Among the many impacts that the COVID-19 pandemic has had on senior living communities has been an intensified focus on the crucial importance of maintenance to creating and sustaining a clean, safe environment. As Marc Manna, vice president of facilities maintenance for Pegasus Senior Living, says, an emphasis on maintenance should be a constant, but “in times of concern, the focus on these items does become magnified.”
“Now more than ever, providing a safe, healthy environment for our residents, associates, and family members needs to be a top priority,” Manna says.
Edward Burton, vice president of special operations at ALG Senior, agreed, saying “There has never been a more important time for good ongoing habits in maintenance and environmental services.”
Burton calls a healthy workplace environment “the lifeblood” of a successful senior living team that serves its residents.
Residents and prospective residents notice, too. Amanda Bakken, lead chemist, research, development, and engineering at Ecolab, pointed to a survey from the American Seniors Housing Association and ProMatura that found that the No. 1 factor to influence move-ins at senior living communities is “an environment with attention to physical safety and infection prevention and control.”
“Developing good ongoing maintenance habits is critical to helping achieve and maintain a healthy environment as they can have a direct impact on resident quality of life as well as top- and bottom-line potential,” Bakken says.
“Although the current climate has made healthy environments a more prevalent topic of discussion, healthy environments have always been a top priority within senior living communities — where residents live, socialize and dine in close contact with one another and are at a greater risk of infection.”
Maintenance can be enlisted to play a vital role in mitigating heightened infection risks in a community. Well-trained team members, Burton says, help monitor effective practices and contribute to the ongoing identification and treatment of new pathogens and other risks to the community.
“Keeping the health care environment clean from dangerous viruses and pathogens is a resident safety/care initiative,” Burton says. “Many of our residents have compromised immune systems. Everything that we do to prevent infection and cross contamination is job one.”
Donald F. Breneman, vice president of risk management and business operations at Juniper Communities, says all stakeholders in senior living communities need to buy into the importance of infection control.
“Routine best practices within the maintenance and environmental services department support practice standards for health and safety,” he says. “These high standards help promote an environment of well-being for all.”
Juniper emphasizes that the responsibility lies with everyone to practice basic infection control, he says: “By creating this foundation and threading it through all tasks, a greater success rate can be achieved.”
At the heart of this, Breneman says, is the understanding that “habits are formed through repetitive cues and training.”
“It’s important to diversify training opportunities in a way that supports the individual learning process whenever possible.”
Dan Forgacs, vice president of market intelligence and analytics for APPI Energy, notes that utility costs have risen dramatically in the past year, driven by factors such as a rebounding economy and a transition away from fossil fuels toward renewable energy. In this climate, good, regular maintenance and efficiency measures are more important than ever for senior living communities.
Best practices in maintenance start from the ground up, says Randall Towb, senior manager, business development senior living for Mitsubishi Electric Trane HVAC US. Good maintenance “requires knowledge of the installed equipment and accurate ‘as-built’ documents from the general contractor and mechanical contractor. I would say good maintenance starts during the construction of the building, and for HVAC, during the installation of the equipment.”
Skimping on preventative maintenance of large equipment in an attempt to limit costs is a mistake, says Michael Lewis, senior client advisor, energy solutions, for APPI. Strong maintenance habits and preventive equipment maintenance help identify potential or existing unknown issues that could prove troublesome.
“It is quite common to see equipment lose efficiencies, or older equipment kept running long past usable lifespans due to perceived budgetary constraints,” Lewis says. “While the upfront cost to replace older equipment is sometimes daunting, the true cost to maintain old equipment is often much higher than understood when high utility costs are not factored into the cost-benefit analysis.”
Lewis says a core challenge senior living operators face is weighing a cost-benefit analysis to older equipment or when to upgrade older maintained equipment.
“This is the typical chicken or the egg debate,” Lewis says. “Because of increases in utility costs, operators will see cost benefits to updating older and aging equipment as a cost-benefit in the current market.”
New, more sophisticated utility-related equipment often provides more automation and controls that can help reduce down time, help reduce demand charges for electricity, and reduce the volume of gas necessary to operate.
“These will be cost-saving measures that save operators money,” Lewis says. “Additionally, automation ensures facility maintenance technicians can operate equipment without years of training or loss of knowledge when employees leave or retire.”
“Similar to our bodies, when a building is exposed to pathogens and chemicals in the air, if you don’t properly maintain the airspace, then the building becomes sick,” says Larry Sloan, CEO of the American Industrial Hygiene Association (AIHA).
For that reason, improving indoor air quality is being viewed as an essential component of maintenance in senior living. Commit to C.A.R.E., an initiative launched last year by the AIHA and the Integrated Bioscience and Built Environment Consortium (IBEC), is focused on indoor environmental mitigation strategies.
“There’s just so much that can be done to enhance the quality of the air, and we haven’t focused enough attention on it yet,” Sloan says.
It’s not about one cure-all technique but “layer over layer of protections…a combination of strategies on top of each other,” Sloan says. “We talk about a holistic approach.”
Ken Martinez, chief science officer for IBEC, agreed. “It’s an all-of-the-above philosophy,” he says. “You need to look at your HVAC system, you need to get air filtration, you need to look at the amount of fresh air that’s coming in from the outside.”
For instance, Martinez says, dilution techniques and technologies can help reduce the risk of exposure to airborne viruses such as COVID. “You don’t have to be an expert in ventilation or HVAC systems to adopt these strategies,” he says.
Mitsubishi’s Towb says HVAC system maintenance is critical to the air quality and internal comfort of a senior living community.
“Typically, the two most important HVAC maintenance items are cleaning/replacing the indoor unit, or air handling unit, filters and cleaning and protecting outside condenser coils from dirt and dust buildup, saltwater corrosion, and damage from hail, ice, or snow accumulation,” Towb says.
Aspects unique to senior living can get special attention, Martinez says—using negative pressure ventilation, for instance, to keep pathogens from migrating from hallways into the rooms and putting vulnerable people at additional risk.
“Even if you can’t upgrade the ventilation system with more filtration, it is plausible to put a portable air cleaner in there to help bring down the concentration of what might be in that space,” Martinez says.
Breneman says rapidly evolving viruses require a response that evolves with them. Smart devices and other technologies can help senior living communities improve workflow efficiency in cleaning and reduce the use of harsh chemicals, he says.
For instance, Juniper Village at Brookline Skilled Nursing in State College, Penn., introduced “Violet,” a hospital-grade ultraviolet-light air disinfection system.
“Having higher-level technologies that are visible to both residents and visitors and family members also creates a higher level of trust in the infection control process,” Breneman says. “‘Violet’ is a great example of a highly visible tool in the community environment that also creates a sense of validation toward cleaning protocols.”
Ecolab’s Bakken recommends considering the impact on employees when adopting new equipment or maintenance procedures since those staff members will be doing the work.
“Emerging solutions such as ergonomic cleaning tools or high efficiency applicators can come with a learning curve so it’s important to pay special attention to manufacturer’s instructions for use as they may be new tools for the staff or present unforeseen safety considerations,” Bakken says. “There have also been advancements with environmental sensors that provide digital insights to help staff make more targeted decisions about maintenance, such as cleaning the most-used areas more frequently or addressing special risks based on residents’ habits.”
Increasingly sophisticated technology and equipment designed to improve air quality can help, but Sloan and Martinez caution managers to be wary of bold claims and to investigate these with the help of experts. While many technologies, such as ventilation filtration, are tried and true, others may not be as useful.
“It is a challenge to kind of separate the wheat from the chaff to figure out which ones are appropriate for your facility,” says Sloan. “There’s a lot of misinformation out there, and it can get very complicated very quickly.”
Emergency planning is an interdisciplinary process, but maintenance serves as “the driving force for compliance and education to the team,” Juniper’s Breneman says.
“Maintenance supports major systems of physical plant and other protocols, which might be impacted during emergencies,” Breneman says. “The fact is that emergency events have shown to be increasingly unique, and even with the best planning, every emergency plan must be fully adjustable. A great example is the transferability of IT infrastructure and communication platforms to evacuation points.”
Manna, of Pegasus, says preparation, planning and practice are at the heart of readiness for emergency situations.
“We focus on ongoing drills, emergency procedure manuals, and training,” Manna says. “Site inspections are conducted routinely by our risk manager. During the recent hurricane in New Orleans, we had to evacuate all of our residents to two of our sister communities. Through prior planning and preparation, we were able to do this successfully and keep the residents safe and comfortable.”
What matters for utilities in emergency planning is redundancy, says APPI’s Lewis.
“Understanding your options for backup power will move to an understanding of power requirements, natural gas requirements, and what is available from an infrastructure standpoint in your location, or what size of storage tanks will be needed to power cogeneration equipment in the event of a brown-out or power outage,” Lewis says. “This equipment needs to be tested regularly and all testing and preventative maintenance logs documented.”
Extreme weather conditions affect the electric energy grid in summer and winter, Towb points out. If a community’s HVAC uses minimal electricity, it helps create stable energy usage for community backup power generations and resiliency planning, he says. Remote access and preventative maintenance strategies can clarify when a system has problems in advance.
“For example, if you know one of your HVAC systems has a low refrigerant charge before the hottest summer days or coldest winter months, you can fix the problem in the shoulder season months to avoid costly emergencies,” Towb says.
Bakken says keys to developing and maintaining good maintenance habits include “establishing a comprehensive program that promotes a healthy environment, finding the right partner to help you achieve your goals, and implementing a validation process to help measure and optimize program effectiveness.”
Maintenance programs, she says, are becoming “more holistic” for a reason.
“Comprehensive programs…can help make the people in the community feel safer, be more productive, and have a better sense of well-being,” Bakken says. “Bringing together the right tools with the right procedures and program validation can help provide a comfortable, healthy environment.”
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