The cleanliness challenge: the housekeeping and administrative viewpoints.

"Housekeeping is the one occupation with a staff that never runs out of things to do. We remove today's dirt to make room for tomorrow's." -- Patricia Grady

And removing that dirt in the nursing home has become increasingly complicated in the face of new regulations, new products, and staffing, environmental, and budget considerations.

Recently, Nursing Homes discussed these issues with executive housekeepers, Michael Ginsberg, REH, and Patricia Grady, REH, and nursing home administrator, Wallace Warren, NHA. Though their perspectives differ, their commonality is clear: the continual striving for a safe, clean living and working environment within the confines of budgets and government regulations.

What are the greatest challenges facing nursing homes today with respect to cleanliness?

Ginsberg: Motivating and training housekeepers in the face of increasing, constantly changing regulations poses a great challenge. And a combination of factors -- low pay, poor morale, high turnover rates--is contributing to a trend in which many executive and staff housekeepers are leaving the field.

Grady: It's becoming increasingly difficult to find qualified department leaders to educate an often under-educated housekeeping staff and help instill a sense of pride in their work. Nursing home housekeepers know they're viewed as less important than other employees and that has a significant effect on job performance.

Warren: I'm sure it's tempting for housekeeping staff to trade in all those regulations, the low morale and poor pay for a job at McDonald's for the same pay. Now that nursing assistants are becoming certified and demanding higher pay, many housekeepers are being left behind with respect to wages. Even long-term employees can only hope to catch up to the lower end of the pay scale.

What are the best ways to handle these problems?

Warren: Since morale and longevity are so closely linked to improved job skills, we need to provide as many educational opportunities as possible. It's important to remember that for many nursing home housekeepers, this is their first job outside the home.

Ginsberg: I developed a system of recognition that seems to bolster morale and improve job performance. Compliments from residents, visitors, or staff are announced and recognized by the whole facility and rewarded with stars that housekeepers redeem for free meals, gift certificates, or time off with pay.

Grady: We have similar programs. But I think something as simple as an administrator who takes the time to smile and say good morning to a staff member who is rarely recognized makes the greatest impression on my staff. I've always found that most housekeepers feel that the dollar issue is second in importance to a feeling of self-worth and pride.

I also use a great deal of teamwork and crosstraining, rotating the staff periodically to alleviate boredom and let housekeepers experience all aspects of the job.

How can administrators be sure they're hiring a qualified executive housekeeper or department head?

Ginsberg: Membership in the National Executive Housekeepers Association is a good place to start. NEHA has excellent certification and registration programs, with comprehensive training that includes all aspects of personnel management, from chemical control and housekeeping technique to sociology and psychology. They also have a job referral service that makes resumes available to administrators looking for qualified housekeepers.

Grady: Some local colleges offer the NEHA 330-hour program, and a correspondence course for that can be purchased to train executive housekeepers.

With respect to personal qualities, I feel that someone who can laugh at themselves, who's outgoing and a communicator, is likely to be an effective department leader.

What are some of the significant changes you've noted in cleaning products and equipment?

Ginsberg: Many of the older, heavier machines have been replaced with more advanced, easier to operate, one-step equipment. We have a terrific one-step carpet cleaning machine that fills and empties the tank, and puts down and picks up the water without heavy lifting. This not only makes the job more pleasant but also produces results that are seen almost instantly.

Grady: These days, if you don't review products every 3 or 4 months, you're falling behind. Today we have to deal not only with budgets, but with environmental effects and waste stream control. And because many nursing homes can't afford those new user-friendly machines, the easiest place to initiate change is chemical selection. There is an array of products available that are extremely safe and do the job with much less elbow grease.

What are the most important factors to consider in product selection?

Ginsberg: It's very important to make use of the executive housekeeper's expertise, especially during remodeling. They are rarely asked for input with respect to the type of carpeting, wallcoverings, and furniture being considered, and that can be a costly mistake.

Everything in a nursing home has to withstand a great deal of abuse and must be not only washable, but washable with the types of chemicals we're required to use. One of our facilities learned the hard way by putting down carpeting that couldn't be effectively cleaned or deodorized and had to be picked up and replaced after only months.

Grady: I think the most costly mistake we can make is to become locked into a single vendor. Administrators need to compare supply houses and work with the executive housekeeper to research and test an array of products. Claims that seem too good to be true usually are, and there's no substitute for product testing. Every property is unique with respect to housekeeping needs. And what works for your building may not work for the building next door. Those needs differ according to a number of factors: the type of flooring or wallcoverings, the way they've been maintained in the past, the type of clients, staff, traffic patterns, etc. Controlling the number of chemicals used is a top priority and mainstreaming is the most effective way to keep those numbers down. The first step is to review the products you're using and determine how many you actually need.

The new hospital-grade germicides are a good example, since they're also considered heavy-duty cleaners. So, by purchasing what may be a more expensive cleanser, you can eliminate the need for a separate odor counteractant and degreaser.

How can administration and housekeeping work together to select the best, most cost-effective cleaning products?

Warren: When an administrator makes a decision that affects housekeeping, it's important to make sure that the housekeeping supervisor has a clear understanding of the reasons for that decision; the big picture often involves departments other than housekeeping.

Grady: The greatest potential for cost-effectiveness is in a well-trained, long-term staff provided with chemicals that make their job as easy as possible. The result is a job done more rapidly and effectively, ultimately by a smaller number of people. We also need to improve interdepartmental communication. Housekeepers need to demonstrate and explain the pros and cons of purchasing specific products and equipment, and administrators need to become more familiar with the executive housekeeper's concerns, such as product efficacy, material safety data, and dilution rates. Housekeepers are responsible for, but often have no control over, those factors, especially in nursing home chains that use purchasing agents to simply buy the "best" product at the lowest price.

Ginsberg: I'd also like to see administrators become more involved in product selection and testing rather than simply opting for the least expensive product without considering the ramifications. Housekeepers should be encouraged to bring products in and test them, preferably right in front of the administrator. In this way, the housekeeper can demonstrate, for example, that buying a more expensive product may mean eliminating the need for two or three others.

Grady: When I wanted to test a product at our nursing facility, I sent a form to administration asking permission for a 30-day test (most companies will provide a month's supply of product free of charge for that purpose). After the test, I gave the administrator a checksheet with the test results and my recommendations so he was able to make a decision based on factual information rather than on the claims of some salesman.

The administrator, whose only concern is cost, can be sold on a product that isn't the best for the facility. At one point, I was able to convince administration to purchase a $3,000 piece of upholstery cleaning equipment by documenting the potential savings over contracting the service out. But that takes a willingness to work closely together and communicate.

Are you optimistic that the necessary changes will be made?

Warren: The cold, hard fact is that long-term employees are more economical. So, partly out of necessity, administrators are finally realizing that people aren't disposable and must be given the recognition they're due.

Ginsberg: As district secretary for the Texas and New Mexico NEHA chapters, I've been running the job referral service. I'm having a hard time filling positions with qualified housekeepers. Without a qualified director, how can you expect to have a qualified staff to do the job?

We have a great deal of good equipment and chemicals, but, at least in the Southwest, I'm seeing more people losing jobs than getting them and positions go unfilled. Those of us in the field need to show supervisors and staff employees that there's a future in housekeeping and to encourage them to work their way up the ladder.

Grady: That's very true. Housekeeping is really a neglected field. It's wide open, the opportunities are there, and the changes in federal and state laws have made modernization a reality. But we need directors who enjoy teaching and working with people. And I think administrators are finally realizing that not just anyone can do the job. So before too long, I think we're going to start requiring that housekeeping department heads be trained and certified. And what better person to teach the regulations than someone with training (as through NEHA) in those laws.