Facility maintenance: an overlooked essential.

An Overlooked Essential

Budgets are tight these days, and operational margin expectations continue to become more aggressive. Too often, however, that means assisted living facilities cut back on maintenance. They might be tempted to prioritize spending on the more obvious daily support services, such as dietary. When constructing new buildings, they might trade off some quality in basic systems in return for direct resident care services. When operational budgets tighten up, it sometimes seems as though maintenance and housekeeping are the first to fall under the ax. In terms of overall market success and longevity, all of this is a big mistake.

Assisted living facilities tend to look old quickly. Incontinence and the use of walkers and wheelchairs pose the possibility of destruction. In a setting such as this, regular maintenance is a must; carpet, walls, rails and baseboards must be cleaned or repaired continuously and whenever necessary.

Another reason assisted living maintenance is a challenge is that the HVAC, sprinkler and fire systems can be unusually complicated in order to comply with local and fire department safety regulations and standards. Regulations also mean regular inspections. Not only maintenance, but also preventive maintenance, is, therefore, of major concern.

We recently turned to an outside contractor, BGE Commercial Building Systems, and have in the past utilized ServiceMaster in Chicago, to evaluate our maintenance programs. They recommended that we perform such regular maintenance services as changing filters, keeping coils clean, logging temperatures and checking the sprinkler system on an ongoing basis. They recommended appropriate time increments for doing this work, and they tracked the life expectancy of our equipment. We've found that an approach such as this has given our capital equipment a longer lifetime than was scheduled; we have, therefore, saved on replacement costs.

Assisted living poses other unusual demands on a maintenance workforce. When we hire maintenance workers, we make sure that they are not only qualified in what they do, but that they will be good at interacting with the residents. Going into a unit involves not just fixing something, but making the residents feel happier and more satisfied. For example, when people move in, we give the maintenance team extra time to put up shelves and pictures, place lamps and move furniture.

We have also found that our male residents like having our maintenance workers do special activities with them, such as workshops, where they can talk about tools. Many of the male residents miss having that in their lives. One of our maintenance men even used to take a resident on shopping expeditions with him to buy supplies, and the family was very appreciative.

In other words, we treat maintenance as part of the caregiving team. Our maintenance people, because they are actually in the resident units, provide an extra set of eyes and ears. They can see the wear and tear, notice when a cupboard door, for example, is getting unusually heavy use or see evidence of resident behavior changes, such as incontinence, that they can report to the director. Maintenance people give us valuable input when we do our individual service plans. In addition, our maintenance team is trained in first aid and CPR, as well as sensitivity training, the same training we give our caregivers.

We now staff with one maintenance director for a 76-unit residence and contract out for such services as yard work and such special projects as boiler repair.

When all this is considered, facility maintenance, far from being a budget-cutting opportunity, should instead be a viewed as an essential operational component receiving adequate budgetary allocation to function responsibly. In assisted living, this pays for itself many times over.

RELATED ARTICLE: Maintenance: The Assisted Living Difference

by David Ratliff

One major way that maintenance in assisted living differs from that in other long-term care facilities is that it is not applied to an institution, but to a home. There are extra requirements that go along with this. For example, we are regulated to some extent by our state's Division of Social Services, which has certain criteria governing safety measures and resident rights. This means we sometimes have to upset our own routines out of consideration for the resident or the staff - in essence, working around their schedules. Assisted living also differs in that facilities and equipment have a higher level of use. Most residents are ambulatory and very active. This higher level of activity translates into a need for higher-intensity maintenance programs. A building can go downhill quickly without them.

Beyond this, the basic rules of good maintenance apply:

* Get the information. You need a good set of blueprints, for instance, and background on all of your equipment. And all this should be organized into categories, so that it is easy to access.

* Document every step of maintenance, so that new employees don't have to start from scratch. You really need to assure "continuity of care," even in maintenance of your plant and equipment.

* Develop a system of preventive maintenance that is specific to your facility. Organize a checklist so that you know what needs to be done when. Our organization has created a basic outline that includes a system for creating work orders, an equipment inventory and a basic maintenance schedule, as well as a filing system and administrative backup to ensure that the plan is being implemented.

* Provide sufficient funding of personnel hours and materials to get the work clone well.

David Ratliff is facilities engineer at Liberty Healthcare Services, Wilmington, NC. For further Information, phone [phone].

Jacqueline Smedley is vice-president of operations for Constellation Senior Services, a senior housing development and management operation with facilities In four states. For further Information, call Trisha Weller, director of marketing, at [phone].