The challenge for operators has always been keeping residents safe inside and keeping unauthorized visitors from entering the facility while maintaining a friendly, welcoming atmosphere. In an age where assisted living properties are marketing themselves as “home like” and “resident friendly” to prospective residents and their families, the need to balance security and freedom is becoming a paramount concern, says Sean Slovenski, CEO at Intel-GE Care Innovations.

“Managing efficiently and proactively is the most pressing security need facing assisted living facilities,” he says.  “Efficiently managing their staff resources to check up on and manage residents with the greatest risk of a transition of care is a pressing issue in this ever-changing landscape of aging and healthcare.”

For the most part, assisted living communities are doing an adequate job responding to residents’ security needs, says Steve Elder, senior marketing manager for Stanley Healthcare, but he maintains they need to take the next step for optimal protection. 

“They need to move beyond reactive mode into the analysis of data generated by the system to understand changing resident needs and ultimately arrive at predictive analytics,” he says. “Resident safety technologies like wander management or bed movement monitoring capture a wealth of data that can be used to make care plans better and more personalized.”

Because more assisted living facilities are taking on memory care residents, Elder says operators need to focus on providing a stronger security presence that meets their specific needs.

“Facilities need to expand their safety protocols to make sure that all their resident groups stay safe,” he says. 

Having memory care residents creates a higher security risk, which means operators need to review all their current equipment, staff training and processes, adds Mylinda Allen, a technology consultant for Direct Supply Technology Solutions.

“I am learning that the biggest impact is determining what equipment to use for this type of environment,” she says. “We are seeing a trend with a majority of memory care units leaning towards providing a locked, secure unit with access control versus adding wander management. A secured unit gives staff and family members peace of mind that the residents are safe and in an environment that is free from worn devices and bothersome noise.”

Yet while a locked unit may ease memory care security concerns, resident freedom is also an important factor in quality of life and needs to be addressed, says John Rydzewski, general manager of Direct Supply Technology Solutions.

“There needs to be a way to allow residents to move freely and safely through the community and campus,” he says. “This often means providing residents with a way to call for help, such as a personal emergency response device, that will alert caregivers when they need assistance. The next challenge is then finding a technology that will allow caregivers to more accurately and quickly locate the resident when they do call for help.”

Technology solutions

Technology has advanced the resident security field drastically over the past decade and it continues to evolve very quickly, Slovenski says. Among the product options are passive sensors that provide alerts on changes in behavior patterns, as well as when residents leave the premises.

“There are also mobile personal emergency reporting system products residents can use that allow a greater range of movement but still provide information on their whereabouts,” he says. “We are constantly testing new products for their effectiveness and integrating ‘best of breed’ into our software platforms.”

Amid a wide array of technologies available, Rydzewski says it can be a formidable process to find the one that will actually meet each provider’s needs.  

“When it comes to security technologies, many providers do not have the experts on staff to navigate and understand the technical aspects that may create a problems for them in the future,” he says. 

Choosing a security system is more about how a facility approaches technology than the specific technologies used, Elder says.

“The best results come with careful planning,” he says. “I’d recommend taking the time to thoroughly define your requirements, bringing in all the stakeholders in your community for input.”

Beyond surveillance

Effective security goes beyond watching and tracking residents in the facility — it should start at the bedside for memory care patients, says Maayan Wenderow, director of marketing for Early Sense.

“We focus on clinical safety and see the bedside as the center of safety,” she says. “The most challenging times for these patients is during the night. During the day, the staff can handle them; at night it is more challenging — the number of caregivers is lower and staffing is limited. These patients, when they leave the bed, they are at risk for falling and this is the time when most falls occur.”

While some bedside sensors rely on pressure, the Early Sense system detects motion and degrees of restlessness. 

“It gives caregivers an early indication of what the patient is doing in bed without having to be in the room,” she says. “By realizing what is going on at the preliminary stages, it lowers the risk of a fall.”

Patients and their caregivers attending an eight-week program showed improvement in depression scores and sleep quality, as well as their overall quality of life, according to Northwestern University investigators.

The training also helped patients and caregivers accept new ways of communicating, investigators found.

“The disease is challenging for the affected person, family members and caregivers,“ said study lead author Ken Paller, a fellow of the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern University Feinberg School of Medicine. “Although they know things will likely get worse, they can learn to focus on the present, deriving enjoyment in the moment with acceptance and without excessive worry about the future. This is what was taught in the mindfulness program.”

The study included 37 participants, including 29 individuals who were part of a patient-caregiver pair. Most of the patients were diagnosed with dementia due to Alzheimer’s disease or mild cognitive impairment, often a precursor to dementia. Others had memory loss due to strokes or frontotemporal dementia, which affects emotions as well as speaking and understanding speech. Caregivers included patients’ spouses, adult children, a daughter-in-law and a mother-in-law.

Full findings appeared in the Aug. 25 issue of the American Journal of Alzheimer’s Disease and Other Dementias.

“One of the major difficulties that individuals with dementia and their family members encounter is that there is a need for new ways of communicating due to the memory loss and other changes in thinking and abilities,” noted study co-author Sandra Weintraub, a neuropsychologist at Northwestern Memorial Hospital. 

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks of daily living. Symptoms typically first appear after age 60. Alzheimer’s is the most common cause of dementia among older people. 

A resident panel works like this:  Invite about 12 articulate residents and several immediate family members for a discussion session. Tell them the meeting will last about 90 minutes and they will be discussing how they went through the decision process to move to your community.  They will also discuss their current lifestyle experiences. In their own words, residents will be asked to offer their true, unbiased opinions on a number of other important decision issues.  

Tell them the 90-minute discussion will be moderated by a professional. You want them to help other seniors and their families in making important retirement living decisions for the future.  A moderator introduces the subject matter, but should not influence the residents’ objective responses.  You will ask them to sign a release giving you permission to share their experiences with other seniors who are considering moving to their community. The 90-minute session will be recorded and will be edited in DVD format to an efficient 12- to 15-minute summary.  

A carefully planned moderator discussion guide could contain a broad spectrum of up to 25 important issues. Let’s focus on senior living prospects’ concerns and misconceptions regarding financial issues that the resident panels should discuss. These include the following:

1. What was your first reaction when you discussed pricing?
2. How did this pricing seem to initially compare with your current cost of living?
3. What was your initial reaction regarding pricing versus affordability versus value? Did it change during your decision process?
4. How do you now define the “value” of your community?
5. Were you concerned about future monthly fee increases (then and now)?
6. Did you have to reduce your current savings portfolio or did you use some of your newly acquired home sale proceeds?
7. Did you experience some new favorable income tax deductions?
8. Do you now consider living here a sound financial planning decision? Why?
9. What advice would you give other seniors like yourselves as they go through the financial evaluation process for your community?

The 12- to 15-minute DVD can be used in a number of innovative ways: 1) shown during a sales and marketing encounter and tour, 2) a handout/giveaway for prospects or their adult children to take home and view, 3) show and provide DVD copies to attendees at planned community events.  This presentation can perhaps be integrated with other campus event central themes, 4) distribute as a communication resource to key agencies and referral sources, 5) offer viewing access on your web page (require that they register by providing their email address) and 6) use as a theme for a targeted broadcast email.

The resident panel can be a new innovative sales and marketing initiative using electronic media. The DVD provides permanent retention of a very innovative message, and can effectively communicate with some prospects and family members that you might not initially meet face-to-face. 

“Frankly, this is an outrage,” Pat Latham Bach, Psy.D., RN, told McKnight’s. Bach is the president of Psychologists in Long Term Care, a network of psychologists and other professionals focused on maintaining high-quality mental health services in senior living. “Older adults have once again been marginalized and forgotten, as they too have significant need for mental health services.”

Bach said that declines in mental health among older adults are significant, given age-related changes, mood disorders, functional impairment, medical illnesses, social isolation and other factors. Depression rates among long-term care residents are estimated in the 22% to 48% range, while those with thoughts of suicide range from 11% to 43%, Bach noted.

Stressed caregivers

A lack of necessary authority and struggles with management are among multiple factors contributing to nurses’ high levels of stress, according to recently released survey results. 

Out of more than 3,300 respondents, 75% reported that they do not have the desired level of authority to do their job well. About half said they “sometimes” have the needed authority. The survey was administered in May by the Vicki Milazzo Institute, which trains legal nurse consultants.

Nearly 90% of respondents said apathetic superiors and inadequate support staff hamper them. Lack of concern, favoritism, lack of current clinical information, poor communication skills and unrealistic expectations were among the management issues described by participating nurses.

Poor eating and sleeping habits linked to long shifts and struggles to maintain work-life balance also are common challenges nurses face, based on the survey results.

Body hidden?

A nurse at an assisted living facility in Georgia has been charged with concealing a body that was buried on the property, according to local news reports.

Police acting on a tip went to Rosewood Manor in Nicholls and questioned nurse Diana Marie Malphus Jacobs, officials said. She told them someone had been buried in a shed, and the body was recovered.

Investigators believed the body is that of a former Rosewood resident but were awaiting confirmation from an autopsy, local ABC and NBC affiliate WALB reported. Authorities still were trying to determine the cause of death and who was involved in the burial.

Soap warning

Experts advise healthcare facilities to avoid a “heavily marketed” soap in recent hand hygiene guidelines. 

Triclosan antibacterial soaps have proved to be less safe and effective than recommended products such as chlorhexidine soap and alcohol-based hand rub, according to recommendations from the Society for Healthcare Epidemiology of America and Infectious Diseases Society of America. Triclosan is often added to antibacterial soaps and body washes to reduce or prevent bacterial contamination. 

However, research has shown an increased risk of contamination and resistance with the use of triclosan-containing soaps. Past studies have found significant reductions in nosocomial infections and multidrug-resistant organisms when switching from using triclosan soaps to ABHR, the researchers noted.

“In the absence of clear evidence suggesting superior effectiveness in healthcare settings, combined with risks of resistance and contamination, use of triclosan-containing soaps in healthcare settings for hand hygiene should be avoided,” the researchers wrote. 

Katherine Ellingson, Ph.D., and Janet P. Haas, Ph.D., RN, CIC, are the co-lead authors of “Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene,” which appeared in Infection Control and Hospital Epidemiology.

Drug halts Alzheimer’s

An arthritis drug stopped the deterioration of cognitive functions and activities of daily living capabilities in Alzheimer’s patients in a small trial, researchers from the University of Southampton in England recently announced. 

The Food and Drug Administration needs additional funding and technical expertise to tackle some of the 100,000 mHealth apps on the market, only 100 of which have been cleared by the agency, said author Nathan Cortez, the Southern Methodist University Dedman School of Law Associate Dean of Research.

“There is a lot of faith that these can help with low cost and spotty access to care,” Cortez told
McKnight’s. “There are a lot of helpful apps but a lot of apps can’t do what they claim to do. They may even be harmful.”

By 2017, mHealth apps are expected earn $26 billion — up from $2.4 billion in 2013.

“You have venture capital flying into these products,” Cortez said. “On Capitol Hill, you hear congressmen and heads of industry talk about how these products might solve some of these deep challenges in healthcare. There is tremendous enthusiasm for these products across the board. I think tying the FDA’s hands is convenient for these companies in the short term, but it’s really damaging for the technology industry in the long-term.”

Many consumers, who may include seniors using apps regarding diabetes, dementia or pulmonary problems, are relying on the data provided by the apps. 

But bugs in the software or a software flaw could cause a user to make a bad decision. This could range from administering too little insulin to avoiding a necessary visit to a healthcare provider. 

Many hospitals and long-term care facilities are increasingly relying on apps to do their jobs. That’s less of a worry, Cortez said, but caution is still needed.

“If there’s a gradient and range of users we should definitely be most concerned about lay users with no training,” he said. But there is still “automation bias” among physicians using equipment.

Associated Factors

Falls are caused by many different influences, often in combination. Some common elements include:

• Medication — the major contributors are psychotropics (especially benzodiazepines, antidepressants, and antipsychotics), medications that reduce blood pressure and anticonvulsants
• Polypharmacy — one study found a 14% increase in fall risk with the addition of each medication beyond a four-medication regime, regardless of the group of drugs studied
• Orthostatic hypotension — researchers noted a 69% increased risk of having an injurious fall during the first 45 days following antihypertensive treatment
• Alcohol abuse
• Diabetes mellitus
• Confusion and cognitive impairment
• Gait and balance disorders
• Muscle weakness
• Poor vision
• Urinary incontinence
• Inappropriate footwear
• Environmental factors including home hazards

Impact of falls

Falls can have a huge effect on the quality of life of our elders, who may have diminished mobility following an injurious fall. One-third of those who have fallen develop a fear of falling again and often reduce their activities in order to decrease the likelihood of similar mishaps. For those who have fallen in a facility, staff may limit the resident’s activities. Restricted activities, whether self-imposed or enforced by others, can contribute to depression. As noted above however, prescribing anti-depressants can increase the risk of future falls.

Concealed falls

Due to fear that their independence will be limited, some elders may hide the fact they’ve fallen. Residents have confessed past falls to me in their psychotherapy sessions, saying they were afraid they’d be forced into a wheelchair if anyone knew, or that they wouldn’t be allowed to go home after rehab.

“Residents want a variety of activities, including those that are not childish, require thinking, are gender-specific, produce something useful, relate to their previous work, allow for socializing with visitors and participating in community events, and are physically active,” said Kathleen Weissberg, MS, OTR/L, education director for Select Rehabilitation. 

More than ever, communities are finding innovative ways to fulfill that need. What was once largely limited to bingo, bridge and basic arts and crafts has since blossomed into therapeutic activities that are rich in complexity, scope and content, and highly individualized, noted Pam Hayle, director of quality improvement at Augustana Health Care Center of Minneapolis. “Activity professionals have been examining their work in very different and exciting ways.” They’re asking tough questions about activity practice — such as why seniors are often steered toward childish or herd-like activities, and how facilities can better engage and interact with residents — and then translating that into systematic change, she said.

Providing a healthy mix of activities for all skill levels and cultural preferences takes interdisciplinary teamwork, and a willingness to think outside the traditional activities toolbox, experts noted. It also hinges on management and activity professionals’ understanding of value-based outcomes and the importance of designing activities that are well-planned, engaging and tailored to adults’ ever-evolving interests.

“Management has to see the value and support recreation as much more than keeping folks occupied so staff can just get their job done,” said Jenni Seaman, an account manager for It’s Never 2 Late. 

Assess for success

Experts say meaningful, resident-centric programming begins with solid assessments. Upon admission at Levindale Hebrew Geriatric Center and Hospital in Baltimore, residents are assessed on their likes, for example, past occupations and hobbies, and other interests. From there, ongoing assessments and targeted activities help paint a more detailed picture of resident needs and preferences, explained Amanda Bojan, a certified therapeutic recreation specialist at Levindale. 

“We have reminiscent programs where we can find out more about our residents and then brainstorm on how to incorporate their interests into meaningful activities,” she said. “We also communicate well with all staff on the unit. Some of these people know the residents better than we do and can offer great insight into what we can do to meet their needs — such as a resident’s desire to spend more time outside or work in the garden.”

Of course, thorough assessments also help determine functional ability. “It’s unfair to offer a resident an activity in which he or she is unable to fully participate,” stressed Weissberg. 

A therapist’s skilled intervention should involve evaluating functional areas that impact activity performance and providing treatment to address performance barriers. Many occupational therapists complete an occupational profile with clients where backgrounds, interests and hobbies are uncovered — and that information is then used to choose functional- and performance-based activities for treatment that will help resolve observed deficits, she continued. 

“This information can easily be shared with the activities department so they, too, can develop meaningful and fun activities,” Weissberg says.

Physical, cognitive needs

Resident activities must meet both the physical and cognitive needs of all participants, noted another rehabilitation expert. Many activities, such as bingo, crafts and current events-based offerings, are geared toward higher functioning residents, resulting in a portion of the activity group sitting, unengaged, Judy Freyermuth, clinical performance specialist for RehabCare, noted. 

“Many residents who are unable to engage in higher level tasks are left without stimulation, sleeping, wandering or perhaps sitting in the hall. In order to provide activities that meet the cognitive needs of all residents, therapy must work closely with the activities department,” she said. 

Therapy can assist the activities department in adapting programming for various levels of performance and can train activities personnel to assist or facilitate resident performance.  Activities should be adapted for residents with hearing or visual impairments, physical or cognitive limitations, use of only one hand, a language barrier, terminal illness, pain, room-bound, varying sleep patterns, diverse ethnic or cultural backgrounds, or behaviors such as wandering or agitation, Weissberg said. 

Dementia residents, especially, require thoughtful activities planning. As Cheryl Stollman, director of resident engagement at Silverado The Huntington Memory Care Community in Alhambra, CA, explained, activities that require sequential steps to complete may not be conducive for someone with dementia. 

“Those with dementia don’t necessarily think in a particular order,” Stollman explained. “Utilizing the brain creatively with free-form expression is much more
productive.” 

Baking muffins is one example of how activities can be easily modified to still engage all residents, including those with dementia. Rather than having the resident read the recipe and perform most of the tasks, they could be asked to stir the batter in the bowl, reasoned Susan Leport, caregiving manager for Senior Helpers. “The best part of any activity is the companionship and sense of wellbeing the activity can bring,” she noted.

Distractions can make or break resident activities, reminded Charles de Vilmorin, CEO of Linked Senior: “Research shows that residents will leave or withdraw if distractions are too high.” The same is true of activities that don’t adequately match interest or capabilities, he said.

Let residents lead

Great activities don’t always have to be run by staff. In fact, some of the most popular have residents at the helm. 

“Residents offer a wealth of knowledge, experience and talents that can really enhance activities within their own communities. Asking a resident to share of themselves and lead an activity can be a wonderful experience,” assured Seaman.

Fostering teamwork is an effective way to build camaraderie and drive resident participation. 

“Give more responsibilities to able-minded residents to lead activities, or in the very least, assume a role in them. Do activities as a team and give team members t-shirts and appoint [a resident] team captain,” suggested Dennis Berkholz, founder of National Senior League Games.

Wii bowling tournaments and other team-based games, and clubs for those with shared interests, such as art, music or travel (with a resident chairing the group) are also catching on. Levindale, for example, has book clubs, cooking groups and horticulture groups, to name just a few, which allows residents to stay rooted in their interests. 

Flowers are delivered to a different unit each week and residents gather to arrange them, according to Bojan. In the greenhouse and outdoor garden, residents plant, tend and harvest mint, tomatoes and flowers in raised beds. “They cook with the tomatoes and we’re using the mint in their tea this summer.”   

For memory care residents, Stollman stressed that special interest clubs — such as those geared toward cultural cooking, vintage cars or clothing — can be big hits with residents. “All these clubs need real-life props to enable an opportunity for peer engagement.”

Vista del Monte, a Front Porch retirement community in Santa Barbara, CA, has art-loving residents flocking to an art studio and loft where they create and display their work, and there’s even a woodshop on campus so residents can stay vocationally connected. Offsite excursions keep cultural interests sharp and have run the gamut from museums and music festivals to wine tasting, community exploration, restaurant visits, and more.  A new theory in activity programming, called enchantment, is also proving successful. As Hayle explained, this theory functions by creating a deeper intent around an activity to make it more meaningful to residents. Enchantment activities may include exercise classes with intent to walk five miles in a month, or community engagement with a social issue or humanitarian effort, she said.

One-on-one activities can be equally rewarding, especially if they involve engagement that honors a resident’s past. 

If a resident was a patriarch in the family who everyone historically sought for advice or assistance, a staff member can simply ask a resident if he or she would help with a productive activity, noted Leport. In fact, any engagement that enables normalcy and values residents as contributing members of society can help them maintain or recapture a sense of purpose and fulfillment, added Stollman. 

“Normalcy also means simulating an experience or passion an individual once treasured. This could be anything from a one-on-one walk outside to holding an associate’s child or caring for one of our community dogs,” she says.

Support self-discovery

Learning and self-exploration is another essential part of a successful activities program, experts say, as it fulfills the “intellectual” component of the six dimensions of wellness. Among other programs, Vista del Monte offers Spanish classes and educational slideshows, and a speaker series on various topics of interest. 

A strong mix of activities allows residents to branch out into other recreational pursuits. Preferences and interests change and residents often withdraw because their preferences are no longer matched, according to de Vilmorin. 

“One might assume that if Bill likes golf and the impressionists, that will never change and we should only adapt programs to his capabilities over time. That has been proven to be wrong,” he says.

Surveying and effectively communicating with residents is what keeps activities relevant and meaningful. 

“You have to know your residents and always be finding new ways to meet their evolving needs,” reasons Peggy Buchanan, director of wellness and vitality at Vista del Monte. “That’s how you keep them vital.” n

This spring, administrator Elaine Dyer increased the arsenal she’s using to attack the kind of superbugs and contagious diseases that threaten lives and cost long-term care facilities billions of dollars annually.

The Jewish Home was the first senior living community in the United States to buy a pulsed xenon UV disinfection robot, a mobile unit that can stop more than 20 pathogens from replicating and spreading. The robot has cut down on time Dyer’s employees spend disinfecting a room between one resident’s final departure and another’s arrival.

“Now, in about 18 minutes, I can turn that room around safely,” said Dyer, RN, BSN. “We still have to do the manual cleaning first, but this is an extra touch.”

Terminal cleaning presents an opportunity for deep cleaning and sanitizing that is nearly impossible in an occupied room. Turnover efforts ultimately affect other residents’ health, as well as a facility’s reputation and bottom line.

A recent Clorox Professional Products survey found that 71% of U.S. adults with a friend or loved one in long-term care cite cleanliness as a top factor in selecting a facility. One in five worried about infection because a facility didn’t smell clean.

Steven Schweon, RN, board-certified infection specialist, consults with facilities on preventing healthcare-associated infections or responding to citations. He said “inadequate” terminal room cleaning puts the next resident at risk of acquiring the same pathogens a previous patient may have been battling.

“Some of the pathogens can remain stable in the environment for weeks or months,” he said.

As vice president of clinical affairs for PDI,  J. Hudson Garrett assumes every unit is infected. Most communities can’t afford to culture seemingly healthy residents regularly, and that means many illnesses go undiagnosed. Even when cultures are used, more than half of all MRSA-colonized patients remain unrecognized, according to the Centers for Disease Control and Prevention.

“If we don’t do a good job of cleaning the room, there’s a 50 percent chance that the next patient that comes in there will get an HAI,” said Garrett.

Many operators are discovering the power of layering turnover techniques, and incorporating new products and technologies to improve outcomes. For example, Clorox Professionals this year has partnered with UVDI to market a portable UV lamp that supplements their extensive manual surface disinfection line.

“The partnership is an example of how a bundling of environmental surface solutions can provide operators with a more comprehensive approach to help reduce the threat of HAIs among residents, staff and visitors,” said Dane Dickson, Clorox’s research and development director. 

Clean, eliminate, kill

Every turnover effort should begin with manual cleaning, but experts say not everyone knows the difference between cleaning, sanitizing and disinfecting.

Cleaning with soap and water “does not necessarily kill germs, but it does lower their numbers,” Dickson explained. “Sanitizing lowers the number of germs on surfaces … (and) disinfecting uses chemicals to kill germs on surfaces or objects to further lower the risk of spreading infections.” 

Though Dickson said bleach is still the broad-spectrum “product of choice,” Clorox has expanded its professional offerings to help communities become a little greener. Healthcare Hydrogen Peroxide Cleaner Disinfectants are EPA-registered to kill most bacteria and viruses in 30 seconds (without volatile organic compounds — VOCs -— or harsh fumes).

Ecolab recommends hospital-grade Oasis 14 or A456-II products for routine cleaning but suggests ready-to-use Virasept disinfectant cleaner at turnover because it also kills C. diff.

Whatever products a community uses, PDI’s Garrett recommends turnover begin within an hour of a resident’s departure and focus on the nooks and crannies often missed when the unit is someone’s living environment. Get as much portable equipment, furniture and bedding as possible out of the room. Then follow written procedures to ensure every item is cleaned, he advises. 

“They should start with the high-touch surfaces and work their way out,” said Garrett. PDI’s bleach- and ammonia-free Sani-Cloth AF3 has a three-minute efficacy against 44 microorganisms.

Knowing who will use the product is critical, said Schweon. Should housekeeping or nursing staff wipe down an IV pole or mounted BP cuff? One CDC hospital evaluation found 20% of glucometer storage areas were contaminated. That could be because cleaning teams weren’t using the right cleaners. Seventy percent ethanol solutions are not effective against viral bloodborne pathogens and 10% bleach solutions could lead to device degradation.

Talking to vendor representatives about what solutions to use — and when — can help head off infections.

“I think they embrace that challenge of some of the more difficult items,” said Steven Hietpas, business development manager for Maytag Commercial Laundry. He said microprocessors on today’s washing machines are made to accommodate detergents activated at specific temperatures: use the wrong temperature and you might kill the active ingredients in an “ozone” cleaner instead of the infectious agent you’re targeting.

Ecolab’s Aquanomic Program includes solid, low-temperature laundry products that pair with the company’s SMART wash process to deliver utility savings and hygienically clean results. Their Advacare 120 Sanitizer Sour is recommended for facilities that must abide by EPA-registered laundry sanitizer requirements. But chemical pros know even the most advanced products are undermined by cross-contamination.

“Elimination of cross-contamination sources throughout a senior living community is very important for minimizing the spread of disease,” said Leah Larson, director of long-term care marketing for Ecolab’s Institutional business. “The laundry room and housekeeping staffs need to be aware of and follow correct procedures throughout the linen flow process from the very beginning of the collect phase and ending with the storage and use phases. Practices include use of proper personal protective equipment [PPE] … designated clean and soiled linen carts and storage areas, and decontamination of hard surfaces throughout the laundry room.” 

Technology moves in

For items that can’t be laundered, Medical Facilities of America opted for Vancare ESS carts in its 40 nursing and rehabilitation facilities in Virginia and North Carolina. The cart uses technology developed for cruise lines — a handheld gun sprays electrostatically charged chemicals that are drawn under and in-between surfaces — in a senior living-friendly delivery system.

“Before, we were using good products, but the application and the user variability weren’t giving good results,” said MFA’s Clinical Education Specialist Lajuana Jordan, RN, MSN. “We wanted something that would keep it as simple as possible for our environmental services folks while being highly effective.”

MFA staff use the cart once a week in all resident units, increasing this to three times a week in isolation rooms. They roll it in again for terminal cleanings. Instead of trashing or laundering items such as privacy curtains or pillows, those without stains can be treated by the spray, making turnover quicker.

Before instituting the roughly $7,000 carts system-wide, Jordan wanted proof they worked. Her team swabbed two C. diff-infected rooms treated with Virex 256 or Ultra Clorox and isolated 325 organisms (including acinetobacter, MRSA, VRE and pseudomonas). Thirty days after beginning the ESS protocol, the same sampling methods turned up just 10 organisms — all of them common environmental players such as staphylococcus coagulase or bacillus.

Jordan credits the carts with completely knocking out pervasive norovirus and flu infections that forced a 180-bed building to shut down admissions twice last year.

The ESS system requires non-toxic chemicals that are more costly than bleach. Gary Krupa, president of HAI Solutions, designed the cart for Vancare. He says its cost of use pales in comparison to what’s required to treat HAIs. They’re also marketable — to residents, families and hospitals that refer patients.

“The regulatory and payment stars have aligned” to force some operators to seek out these next-generation solvents and technologies, Garrett noted.

At the Centers for Living and Rehabilitation in Vermont, administrators followed the lead of an affiliated hospital and began using Sanosil’s Halo fogger to sanitize rooms. 

Each machine cost about $5,000 when Southwest Vermont Medical Center purchased them about two years ago.

Halo’s “fog” combines hydrogen peroxide and silver in a way that allows free radicals to attack microorganisms. Once it’s done its job, the mixture breaks down into water and oxygen. 

Constant application

European import Novaerus has built its reputation on its ability to reduce upper respiratory infections. The machines use airflow to pull microorganisms across a charged plasma field and destroy their cellular structure.

“Once the product is installed, that technology is working constantly to reduce airborne pathogens,” said Chief Marketing Officer Brendan Sullivan.

Since being introduced in Florida in early 2013, they’ve been ordered by some 100 operators in 20 states, according to Sullivan. 

The focus on airborne pathogens had grown in recent years, especially given an MIT study published in March that found some particles could travel much farther through the air than previously thought.

Dangerous organisms that live for long periods untouched by typical daily cleaning may be aerosolized again by vacuuming, wiping or other cleaning and room-arranging activities. 

According to Novaerus, routine use of its products (an average of 35 to 40 mounted units for a 120-bed SNF at $69 a month each) will keep zapping the germs. Sullivan said a mobile unit could conceivably be used only at terminal cleanings, but no long-term care provider currently is using it that way. 

I once had a perplexed operator tell me about a thankless soul who departed his fine institution to work at a local department store. He asked if I could believe that this ingrate would leave a place where she could do God’s work, just to work in a shoe department? Actually, I could. Especially after, ahem, putting the proverbial shoe on the other foot.

Let’s see: She was leaving a place where residents sometime berated her, where the work hours were routinely played with and where weekend and holiday shifts were the norm. She accepted another job that eliminated many of those hassles, and by the way, offered more hours at a higher wage. 

Yes, senior living can be an ennobling line of work. Its psychic and other rewards are often life changing. And few things could be considered more worthwhile than helping those who need assistance.

But too many operators let these potential payoffs get in the way of basic marketplace realities. Chief among them is that employees will generally opt to get the best deal they can. Does that make them selfish and ungrateful? Perhaps, but that’s kind of the way it is.

Given how physically and emotionally draining the work in this field tends to be, a certain level of turnover will always exist. And that’s not necessarily a bad thing. Those who do not possess essential levels of empathy, skill or commitment should not be working in this sector.

That being noted, the number of good people who do depart remains far too high. 

Much has been written and said about how to address the sector’s staffing challenges. But one absurdly simple solution often gets lost in the discussion: Make your community  a better place to work.

It starts with offering compensation that your competitors can’t easily overcome. But beyond pay and perks, you need to do other things that keep people around. That includes treating people fairly and with respect, not jerking them around (especially when it comes to pay and work hours), giving them a chance to move up, and not making them work for bosses who are a living nightmare. 

It’s easy and perhaps cathartic to talk about how good help is hard to find. But a far better option is to make sure you run a place where good help wants to be. n