Something in the air.

Use this HVAC checklist to maintain a healthy atmosphere and decrease expenses.

Nursing homes are shrines of healing and nurturing. Yet, paradoxically, the very building that shelters the aged and infirm can harbor unseen environmental gremlins that pose a health risk to residents and staff. Discovering and vanquishing these gremlins is part of your job in maintaining a healthy environment. Your heating, ventilating and air conditioning (HVAC) system is

meant to help you, not harm you.

Why not treat your HVAC system as you would a troubled resident? If it complains, pay attention. If it's ailing, heal it. A little extra vigilance can make a big difference. And the cure may not be as expensive as you think.

Following is a checklist of five HVAC warning signs along with steps you can take to ensure a safe, healthy nursing home environment.

1

Frequent equipment breakdowns

Old or new, a neglected HVAC system has ways of letting you know something's wrong. When broken fanbelts, burned-out bearings, blown circuit breakers and other mysterious maladies start to cause too much downtime, it's more than an expensive nuisance. You are licensed to deliver a specified amount of properly conditioned outdoor air to your residents 100% of the time. As long as your system is down, you're out of compliance.

The answer to frequent breakdowns? Check the repair history of the various elements in your HVAC system. If you don't keep such records, start today. Check your repair expense records. Check the resident complaint log. If one piece of equipment is a repeat troublemaker, it may be unrepairable and should be replaced. And while you're at it, step up maintenance on the rest of the system to prevent trouble from striking again. What's that you're saying? You can't afford it? Let's save that topic for later.

2

Rising utility bills

Take a look at your fuel and electrical bills for the past few years. Are they creeping up? Don't just look at the dollars, because rate increases can account for cost increases. Look at the BTU and kilowatt-hour totals. If your consumption is going up even though your operating schedule has remained the same, it's a signal that HVAC efficiency is declining. Other than lighting, HVAC is your biggest energy user.

Energy waste is a problem worth tackling simply because it represents money waste. But it's also a sign of poor HVAC health. Things aren't operating as efficiently as they used to. If this hasn't shown up in the form of observable problems, it will later on. There's an axiom, sort of like Murphy's Law: Anything that wastes energy will break down, and at the worst possible time. If your consumption has risen noticeably, it's time for a professional evaluation and a mechanical tune-up.

And while the evaluators are in the building, ask them to advise you on the new non-CFC refrigerants you'll soon be buying for your air conditioning system. They aren't as efficient as the old ones so you may have to increase the cooling capacity of your system just to stay even.

3

Does it seem stuffy in here?

Nursing home residents are, of course, the world's greatest experts on what constitutes a comfortable living environment. Luckily for you, they offer this expert advice free of charge. While they may disagree on a perfect temperature, when they say it's too stuffy -- and you and your staff agree -- it's a serious matter you should investigate immediately.

Look again at the local health codes (many of them are tightening up on ventilating standards) and have an HVAC specialist measure the air volumes delivered to the various parts of the building. If the problem is limited to one part of the building, you may be able to solve it by simply readjusting a few dampers. But it's possible that the capacity of your fan system is inadequate for your present resident population, so that even under maximum operating conditions, not enough air is moving through the system. If that's the case, you're permanently out of compliance and will have to increase fan capacity.

Before things get that far, though, there's a much easier check you should make: How long has it been since someone changed the air filters? An air filter is a remarkable device: possibly the only inhabitant of your building that gets more efficient with age. As large particles build up in the filter, the holes get narrower, so smaller particles get trapped and less air passes through. Eventually, though, the struggling fan overheats and people start asking, "Does it seem stuffy in here?" Many is the red-faced administrator who overlooked a $10 filter and ended up replacing a $1,000 fan motor.

4

Environmentally-Induced Illness

The air you and your residents breathe must be free from harmful contamination. Adequate ventilation and proper filtration are only the beginning. The media has been scaring you for years with articles about Sick Building Syndrome (SBS). You should be scared. Those stories were written about people who got sick in the workplace, exposed a mere eight hours a day. Good or bad, your residents breathe the air in your building 24 hours a day. Many of them breathe it 365 days a year.

What are the symptoms of a sick building? It's one in which at least 20% of the occupants exhibit several of the following symptoms: headache, dizziness, drowsiness, fatigue, nausea and irritation of the eyes and respiratory system. While many of those symptoms are common among nursing home residents regardless of air quality, there's a better barometer -- your staff. If they exhibit these symptoms, it's definitely abnormal. And if the symptoms abate when people leave the building, it's a tip-off that there is a build-up of contaminants in your HVAC system.

But can you afford to wait for the symptoms to show up? Whatever the cause -- fungi growing in damp ductwork, evaporation of volatile cleaning solvents, improperly located air intake grilles -- you can hardly risk the consequences of an SBS outbreak. But there's only so much troubleshooting you can do on your own. If you suspect contamination, or even if you don't, a quick but thorough preliminary survey by an air quality expert is not overly expensive and well worth the price, if only for peace of mind.

While the expert is in your building, ask about outdoor air quality issues, too. The Clean Air Act of 1993 will soon impose new restrictions on the incineration of infectious waste. And disposal of spent fluorescent tubes is now closely regulated.

5

Inadequate humidification 

Humidity control takes care of itself in the summertime, at least in air conditioned facilities. An air conditioner dehumidifies as it cools. In winter, however, whether you use radiant heat or forced air, it can get very dry inside and that represents an increased health risk.

Studies document the higher incidence of respiratory illnesses, such as colds and flu, among people who live in dry air. Dryness causes cracking of nasal tissues, increasing the likelihood of airborne microorganisms entering the bloodstream. Dryness also affects the skin, particularly in the elderly, aggravating such conditions as dermatitis, winter itch, chapping and painful skin cracking at the joints.

Controlling relative humidity in the range of 35 to 50% during the heating season will minimize these risks. There is also evidence that proper humidification tends to reduce the effects of dust, feathers, etc., on people who suffer from asthma and hay fever. There's another bonus you'll appreciate: people feel warmer when there's more moisture in the air. One study concluded that a 20% shift in relative humidity is equivalent to a one degree shift in temperature. If dryness is a problem in your facility, mechanical humidification is something you should consider.

Self-Funding Solutions

Professional evaluation. Renovation. Replacement. Modernization. Preventive Maintenance. Five excellent solutions to the five HVAC warning signs just discussed. But how can you stretch an already taut budget to pay for them? Like the rest of the health care industry, nursing homes are under the gun to contain costs -- perhaps even more so. Even so, you cannot live indefinitely with conditions that may threaten the health and safety of your residents.

By looking at the capital expenditures as an integrated whole, there is a way to swing it without blowing your budget, even though at first glance the solutions may seem beyond reach. The key is offsetting expenditures with savings. Assured energy savings and avoided repair expenses, spread over a number of years, can generate positive cash flow which can be applied to major capital improvements that are financed over the same time period.

Energy savings come in many forms. The new generation of boilers, chillers and control systems is much more efficient than the units they replace. The same is true of the newer high-efficiency fluorescent lighting systems. Energy management systems regulate equipment operation to create more savings and watch for unsafe conditions as well. Preventive maintenance preserves the efficiency gains you've made. And a little extra training can turn your technical staff into energy conservation commandos.

This isn't pie in the sky. It's a strategy that is already gaining favor in the health care industry, both in large critical care institutions and smaller long-term care facilities. With today's funding realities, leveraging savings to pay for lower-cost operating systems may be the wave of the future.

Mark Shank is Director of Honeywell Inc.'s Health Care Unit, Minneapolis, MN.