Making the choice to carpet.

As competition drives even greater efforts to provide a pleasant, home-like environment for residents and visitors, carpet as a floor covering choice in skilled nursing and assisted living facilities is growing in popularity. In fact, it is estimated that over 22 million square yards of carpet is installed in health care facilities each year - in corridors, patient rooms, public areas, lobbies, and offices. The only areas not generally carpeted are those areas that may have excessive or frequent spills, such as kitchens, restrooms, laboratories and supply rooms.

Carpet provides aesthetic as well as functional benefits to nursing and assisted living facilities, some of which are readily apparent, and some of which may be unexpected bonuses.

* Economy. Savings in actual construction costs can be significant when a building plan initially calls for carpet, since it is then not necessary to install any other finish flooring material prior to the carpet installation. Greater savings may be realized when floors in older buildings need refurbishing. If badly worn wood or vinyl floors are resurfaced, they may need another underlay material before the new hard surface can be installed. By specifying a carpet installation with attached cushion, "bad" areas can simply be patched. This levels the problem area and prevents premature, localized wear on the carpet, avoiding the need for total resurfacing. This solution can also alleviate asbestos flooring, while adhering to ADA standards.

* Safety. Hard surfaces may be appropriate for wheelchair users but are not always the safest choice for ambulatory residents. Wet or polished areas are a major contributing factor to most indoor "slip and fall" injuries. By contrast, carpet reduces the incidence of falls and cushions any falls that do occur: this translates into enhanced patient comfort and savings in medical costs, workman's compensation and insurance claims.

Carpet also reduces or eliminates reflected glare, minimizing residents' disorientation, and reducing staff members' leg fatigue - and increasing productivity - associated with walking on hard surfaces.

* Psychological "uplift." The prestige that carpet lends to any nursing facility is widely recognized. The sophistication of carpet dramatically enhances the feeling of quality and comfort in interior design and has the ability to "deinstitutionalize" a facility. The atmosphere improves both patient attitudes and staff morale.

* Noise control. Soft floor coverings are highly effective in controlling noise by reducing ambient sound and surface noise up to 70% and by reducing impact sound transmission from floor to floor. Carpet with attached cushion, or with a separate cushion, controls noise even more than uncushioned carpet attached directly to the floor. To appreciate this aspect of its total value, the cost of carpet should be compared to the costs of other flooring materials plus an equivalent acoustical treatment.

* Temperature control. The pile construction of carpet is a very efficient thermal insulator, reducing energy consumption for heat and air conditioning. The surface temperature of carpet is substantially higher than that over cold, hard surfaces, thus reducing coldness at foot and ankle levels.

* Air quality control. Most facility managers understand that carpet emits fewer emissions than most other indoor furnishings. Carpet also improves indoor air quality by holding airborne dust particles and allowing them to be removed easily by vacuuming. In studies, airborne particle counts were significantly lower in carpeted areas than in the hard surface areas, and bacterial counts at the carpet surface were lower than those at the surface of hard floors.

Selection Issues

As the popularity of carpet in health care settings grows, so does the complexity of product choice, not to mention questions about Federal regulations, installation, air quality, cleaning, and maintenance. To provide the appropriate carpet for specific areas, it helps to understand performance guidelines, color options, and functional attributes for elderly persons.

To ensure that you end up with the product that will meet your facility's aesthetic and functional needs - and will continue to do so for years to come some important decisions need to be made before you make your carpet purchase.

Loop Pile or Cut Pile?

Tufted or modular carpet is usually specified in nursing homes and is a densely tufted, level loop or cut pile, low pile height, construction. In corridors, lobbies, and patient care areas, loop piles offer good performance, retaining appearance and resiliency and generally providing a better surface for rolling traffic. Cut pile carpet, with its more residential appearance, is a good choice for administration areas.

Carpet's performance is associated in part with pile yarn density, ie., the amount of yarn in a given area of carpet face. A higher density and lower pile height, 1/2 inch or less, will be more durable, will accommodate rolling traffic, and adheres to the Americans with Disabilities Act (ADA) requirements. Minimum Federal (HUD/FHA) requirements for nylon carpet in facilities for the elderly are 20 to 24 ounces in weight per square yard, with a density of 3300 and up. An average, adequate density, where there is wheelchair, cane, and walker use, is 4,000.

Carpet surfaces that are too soft are easy to sink into and may cause loss of balance when walking. Large loops can catch on braces, canes, and walkers. Using a thin, dense cushion (either attached or separate), not more than 3/8 inches thick, adds to walking comfort and extends the wear of the carpet. To adhere to ADA standards, floor elevations should be carefully considered, using graduated carpet strips or ramps when vertical changes in level exceed 1/4 inch.

Fiber Choices

Nylon is by far the most prevalent fiber in use due to its excellent wearability, abrasion and stain resistance, resilience and favorable pricing. Olefin (polypropylene) has attributes similar to nylon but at a lower cost and is being used where the generation of low levels of static electricity is important. Nylon yarns can be enhanced with a conductive fiber to minimize static electricity for areas such as computer rooms.

Solution-dyed nylon is increasing in use because the color pigment is inserted into the polymers as the fiber is made. The color is throughout the yarn, offering excellent cleanability (some solution dyed nylon can be cleaned with diluted bleach), stain resistance, and colorfastness in extreme light. Wools wear well, but because they are more costly, are used primarily in office areas or boardrooms.

Color and Design

Color options are highly diverse and can provide a variety of stimulating or soothing effects. Mid-range colors and multicolor blends or heathers are best for hiding soil near entrances. (Walk-off mats are highly recommended to avoid tracked-in soil from the outside.) Research indicates that blues, greens, teal, mauve, coral, peach, and warm neutrals are preferred in nursing facilities. A new trend toward yellow and gold-bronze shades can be found in common and office areas, but not in patient rooms or treatment areas. There is also growth in the use of brighter, more stimulating colors,

Color can play a significant role in the care of patients with Alzheimer's disease. According to the Alzheimer's Association, patients seem to remember colors better than numbers; therefore, color in carpet can provide a link to a specific hall or wing.

In areas with visually impaired patients, brighter colors aid in depth perception and differentiation of areas, and lighter shades increase the light quantity in the rooms. A person who has difficulty keeping his or her head in an upright position may orient better from lower levels, including floor coverings. To accommodate these impairments, avoid bold patterns or swirls, contrast the carpet with wall colors to highlight the edges of the room, and choose carpet that contrasts with the furniture to prevent collisions.

Accent colors can be used to flag inclines or clarify stairways by alternating colors between steps. Both broadloom carpet and modular carpet tiles are proving to be useful way-finders in corridors and entryways. Acting as arrows, carpet can be cut and laid out in color-coded borders and patterns, pointing residents and visitors in the right direction.

Carpet borders can be used to accentuate certain architectural features, for example, borders or patterns placed beneath a skylight, mirroring its particular shape. An area rug look can be created by using wall-to-wall carpet with an inset in a contrasting color or pattern.

Antimicrobial Treatments

In response to the problems associated with resident frailty and incontinence, some manufacturers produce carpets treated with an antimicrobial product, both in the latex and applied on the face yarn. The treatment, a combination of disinfectants and fungicides, makes the carpet more resistant to the destructive effects of microbial organisms, especially fungus or mildew.

It's important to note that using an antimicrobial treatment does not eliminate the need for maintenance. Thorough cleaning is of utmost importance for any surface. Chemicals used for cleaning must be compatible with the antimicrobial treatment and must not cause interference with other solutions. For that reason, the manufacturer's recommendations for cleaning should be followed. In fact, manufacturers do not have warranties on antimicrobial treatments because the durability of the treatment is dependent on the type of cleaning methods and solutions used, the frequency of cleaning, and unusual chemicals used outside of the normal cleaning program.

It also is advisable to seal carpet seams well and, perhaps, choose a carpet with an impervious moisture barrier backing system and/or seal concrete slabs under the carpet in order to minimize the absorption of spills.

Flammability

All carpet sold in the United States must meet minimum Federal flammability standards for small-scale ignition sources, but additional local or state standards may also exist. The local fire marshall has the authority to establish additional specific criteria and should be consulted prior to writing specifications or purchasing carpet for a particular installation. Most carpet used in hallways or other exitways for nursing homes is required to have a "Class I" rating (for moderate traffic), according to HUD, to accommodate reduced patient mobility.

Air Quality

Choose a carpet that displays the Carpet and Rug Institute's (CRI) Indoor Air Quality Carpet Testing label, showing that the carpet has been tested and meets the criteria for low emissions. Also, choose a low volatile organic compound (VOC)-emitting adhesive displaying the CRI Indoor Air Quality Adhesive Testing label.

Proper Carpet Care

Once you've made your carpet selection, proper installation and a carefully thought-out maintenance plan become key in ensuring that your carpet will serve your facility well for the years to come.

Planning a quality carpet installation is just as important as determining which carpet to purchase. To that end, the Carpet and Rug Institute publications How to Specify Commercial Carpet Installation and CRI-104, Standard for Installation of Commercial Textile Floor Covering Materials provide details of requirements for measurements, seam locations, qualifications required of contractors, responsibilities of storage and delivery, preparatory work required, auxiliary materials - moldings, base materials, cushion, tested low VOC-emitting adhesives for glue-down the method of installation, responsibilities for cleanup, and ventilation. The CRI-104 is a minimum industry standard for installation and should be required of the installer.

A consistent and thorough maintenance plan, plus a plan to address unusual spills, is of importance, regardless of the type of surface used. Carpet only requires regular vacuuming and periodic cleaning, while hard surfaces require a schedule of mopping, buffing, stripping, and rewaxing, all of which use more chemicals and are more costly than maintaining carpet.

The carpet maintenance plan should adhere to manufacturer's recommendations for cleaning methods and should delineate low, medium, and high traffic areas, for determining the frequency of vacuuming and intensive cleaning. Regular, planned maintenance is considerably less costly and results in better carpet performance than "emergency maintenance."

A quality vacuum cleaner in good repair, preferably with good suction and an enclosed, high-efficiency filter bag, is essential to hold vacuumed dirt in the bag instead of blowing it back into the room. Both wet and dry extraction periodic cleaning methods are effective. Regular, scheduled cleaning before the carpet shows soiling is critical.

Conclusions

Advances in carpet technology have made carpet a congenial and beneficial floor covering for many areas of the nursing home. Selection should be based on factors such as underfoot safety, aesthetics, noise level, budget, walking comfort, and comparative costs of installation and maintenance. The visual beauty and comfortable, home-like atmosphere that carpet creates make it a viable choice.

The Carpet and Rug Institute is the trade association for the carpet industry, representing manufacturers of carpet and suppliers to the industry. CRI offers technical, consumer and issue-related information. For more information: Carpet and Rug Institute, P.O. Box 2048, Dalton, GA. 30722-2048. Phone: [phone] or [phone].

Kathryn O. Wise is Director of Public Relations and Communication for the Carpet and Rug Institute in Dalton, GA. She acknowledges the assistance of CRI's Technical Department and the information provided by member companies in the preparation of this article.