outbreaks, with nursing homes being most affected.

There are several reasons for this trend, he says.

“First, residents have more personal belongings, that may come into the facility harboring bedbugs and are not addressed by the same cleaning practices used for facility furnishings,” Copps says.

“Second, long-term care facilities are highly trafficked with visitors who may also carry in the pests on handbags, luggage or items they bring to loved ones. Finally, studies have shown that the elderly may be less likely to react to bedbug bites, meaning that it could take longer to identify and address the pest’s presence.”

Copps recommends that facilities follow a four-step guideline to keep bedbugs from becoming a reputation-tarnishing problem, starting with staff training and methodical inspection, and upon discovery of bedbugs, immediate notification and plan-of-action protocol.

“Upon positive identification, you should be prepared to follow the action and treatment protocol that you have developed with the recommendation of your pest management professional,” he says. “This may include stripping the room of linens to be laundered separately from other bedding, preparing furniture for topical treatment, readying the room and its contents for heat treatment or disposing of infested items.”

Organization, systems key
As HCSG’s divisional training manager for laundry and housekeeping operations, Albert Raymond  knows what constitutes a top-flight operation. One thing they all have in common is a strong organizational structure.

“It starts with management — there has to be an organization in place,” Raymond says. “There must be an established system and procedures to follow. If the system isn’t set up, there is no way an individual can understand and maintain everything about that department.”

Along with organizational skills, laundry and housekeeping managers need to be strong communicators, Raymond says.

“Over the past 60 to 70 years, things have stayed pretty much the same in cleaning,” he says. “How you deal with employees and different situations is what has changed.”

In this day and age, there is no one concrete way to manage, Raymond says. Because the long-term care industry is so heavily regulated, he maintains that provider organizations must deal with staff in a way that is different from any other industry. Careful discretion must play a role in every management decision, he believes.

“Public relations is also very important — they have to know how to handle complaints from families,” Raymond says. “Occupancy rates are everything now and with that push, everything is magnified 100 times over.”

Staff empowerment is another important element, Keeley adds. He says managers need to make employees feel like they are not “the lowest rung on the ladder” and that they are instrumental in creating a safe and comfortable environment for residents. That can help create a care team that works together.

Rethinking laundry
Even well-run laundries have room for improvement. Shady says the need for upgrading efficiencies is nearly universal in long-term care. A truly successful laundry and housekeeping operation, he says, not only provides high-grade cleaning and decontamination services, but does it at the lowest energy and labor costs possible.

“Very few administrators have the knowledge about what makes laundry successful,” Shady says. “They don’t know about the effectiveness of the equipment or how to efficiently schedule staff. It’s just not something they think about.”

An important consideration for administrators, Shady says, is how labor relates to equipment and flow of linens through the facility. Frequently, he says what facilities will find is that worker scheduling does not line up properly with the workflow.

“The best solution is to stagger the starting and stopping times of the workers,” Shady says. “If everyone starts at 9 a.m., there is only enough work in the first 45 minutes of the shift to throw in a dirty load and sit and wait for it to be completed. At the end of the day, it’s the same thing: There are no more soiled linens to wash, but everyone is waiting for a dryer to be done so they can fold the last items. Spreading out workers across the shift is a good way to control costs.”

Careful monitoring of drying cycles is another way to chip away at expenses, Shady says. Checking the load to see if it’s dry before the timer ends could save five minutes per load.

“Five minutes doesn’t sound like much individually, but after 12 loads, it adds up to an hour,” he says. “That can produce significant energy and cost savings.”

More than cleanliness
A premier laundry and housekeeping operation doesn’t settle for minimum standards of performance. It shoots for the highest level of excellence, Keeley says.

“A quality job means more than simply good state survey results. There are in fact, many weak housekeeping departments who do well survey after survey because they benefit from very strong nursing departments,” he says.

“If the environment is a focus of administration and nursing leadership, the whole facility becomes part of the housekeeping effort and the results are great even if the housekeeping department is less than stellar.”

In most cases, what separates the best housekeeping and laundry departments from the merely average is personnel interaction with residents, families, visitors and co-workers, Keeley says.

“A laundry department that proactively reaches out to residents and staff, and participates in resident council and family meetings will be well-received for its involvement and concern,” he comments.

Housekeeping by its nature is more visible and more involved with the residents and the public, but Keeley says the best employees make the job personal, such as knowing the residents and their families by name.

“This elevates the housekeeping department to a high status,” he says. “In many ways, the housekeeper knows the residents better than the CNAs or nurses. Housekeepers spend 10 to 15 minutes a day in the resident room, emptying the trash and mopping the floors and maybe asking, ‘How are you feeling today’ or, ‘How was breakfast?’”

Ultimately, fine housekeeping and laundry operations are much more than clean floors and wrinkle-free linen, Kelley says.

“From the standpoint of the resident, it is Sally who cleans my room or Jennifer who delivers my clothes and chats for a moment or two,” he says. “Those things are what create a top-notch image.”

Integrated pest plans work best
Integrated pest management practices are an effective and environmentally sensitive approach to pest management that relies on a combination of common-sense practices. IPM programs use current, comprehensive information on the life cycles of pests and their interaction with people and the environment. This information, in combination with available pest control methods, is used to manage pest damage by the most economical means and with the least possible hazard to people, property and the environment.

Bedbug control is most effective when residents diligently participate. In multi-family housing, active participation is also required of the building management.

A comprehensive IPM program to control bedbugs should include a number of methods, such as:
*Using monitoring devices
*Removing clutter where bedbugs can hide
*Applying heat treatment
*Sealing cracks and crevices to remove hiding places
*Using non-chemical pesticides and judicious use of effective chemical pesticides

Sources: Centers for Disease Control and Prevention; Environmental Protection Agency, 2012

The case for in-room washers
Most skilled nursing facilities probably would not consider adopting an in-room washer and dryer, citing impracticality and cost prohibition. But that doesn’t stop Dan Hayes from making an argument in favor of it.

Hayes, president of Creative Laundry Systems, specializes in high efficiency washers and ventless dryers, which he says are tailor-made for older communities. While he’s not advocating supplanting central laundry operations, he says there are certain advantages to having in-room units.

“It’s a matter of safety, sanitation, convenience and status, and in senior living communities, it’s also a matter of pride and privacy,” he said. “Literally, no one wants to wash their dirty linen in public. There is a tremendous sense of shame associated with wetting your pants as an adult.”

In-room units have tremendous marketing potential for attracting new residents, Hayes said, citing a recent survey that found in-room laundry was the most-requested amenity in apartment searches.