Picky, picky, picky

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Photo: Unimac
Photo: Unimac

Seniors entering assisted living today are said to be the pickiest bunch ever. And owner-operators are stumbling over themselves to please them. Could laundry service deserve a second look? Many vendors seem to agree.

A few things are abundantly clear:

  • Surprisingly, the healthcare laundry business has fewer parallels with the hospitality industry than it seems at first glance.
  • Although people who live in assisted living and long-term care communities want the same things hotel guests do when it comes to their linens, they're likely to complain loudly and more often if they aren't available, clean or comfortable.
  • Seniors have a profoundly different set of physical issues, many serious, that a typical churn-and-burn hotel laundry isn't built to handle. If factors like pH and caustic chemicals aren't addressed, little problems get big very quickly.
  • Residents also have expectations that typical hotel guests abandoned long ago.
  • Owner-operators continue to make inexplicable mistakes, most of which are unavoidable. Others, including those influenced by strapped budgets, simply aren't.

Resident expectations

One doesn't have to go far to see just how much of a connection seniors make between the life they left behind and the smell and feel of clean fresh bed sheets. When it surveyed 500 long-term care employees, Procter & Gamble found 85% of them agreeing with the statement that residents who are surrounded by familiar sensory [laundry] experiences, such as softness or fragrances, say they feel more comfortable and at home in their living environment.

As Barbara Richter, healthcare segment manager at P&G Professional, explained in a recent blog for sister brand McKnight's Long-Term Care News, “Rising expectations among family members of seniors are inspiring many extended care providers to offer more comforts and amenities to their residents.” Richter referenced a 2014 P&G survey of long-term care nurses, 98% of whom agreed that “the quality of the laundry system, including detergent, is important to a resident's well-being.”

Still, the complaints roll in. “Residents today are more aware of their surroundings and the services that they receive from the retirement community,” says Bob Dibble, a director of business development for EMS. “They express their expectations quite well and let us know when we fail to meet them. Residents who are alert and accustomed to their quality personal linens at home may be vocal about the linen that is used in a nursing facility. Failure to meet their expectations will result in frustration and dissatisfaction with the entire facility experience, not just the laundry/ linen service.”

Among the complaints, according to Dibble, are stained towels and wash cloths, stained, holey or torn bed linens, missing or ruined personal clothing and poor laundry turnaround.

Many vendors say more and more non-skilled senior living communities are installing or adding new space for on-premise laundries, or OPLs. The primary motivation is better control in hopes of not getting all of the aforementioned complaints. As Ricky Munch, on-premise laundry manager for Pellerin Milnor Corp., observes, “residents want clean, quality linen delivered on time. An OPL gives the operator full control of the linen and the amount of inventory they have on hand to meet their residents' expectations.”

“In terms of linen quality, most seniors want softer sheets and luxury towels with higher thread counts,” notes Seth Willer, national sales manager for Girbau Industrial. “With an on-premise laundry, operators enjoy complete control over quality, inventory, labor and production.”

“On-premise laundries are a big deal,” adds Bill Brooks, UniMac North American sales manager. “There's a reason that facilities hire their own nursing and care staff and devote resources to train- ing. It's about quality and ensuring that quality service is always delivered to residents. The same is true of the laundry. Processing laundry in-house not only is less costly than outsourcing, but perhaps more importantly, nobody will be more focused on the quality of finished linens than in-house staff.”

Willer claims the payback makes OPL a wise investment. “The value-added benefits of in-house laundry can typically outweigh the price,” he says. “Senior centers are looking to add amenities such as high-end sheet/bed packages to attract more customers at a higher premium. Equipment improvements can help you achieve better quality and production while maintaining a higher level of service.”

Willer said it's futile to try to pull the sheets over residents' eyes. “In many cases seniors are well aware of wash quality and the way in which linens feel and smell,” he adds. “Highly programmable washers and dryers and automatic chemical injection allow laundry operators to consistently clean a wide array of items according to fabric specifications.”

Still, Brooks and others believe higher-quality linens are only part of the solution. “For facilities opting for higher thread count linens, this is no small expenditure,” he said. “Therefore, the laundry must employ the proper processes to ensure not only a maximum lifespan for linens, but that linens emerge from the laundry with a high-quality look and feel.”

Meanwhile, Jim Keeley, vice president of management development for Healthcare Services Group, downplays the importance of expensive linens. “Upgrading linens [and] buying sheets and towels like they use at the Marriott or the Hilton does not really resonate with residents or families,” he says. “Higher-end sheets and towels are much more expensive and put even more pressure on the budget, making it even more difficult for the facility to buy what they need monthly. Secondly, no matter how top-end the linen is, the facility still only gets a limited amount of washings before the quality of the sheets and towels is compromised.”

Common mistakes

Owner-operators may look at the issue through a different lens, but vendors are quick to point to a few badly needed areas for improvement.

One of them boils to lack of education about laundry operations. “Whenever I'm asked about where laundries are falling short, it doesn't matter if the industry is long-term care, hospitality or something else; most of the issues are due to a lack of information,” Brooks says. “Most laundry managers think they have a handle on quality, chemical usage, costs and labor. But few could quote the actual cost-per-pound to process laundry or whether quality procedures and prescribed cycles are being followed. This is exacerbated when it comes time to replace equipment or a facility looks at outsourcing laundry. There is no baseline on costs. So I think the biggest mistake I see is just not having an overall handle on the operation, figuring that if nobody throws a flag on costs or quality, everything must be operating efficiently. That is usually not the reality.”

Hector Loureiro, on-premise laundry business development manager for Laundrylux, asserts that too many OPL managers, wrestling with both facility and resident personal garments made of myriad materials, grossly under- estimate their capacity, and end up grappling with stockouts and a host of service complaints. A simple fix would be a sorting system, which many don't have. There's a more serious effect, however. “The proper separation between residents and wash classifications can put a strain on the daily wash process,” Loureiro adds. “Proper cross-contamination procedures is an area that any healthcare facility needs to look closer at. Some of these issues can be addressed by adding a smaller capacity washer to supplement the room laundry.”

Another common mistake is the dearth of “science” about the effect of laundry chemistry on linens and seniors. For example, harsh chemicals, and even seemingly benign things such as fabric softeners, can reportedly impede or even aggravate wound care or bed pad absorbency.

A fundamental understanding of managing material resources is the root of yet another major mistake: inventory management. Munch asserts that major outages simply can be avoided with the OPL approach because it “allows the operator to carry less inventory ... [and] no longer depend on an outside company to deliver clean linen on time. Less inventory and less storage means the operator saves money.”

Keeley believes, in fact, that inventory, or lack thereof, is the biggest challenge long-term facilities face today with laundry. “Beside the requirement of meeting state regulations, not having enough linen in inventory leads to most of the issues facing the laundry and their attempts to provide quality service to the residents,” he says. The reasons for inventory snafus are influenced heavily by strained budgets, which force facilities to stock the bare minimum of linens needed. The problem is, something always happens to cause a sudden drop in supply.

“It's the number one reason old and worn linen makes it to the floors,” Keeley said. “Facilities often do not have the proper monthly linen replacement dollars budgeted and, even when they do, administrators often see this area as a place to control their costs by only spending a part of their overall linen budgets.”

Finally, simple, yet misguided, organizational issues can lead to a host of mistakes. One solution — a good labeling system — could stave off common issues like misplaced or lost linens or personal garments, according to Grant Lorge, associate product manager, foodservice and environmental, for Direct Supply.

“In some facility laundry operations, the staff fail to sort the residents' soiled clothes and check to see that each garment is labeled,” says Randy Brown, a director of business development for EMS. “They just load the washers and after drying, rely on memory, possibly returning the wrong item to the resident. Or, the item might just sit in the laundry until a resident inquiries about the missing item.”

Simple fixes

To recap: Seniors in assisted living can be demanding with laundry — to a point. They value thread counts, but even more, they value 24/7 availability and the TLC when handling their personal laundry. Check. More than anything, they attach value to the memory of cleanliness they were assured in the former lives. As Lorge observes: “We have seen that cleanliness in general can be linked to the perception of quality care. Having a reliable, fast and efficient laundry service helps to increase that connection. Also, as always, having a dependable laundry service also can help with an operator's infection control program.”

P&G advises the appropriate use of fabric softeners, whiteness enhancers (to rejuvenate the dingy), phosphate-free cleaners with a near-neutral pH and pre-treating stains. It also encourages OPL staff to keep a 2-4 par linen level inventory at all times (to extend linen life), energy-saving machines, proper staff training and staying on top of things like “unique laundry room conditions such as hard water, aging equipment and water temperature.” It also strongly urges OPL staff to inspect every piece of linen and laundry before it gets sent to a resident's room — something that dramatically cuts down on phone calls and nasty emails.

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