A new spin on an old issue.
ACCORDING TO INDUSTRY STATISTICS, the average continent resident of a long term care facility produces between 5 and 11 pounds of laundry per day. The number approaches 15 pounds for incontinent residents. The process of cleaning that many pounds of goods accounts for up to 5 percent of the average long term care facility's annual operating budget, and up to 40 percent of all resident complaints pertain to lost, missing, or damaged clothing. Clearly, dirty laundry is no drop in the basket!
Rick Kelly, marketing director at Pellerin Milnor Corp., a Kenner, La-based provider of laundry equipment, comments, "With staffing pressures and labor costs representing a major industry concern, selecting the right machinery is critical to saving money. Choosing more productive machines helps properties keep up with housekeeping requirements without spending more on labor." (See "Dos and don'ts of laundry," page 21.)
"One of the easiest ways to control labor costs is to choose machines with larger capacities," says Kelly. "Older machines with 50-pound capacities can now be replaced with 60-pound machines."
Other ways to save on labor costs with washer extractors, according to Kelly, are:
* purchase suspended machines that cushion vibration and provide smooth extraction, which helps prevent loads from becoming unbalanced, thus reducing stopping and recycling;
* choose machines with microprocessor controls that provide simple, fast operation with little training. Self-diagnostic features also help with troubleshooting and with maintaining productivity;
* select machines with large, conveniently placed door openings that make loading and unloading fast and easy, increasing productivity.
Who's doing the wash and where?
Mike Floyd, executive vice president of Continental Girbau, an Oshkosh, Wis.-based manufacturer of laundry equipment, explains that if you consider the cost of labor (which accounts for almost half the total laundry expenditure), space, linens and replacement, equipment, utilities, and chemicals, "you can launder in-house for between 21 and 25 cents per pound; using an outside linen service raises that to 35 to 40 cents per pound."
In addition to cost, Floyd believes that another benefit of handling laundry in-house is flexibility. "A nursing home produces a lot of dirty linen at all hours of the day and night, not just during business hours," he says. "Doing laundry in-house allows the facility to be a lot more sanitary because they can deal with dirty laundry on a 24-hour basis if need be." Floyd explains that since soiled linens are considered contaminated waste, "If you don't do your laundry on-site, you have to deal with a whole lot of waste-storage issues that can be a challenge."
Continental Girbau emphasizes introducing high-speed, soft-mount washers into long term care facilities. While traditional rigid-mount machines are bolted to the floor and have the capability of extracting up to 200 G-force, the newer soft-mount machines, which are not bolted in place, have internal suspension systems and can extract 380 G-force. Floyd explains, "This means that you can ore water out of a load of linen so that drying time and gas usage a greatly reduced."
Big feet, small spaces
Bill Cusack, capital equipment purchasing manager for HCR ManorCare in Toledo, Ohio, owner or operator of approximately 400 long term care facilities nationwide--and a Continental Girbau customer--says, The major problems we are facing right now concern getting newer equipment into some of our facilities, especially the older ones that have limited laundry space or laundry facilities on the second floor." Cusack adds, "It's tough finding qualified installers and service people for some of our more remote locations."
Like the industry as a whole, Cusack says that only a few of their facilities outsource laundry; about 98 percent handle it in-house. In an attempt to update its laundry equipment and lower costs, HCR ManorCare is switching many of its facilities from hard-mount to soft-mount systems. "Part of the problem with that," Cusack explains, "is that the soft-mount systems have a bigger footprint than the hard-mount machines, and space is already limited in many facilities."
"Another issue we faced recently," Cusack continues, "was switching from wet to dry laundry detergent." Cusack explains they did so because the dry is lighter; the wet detergent came in huge buckets that were heavy to lift. HCR ManorCare wanted to reduce the likelihood of on-the-job injuries.
'The Personal Touch'
Brian Huntoon, mid-Atlantic district manager for Genesis Hospitality Services in Kennett Square, Pa., says that the number-one laundry issue with which they were contending was lost or missing personal clothing. He says that not only are lost articles upsetting and inconvenient for residents, but that state inspectors are focusing more than ever on resident-dignity issues and that a center can be cited for lost personal articles. In response, Genesis Hospitality developed an innovative, company-wide program called "The Personal Touch," which is now being pilot-tested in two of its facilities.
Huntoon says that while most facilities use some sort of permanent pen to mark residents' clothing, Genesis developed a completely new labeling system. Their name labels are computer-generated and printed on a small white piece of cloth that heat seals at 300 degrees to clothing without damaging it and that survives at least 800 washings without fading. He says that by contrast, permanent markers begin to fade after about 50 washings and prove difficult to use on certain clothing items such as pantyhose. With Genesis' method, according to Huntoon, "You can mark anything easily and unobtrusively."
He further explains that the permanent marking method often bleeds through clothing so that you can see a resident's name, for example, on the back of her shirt as she is walking down the hail. He says this, too, can be cause for a state citation because it diminishes a resident's dignity.
The tale of the pink pajamas
Perhaps what's most interesting about Genesis Hospitality's approach to the problem is the way it wrote The Personal Touch program. It wanted to ensure that staff would read it, so it wrote the program from the perspective of a pink pajama top. The program begins with the top's arrival in a long term care facility in the baggage of a new resident and tells the story of its being logged in, labeled, and of its life and times being soiled and laundered in the facility. Huntoon says that one nurse reported that she couldn't put the 20-page program down until she found out what happened to the pink PJ.
Huntoon says that some of Genesis' 300 care centers nationwide have tried outsourcing laundry at times during the years, but the reasons that about 99 percent now handle laundry in-house are cost and product control. Huntoon says of laundry returned from outsourcers, "We were getting thin, torn gowns, or a hairball in the middle of a stack of washcloths, or sheets with some hospital's name on them. It's a state deficiency to have someone else's linen."
Huntoon comments that sometimes it's the smallest details that add up to sizeable costs. He says that many of the Genesis facilities recently switched from reusable to disposable diapers. The new disposables almost never leak, making the use of underpads on beds and wheelchairs largely unnecessary. But Huntoon says that many nurses still use them frequently out of habit and because they haven't been educated and trained sufficiently on the fact that the pads are now unnecessary. Diminishing use of the pads is important because they are one of the most expensive linen items to purchase and launder.
Similarly, although washcloths and towels are among the least expensive linen items to purchase, Huntoon says they are often used to mop up spills because of their ubiquity. "And with staffing shortages, it takes far less time to throw the dirty washcloth in the nearest garbage can than to walk it down the hail to the laundry bin. It all goes back to recruitment, retention, and training," says Huntoon. "The longer you can keep people, the better you can train them, and the lower your costs for so many reasons."
The dos and don'ts of laundry
Some pointers on what to do and what to avoid doing in the laundry room.
* purchase two small-capacity commercial washer extractors rather than one big one. Accumulating a full load takes less time; you'll have a backup; you'll be able to handle small, odd lots more efficiently.
* buy one high-speed and one low-speed washer extractor. The latter can be dedicated to no-iron linens, while the former can handle everything, thus reducing total price.
* purchase a machine versatile enough to launder lightly and heavily soiled items, plus everything in between. If budget permits, buy a programmable machine that prompts the programmer through each step.
* make sure the washing cylinder is big enough for bulky items. Washable drapes, pillows, etc., need sufficient room to tumble in the washing solution.
* purchase washer extractors with a pre-extract load distribution speed to help prevent damaging vibration during extraction.
* be sure front and rear bearings of the washer extractor are fixed in a single housing. This helps prevent damaging misalignment.
* get a dryer with 30 percent to 40 percent more capacity than your washer extractors to allow for effective airflow.
* select a dryer with a reversing cylinder, if possible, for faster drying and less tangling.
* ask if the dealer supplies complete equipment packages and offers laundry planning assistance.
* buy home washers to do a heavy-duty job. Industrial washer extractors are made to run all day and provide professional lift-and-tumble washing action.
* opt for two washing machines over one when: space won't permit two washer extractors; it's tough to work efficiently in a cramped laundry. Your budget won't permit two machines (usually, one large model costs less than two smaller ones).
* get a machine with a wash speed that's too fast. A speed of about 1 G-force or higher will inhibit the lift-and-tumble washing action.
* let wash-cylinder perforations compromise quality. Make sure they are big and plentiful enough to create a high degree of "open" area on the cylinder wall, allowing free flow of water, chemicals, and soil.
* sacrifice vendor accountability for a cheaper price. Is the company substantial? Do they have a track record of supporting what they sell? You should feel confident the vendor will be there later if needed.
* determine if utilities and drains already exist in the preferred location to minimize installation cost and disruption. But weigh this against production efficiency. Relocating a drain may let you position a washer extractor so that it reduces the travel distance between jobs.
* try to find a location on the main floor. This makes laundry-cart movement easier and enables you to install rigid-mount washer extractors, if they are preferred for other reasons, such as price.
* anticipate interference to cart and personnel movement when designing the laundry. Make a dimensioned sketch showing all partitions, doors, columns, drains, stairs, exhaust areas, and ventilation to help you spot potential problems. Check codes, restrictions, and permits, too.
* locate the laundry in or near the linen-distribution area, if possible.
* make sure wall and ceiling materials are relatively impervious to moisture, as a laundry is a high-humidity area. Materials should also absorb sound.
* consider swinging doors, as they facilitate cart movement. They should have windows for safety and bumpers or guards to protect their appearance. Thresholds should be flush.
* locate soiled storage and sorting near the washer extractors to minimize linen movement.
* position dryers near the washer extractors, but be sure they don't interfere with sorting, loading, or unloading.
* locate the folding area so that finished work is moving toward its final storage area in preparation for distribution.
* locate the laundry so close to resident rooms that any noise disturbs residents.
* place soiled- and clean-linen handling areas too close together. This could lead to recontamination of clean goods. (Some localities require that a wall separate these areas in health care laundries.)
* install adjacent machines too close together (or too close to a wall) if your washers have side-mounted supply injectors or necessitate side access.
* place machines less than 2 feet from a back wall if they require rear service access. If space is tight, locate machines in front of a large door to a hall or to the outside; the door can be opened to service the machines.
* put dryers too far from an exterior wall, as they must be vented.
* aim for at least 3 par of linen. This helps maintain a 40-hour work week and avoids costly overtime.
* have all room linen presorted on each floor, and then sent down to the laundry so it is received there in layers, resulting in faster sorting and higher production.
* ensure that all full-time employees do 90 to 100 pounds of production per operator hour. Check machine capacities, formula time, machine idle time, soiled-linen delivery schedules, etc.
* design washer extractor formulas for loading at an average of 1.5 loads per hour or 12 loads per 8-hour shift to generate optimum productivity (while maintaining quality), assuming machines are sized properly.
* provide hot water at between 140[degrees] and 155[degrees] F, as chemicals are designed to work best in that range. Proper washing keeps formula times where they should be and helps prevent linen damage.
* dry no-iron sheets and pillowcases only to about 5 percent of full dry. Make sure they're removed from the dryer promptly and folded to keep them from wrinkling.
* clean all dryer lint screens twice daily or more if needed for best drying results. Efficient drying saves fuel and prevents costly overtime.
* have room and restaurant linens counted to make up loads for every size of washer extractor you have on premises. Linens should be loaded into carts marked to show the loading level for sheets, pillowcases, etc. This makes load size consistent.
* make sure all stains or rewash do not exceed 1 percent. If the rewash percentage is higher, you should reexamine your formulas.
* check lighting For no-iron laundries, place lights above the folding tables. In ironer-equipped laundries, put them over the front of the ironer.
* buy folding tables that are no higher than 36 inches. Cut legs if necessary. This minimizes fatigue.
* keep the area between washer-extractors and dryers clear and clean for better production.
* operate the laundry during periods of low hot-water use to avoid increasing hot-water service.
* begin laundry hours until soiled linen starts arriving.
* wash pillowcases and sheets together. They should be washed in different formulas, as they are different soil classifications.
* underload washer extractors. Water compresses the goods, so it's difficult to overload a washer extractor.
* overload dryers, as this impedes airflow and slows drying.
* leave laundry in the dryer overnight. This could be a fire hazard.
* leave the laundry chute open. This presents a safety hazard.
* leave linens in carts for long periods. This is unsanitary and causes wrinkling and mildew in soiled linens. Freshly dried linens should be folded promptly to prevent wrinkling.
* leave empty chemical drums or open containers in the laundry.
* remove safety guards from the backs of washer extractors or dryers without replacing them.
* block makeup air inlets or dryer vents.
* forget to check air. Laundries with no-iron linens should have at least three or four changes of air a minute for best results.
* have the laundry equipment cleaned each day. Avoid lint buildup for safety's sake and chemical buildup for machines' sake.
* post maintenance information on machines, an adjacent wall, or other appropriate place. You can get this information from the instruction manuals.
* post the name and phone number of the dealer or service technician on each machine.
* make sure the machine is level Many service problems can result if the machine is not level.
* check the chemical pumps to make sure they're lower than the discharge end of the delivery tubes.
* if the maintenance manual calls for a specific type of lubricant, use it or its equivalent. Just because a lubricant is good for one machine doesn't mean its good for another.
* keep grease pails covered if you buy pails rather than cartridges. This keeps contamination out of bearings.
* check water levels routinely and adjust as necessary.
* ignore the manufacturer's required maintenance program.
* use laundry chemicals to clean machine surfaces.
Source: Pellerin Milnor Corp.
East Northport, N.Y.-based freelancer Lisa Maher is a regular contributor to CLTC.
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|Title Annotation:||management of nursing home facilities laundry equipment|
|Publication:||Contemporary Long Term Care|
|Date:||Nov 1, 2001|
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