BEYOND ANY DISTANCE EVER REACHED BEFORE TO FIND

THE BEST LAUNDRY SYSTEM IN RESIDENTIAL CARE FACILITIES

by

Kim Thu Tran

A Project Plan

Presented to the

Faculty of the Department of Public Policy and Administration

School of Business and Public Administration

CALIFORNIA STATE UNIVERSITY, BAKERSFIELD

In Partial Fulfillment of the

Requirements for the Degree of

MASTER OF SCIENCE IN HEALTH CARE ADMINISTRATION

DECEMBER 2017

Copyright

By

Kim Thu Tran

2017

Beyond any distance ever reached before to find the best laundry system

in residential care facilities

By Kim Thu Tran

This thesis or project has been accepted on behalf of the Department of Public Policy and Administration by their supervisory committee:

Chandrasekhar Commuri, Ph.D Date

Jinping Sun, Ph.D Date

I

Acknowledgement

I would like to thank my mom and dad for always supporting and believing in me.

Throughout the years, both of my parents always had faith in me, that I too would become successful in achieving success in my academics. I am blessed to have both of my parents care so much about me and wanting me to have a bright future. They have prayed a lot for me and always have been there for me to remind me that I am just as capable as other students who are also trying to accomplish success in college.

I would also like to thank my professors Dr. Commuri for his patience and for continually motivating and reminding me to stay on tasks with frequent follow up feedback appointments. Each of the appointments with him provided me with stable ground of where to go next with improving my paper and how to do so. Thank you, Dr. Sun for your continued support and guidance. Both Dr. Commuri and Dr. Sun have convinced me that, I, too can also accomplish my goal of completing the Master’s program. It has been quite a long journey. Thank you both Dr. Commuri and Dr. Sun for being so wonderful throughout this whole writing process. I am very thankful to receive both of your time and helpful feedback for me to even improve my paper throughout the semester. It has been a wonderful journey because I have finally made it. Thank you so much!

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Executive Summary Residents expect to receive care by health care providers in residential care facilities.

Health care providers are knowledgeable and skilled in what each person does. The existing problem at care facilities is a continuation of residents’ complaints about the same recurring misplaced laundry. The first thing, then is to identify that there is a growing need to fix this problem. Once there is realization that it is a problem is when it can be placed higher on the to- do list for the administrators to work with all his involved departments to agree on what will likely work and to decide on where or how to begin fixing the problem. Project RSQIC will be the first implemented plan to be practiced in care communities at first. If it turns out all components of this project shows efficiency and outstanding improvement, it can also be adopted by other care facilities too. Initially, laundry service issues were not seen as a complex issue.

Throughout time, with so much more research has convinced the researcher otherwise.

Therefore, whichever solutions are keeping the problem under controlled should be transparent to other care communities to adopt.

According to the Agency for Healthcare Research (2015), the six domains of health care are safe, effective, patient-centered, timely, efficient and equitable. Similarly, a solution that will work also has to be timely and effective. The established modified laundry system will be monitored to identify any additional modifications administrators will need to come up with to improve the laundering process. As of now, it is to the best interests of the organization to become more motivated to make time to control the number of incidences of misplaced or lost clothing. Without enough efforts from all the employees involved in the laundering process, one of the worst faced scenarios will happen: Time of thinking for a way to retrieve back the missing clothing. If the problem had been taken care of in the first place, there was never going to be a demand for how to find the misplaced clothing.

ii

List of Tables

Table 1: Comparison of all types of housing for older adults ...... 10

Table 2: Objectives and methods for the project ...... 25

Table 3: Points of Contact ...... 26

Table 4: Budget ...... 36

iii

List of Figures

Figure 1: Incidence of reported missing laundry ...... 12

Figure 2: Plan, Do, Check, Act model ...... 18

Figure 3: Theory of Change model ...... 19

Figure 4: Cost-related factor and health access ...... 20

Figure 5: Project Timeline ...... 32

Figure 6: Theory of change applied to modifying laundry process ...... 33

Figure 7: Budget Narrative ...... 36

iv

Table of Contents

Acknowledgement ...... i

Executive Summary ...... ii

List of Tables ...... iii

List of Figures ...... iv

Chapter One: Introduction ...... 1 Background ...... 2 Older Adults ...... 3 Description of Residential care communities ...... 4 The Study ...... 5 Statement of the Problem ...... 5 Purpose of the Study ...... 5 Research Approach ...... 6 Significance of the Study ...... 6 Overview of the Project ...... 7

Chapter Two: Literature Review ...... 8 Residential Care Facilities...... 8 Prevalence of laundry service problems ...... 11 Equipment in laundry department ...... 12 On-site versus off-site laundry services ...... 14 Policies ...... 15 Long-Term Care Homes Act, 2007, S.O. 2007, c. 8...... 15 New Jersey Title 8 § 8:36- subchapter17.8 ...... 16 Theory of Change and its Application ...... 18

Chapter Three: Project Plan ...... 22 Background ...... 22 Mission Statement ...... 22 Vision ...... 22 Values ...... 23 Objectives ...... 23 Methods ...... 24 Designated Assignment of Responsibilities ...... 25 Environment ...... 26 Issues and challenges for implementation ...... 30 Deliverables ...... 30 Timeline ...... 31 Outcomes/ Evaluations ...... 34 Budget ...... 36

Chapter Four: Summary ...... 39 Conclusion ...... 39

v

Recommendations ...... 40

References ...... 44

Appendices ...... 50 A. IRB ...... 51

vi

LAUNDRY SYSTEM 1

Chapter One

Introduction

In times when a caregiver decides to put their loved ones in a long-term care facility, it affects the older adult in certain aspects. Emotionally, their mindset may be too focused on negative thoughts, possibly thinking they are too much of a burden on their caregivers.

Physically, their health may decline because the older adult trying to transition into a new life style now has to get used to living in a new environment. Only the older adult themselves can exactly understand how tough it is to adjust to living in a new setting. Imagine for a moment what the older adults’ day may be like in these settings. The older adults now must live with a new and unfamiliar roommate. Families may visit their loved ones from time to time, but visiting a loved one is completely different from living with a loved one. These older adults often feel lonely and depend mostly on employees for help with various medical issues and services. An elder may only be familiar with a particular way of how their loved ones take care of tasks at home. This fact further shows the importance of making the long-term care facility resemble to a home environment. Missing clothing is not a norm of a home environment, so improvements within a laundry department will be necessary for a resident to feel more at home.

In particular, laundry is a task that takes place at home and in long-term care facilities. To this day, although the laundry process is being followed by facility staffs, somehow along the way clothes go missing. This missing of personal items can happen to anyone. Without a clear plan of how to reduce or eliminate this, families will be spending unnecessary money to replace the lost clothes. In addition, when institutions put in more effort towards solving a current problem, the continuous quality improvement inspector will more than likely have records regarding negative impact on residents’ self-esteem or lack of dignity. While some institutions

LAUNDRY SYSTEM 2 may not be aware, some elders attach meaning and memories to their personal laundry. For example, personal laundry has the same chances of disappearing as items with sentimental values to the residents, as a result, there should be changes to the laundry system so residents can continue to be at ease and rely on the staff the same way how these residents trust their caregivers if they were still living at home. Administrators and staff members must now start to utilize a new plan to eliminate the unnecessary time it takes to try to recover a laundry item.

Background

Lost Laundry and its effects

Lost laundry has remained one of the top complaints made by residents living in care communities. According to the National Research Corporation (2012), when an organization addresses a closer look at quality of services and resident’s overall satisfaction, the top concerns include care or concern by staff, competency of staff, residents’ inclusion in choices/preferences, and responsiveness of managers. Often, administrators do not weigh laundry misplacement as a heavy problem. Up to now, there is yet to be a solution to help address the problem of loss laundry. Usually, when a resident notice that he or she is missing one clothing article, he goes to the social services department to fill out the paperwork. Sometimes, the residents’ family member goes to social services department to address the concern. Complaints of lost laundry have been an ongoing problem. For example, the Long-Term Care Resident Satisfaction Survey revealed that only 43% of residents living at Schlegel Villages in Canada are satisfied with housekeeping, laundry and maintenance services.

The effects of lost laundry are residents not having adequate clothes to wear and ending up wearing clothes that do not belong to them. According to Herald (2016), the rights of residents, living in nursing home, includes the residents’ right to wear his own clothes. Solutions

LAUNDRY SYSTEM 3 to improve laundry systems in residential care facilities would ensure residents would have their clothes returned on time and, therefore, would be able to wear clothing that belongs to the resident. Any organization would take as much time and energy working towards solutions to best meet the expectations of residents living at its’ care facility. Despite how small a complaint may be that complaint should be given equal attention as with any other complaints to ensure residents are satisfied in all aspects throughout the resident’s entire stay at these care communities.

Older Adults

The population that residential care facility serves is older adults. Age must be considered when revising a new laundry system because of the physical limitations affecting how much the older adult are involved in the laundering process of their personal clothes. According to the

World Health Organization (2002), older adults consist of those ages 65 and older. Recently, because of advancements in technology and resources made available for older adults, the number of older adults is increasing (Healthy People, 2014). Because older adults are living longer, any institutions that serve older adults should continue to put in effort to focus on serving the residents currently residing at these institutions.

In regards to investment into solving a laundry system, a manager may examine how worthwhile it would be to finally get started on changing something about the laundry system.

According to the Centers for Disease Control and Prevention (2014), 21.7% of older adults not living in care communities are in fair or poor health. In 2014, 63.7% of older adults used adult day care services, 82.6% of older adults used home health agency services, 94.4% of older adults required hospice care, 84.9% of older adults lived in nursing home, and 92.9% of older adults lived in residential care communities (CDC, 2014). Through these statistics, the researcher is

LAUNDRY SYSTEM 4 able to see the range of different care needs required by each individual. For example, in these various settings, residents would need help with brushing their teeth, changing their clothes and bathing due to having weakness on any side of their body. The Centers for Disease Control and

Prevention (2009) revealed 6.9% of non-institutionalized older adults rely on someone else to provide personal care for the older adults. Statistics provides the researcher with more knowledge that the older adults’ health limits the daily tasks these older adults can do without any help. According to Centers for Disease Control and Prevention (2014), 30,200 residential care communities served 835,200 residents in the United States. There are 1,343 residential care communities that serve at least 110,000 residents (Canadian Institute for Health Information,

2001-2002). Residential care facilities are care for older adults who need long-term care, and it may be that these older adults are living longer, and the trend shows the number of residents choosing to live in care facilities is increasing. Since this is the case, it will definitely be beneficial for managers to change the status quo because changing one or more component of the current laundry system may show more improvement. Moreover, if an administrator does not change any component, he or she already will already know the same undesirable outcomes will result after the laundry staff does the laundry using the usual practiced laundering system. This information shows the problem must start to be in control to prepare for the influx of new residents coming in towards the near future.

Description of Residential care communities

A residential care community is one setting where older adults, 65 years and older, may be placed either after hospitalization or by the older adults’ families. The older adults are provided with different resources to meet their needs, which include a room, daily meals, medications, housekeeping, and supervision. According to the California Advocates for Nursing

LAUNDRY SYSTEM 5

Home Reform (2016), examples of supervision include the resident having help transferring from the bed to the wheelchair, have assigned days of the week where they have showers, and receive help with toileting. The residents will have transportation to their medical appointments as well as frequent eye examinations. Staff in different departments provides services to meet the needs of the residents in these communities. Knowing exactly what a residential care facility is helps the researcher know if clutter from the limited space each room has will limit the types of changes that can be done with the laundry system. This information helps the researcher to know to put space into consideration when planning a new laundering process. Information about residential care communities is important because it will increase the likelihood of longevity of a newly developed laundry system by requiring administrators to carefully plan which exact components to modify when planning a more effective laundry system.

The Study

Statement of the Problem

The identified problem is clothes disappearing somehow during the different steps of the laundering process. Administrators and team members struggle to find an effective laundry system that reduces or eliminates this problem. The problem is there may be a procedure on what to do when laundry goes missing, but there is a lack of adequate revisions to the prior laundering procedures even though the number of residents increases each year. Once after every couple of months of this occurring is normal, but when the frequency of missing clothes occurs more often than once every couple of months raise some red flags and encourage further investment of time in coming up with a solution.

Purpose of the Study

The researcher will study best practices of laundry system and develop recommendations

LAUNDRY SYSTEM 6 for residential care facilities. The purpose of doing this kind of research is to find out if a particular standardized laundry system will work also in residential care facilities, given all the factors of age and decline in health in these older residents living in residential communities.

Upon completion of this project, the researcher hopes that more residential care facilities will realize how putting more effort and time in developing solutions will help institutions meet the residents’ expectations. The purpose of this study is to recognize that the issue of laundry is more complex than it appears and more energy and dedication from all employees are required to make the problem become extinct. It will be important to investigate the status of involvement and prioritization of laundry and missing clothing on the care facilities task list. If other care facilities in other countries are able to invest time and effort into creating a solution that can last a long time, so can any residential care facilities in the United States.

Research Approach

This research is a content analysis of existing literature on the best practices in laundry systems in residential facilities. Evaluation of studies previously done will take place. The databases would include Academic Search Complete, ProQuest, and Google Scholar. The keywords that will be typed in order to obtain information about laundry systems in residents are

“personal laundry in facilities”, “long term care”, “laundry department does laundry in residential care”, and “lost clothing.” In regards to journal articles, when one article matches to exactly what a researcher is looking for, related articles link will appear on the left side column.

A researcher would click on related articles to find sources that are more helpful about lost laundry in residential care facilities. Because the research is about best practices of laundry systems, the only identified variable is best practices.

Significance of the Study

LAUNDRY SYSTEM 7

There are problems in each department. Without a deeper understanding of the root causes of laundry misplacement or without information about solutions found from past research, there would be not any direction from the manager to guide his or her employees about what to change about how the employees are doing the work. It would be difficult because there is nothing to compare the current laundry system at the residential care facility with. Because of this current research, future scholars or managers can view this as an external environment looking inside the internal environment. Sometimes, decisions are made solely just from self- determining decision making. Without a second view from the external environment, solutions are being narrowed down and the more apparent facts may just not always be right in front.

Instead, the manager has, unintentionally, buried the most common-sense factors from being too closed minded about what to change about how the laundry system currently works.

Overview of the Project

This project consists of background information about older adults, residential care facilities, literature review highlighting all factors that causes the problem of lost laundry in residential care facility. Then, the project plan will show specific tasks that need to take place.

All identified factors that caused the problem have been identified through the literature review, so the planned tasks to get closer to a solution of the laundry problem have been carefully considered.

The next chapter will focus on all aspects contributing to the problem. These factors are necessary to understand why the problem occurred. After knowing the reasons for why the problem occurs, the researcher can determine which type of new changes to the current laundry system would work. A literature review about laundry system will show the challenges with coming up with a revised laundry system.

LAUNDRY SYSTEM 8

Chapter Two

Literature Review

The transition from a home environment to a care facility is already a huge change for any older adult. Therefore, it is important to make the care facility resemble a home environment. One way to help the older adults adjust to a new living setting includes making sure their laundry always is returned to them in a timely fashion. Laundry is property. The purpose of this literature review is to describe the residential care facilities, prevalence of the laundry service problems, equipment in the laundry department, sorting and mixture complications, insufficient clothes labeling, on-site and off-site laundry services, application of the theory of change, and policies.

Residential Care Facilities

According to the California Advocates for Nursing Home Reforms (2008), residential care facilities are care communities where elders are assigned a room, are provided with services such as housekeeping, supervision, and help with any additional activities of daily living. Nurses are there to distribute or help the resident take their medicines. The Centers for Disease Control and Prevention (2011) shows that the size of a facility indicates the necessary number of beds at a residential care facility. For example, large facilities consist of twenty-six to one hundred beds.

A total of 381,800 residents live in these large facilities (CDC 2011).

Different types of residential care options exist. According to the Family Caregiver

Alliance (2006), various options include board and care homes, assisted living facilities, nursing homes, continuing care retirement community, and special care units for adults with Alzheimer’s or dementia. The level of care is different in each facility. Factors that affect choosing one facility over another includes the older adults’ ability to do daily activities

LAUNDRY SYSTEM 9 independently, the amount and length of time when receiving different resources, Medicare or

Medicaid, the older adults’ future needs, or size of the facility, or the older adults’ decline in alertness and orientation. For example, when a family believes their loved ones need to be in a small facility, he or she would choose board and care home because there are about six residents who live in this kind of facility. Personal nurses are able to provide family-styled care in board or care homes, but this ideal case scenario does not always happen in a fast-paced environment.

Assisted living facilities would be the best option for families who believes their loved one need limited independence because residents in assisted living facilities live in their own apartment while older adults also have nurses who assist the older adults when they need particular help with any tasks. A nursing home is the best option for older adults who constantly need supervision by healthcare workers. Nursing home healthcare workers provide medical services and nurses always supervise the residents in nursing homes. Continuing care retirement communities are large complexes that feature skilled nursing facilities and independent living. A family member would choose this one because of the flexibility it offers. The older adult is alert and becomes less oriented as years progress, the older will be able to move to a different residency option in the continuing care retirement community. Special care units serve elders with Alzheimer’s or dementia and special care units feature specialized security, trained staff, and therapeutic activities.

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Table 1. Older Adults’ housing options for varying case scenarios

Types Costs Level of Independence

Continuing Care Retirement $1,500-$3,500 per month High Community

Memory Care Support $3,000-$7,000 per month Low

Assisted living $2,500-$4,000 per month Low to moderate

Residential care homes $1,500-$3,000 per month Moderate

Skilled Nursing Facility/ $4,000-$8,000 per month Low to moderate (Long term care)

Respite Care $75-$150 per day Moderate

Home Care $20-$40 per hour Low

Adapted from “Senior Housing 101: Senior Care Types Explained.” Copyright 2017 by A Place for Mom.

Different care communities have their own policies on what their residents should bring.

Generally, the residents’ caregiver should have an admissions inventory list that should include warm and comfortable sweatshirts, vests or jackets, cozy socks, non-skid slippers enough to last for an entire week. Also, residents are encouraged to bring limited accessories, wallet or a favorite purse, soap, shampoo, lotion and toothpaste, soft and warm blankets or quilts, a small lap blanket, holiday cards or wall decorations, artwork or posters, family pictures in picture frames. According to the Missouri Long Term Care Ombudsman Program (2013), in regards to a residents’ inventory list, family members are allowed access to the residents’ personal property inventory list in order to add or delete items as necessary. Items may only be removed from the facility with the resident’s permission. In California, a form of LIC 621 (4/99) is provided to the residents and their caregivers, which is titled, “CLIENT/RESIDENT PERSONAL PROPERTY

AND VALUABLES.” Since there is such a form to help reimburse the resident, any care

LAUNDRY SYSTEM 11 community serving older adults should make as much effort to minimize incidences of lost belongings. Another important form that residents and their families are being provided with is form LIC 9059 (5/99), which is titled, “PERSONAL PROPERTY PROCEDURES (RCFE).”

Laundry Services and Responsibilities. According to the Haven Assisted Living (2013) usually, the laundry department, the residents’ family, or the resident does the laundry on site and belongings rarely leave the facility. Another option that a care facility has is to have a contract with a professional laundry service company to take care of only the linen from the care facilities. If the facility chooses Unitex professional laundry service, the company would handle all laundry for the facility (Unitex, 2016). Other times, the housekeeping employees send both the linen and residents’ clothes to the professional laundry service companies. When the laundry department employees do laundry at a care facility, there is a separation of linen from the residents’ clothing. It is only on rare occasions that the laundry staff unintentionally mixes residents’ clothes in the same load as the linens when doing a laundry load. According to

Boscobel Care and Rehab (2014), when a resident’s clothes become very soiled the staff may change a bed sheet for the resident, unaware that the staff also had placed the residents’ clothes on the old bed sheet so both the clothes and the soiled bed sheet end up in the laundry bin.

Prevalence of laundry service problems

Surveys revealed the comparison of percentages of the families do laundry for the resident or residents use the laundry services. According to the Health Quality Council of

Alberta (2014), percentages of the families who do not use the laundry ranged from 22 to 38%.

Percentages of the residents using the facility’s laundry services ranged from 62 to 78%. The results showed there are more residents who are using the laundry services at the facility compared to the number of residents whose families do their laundry. It is important to gather

LAUNDRY SYSTEM 12 this data to determine whether the facility needs to change the laundry process. Prevalence is the total of cases in a population experiences at a particular point in time. According to Frentzel,

Sangl, Cosenza, Brown, Evensen, and Keller (2009), loss of laundry was mentioned 1,771 times in 2008. Sources of complaints were revealed through the process of surveying frequency of the problem experienced. As displayed in figure one, 59% of the residents responded that their clothes were lost at least once throughout the duration of six months. Many survey respondents agreed that lost clothing contributes to the low-quality ratings in quality of services received.

Figure 1. Data showing the time span of the last six months and the how many percentages of the residents experienced losing their clothes when they used the laundry services at residential care facility. Adapted from “Alberta Long Term Care Family Experience Survey,” by the Health Quality Council of Alberta. Copyright 2008 by Agili-T Health Solutions, Inc.

Equipment in laundry department

According to Milch (1995) and Kim (2005), choosing the correct combination of equipment might solve laundry room problems. For example, Khatrii (2014) stated laundry equipment include a washing machine, an automatic cloth drying machine, ironing equipment,

LAUNDRY SYSTEM 13 steam press, tumble-dryer, and a trolley. In addition, Kim (2005) indicated the importance of determining proper equipment size for the care facility. A laundry department at a care facility may be limited to how much space it has. When the laundry room was first designed, there was not the knowledge that the amount of laundry (in pounds) being processed in a single wash cycle determines the best size for the laundry equipment. This may be due to a care facility growing in its size. The total number of beds in the care facility may have changed. This information is important because it would allow the laundry department manager to decide on how much more often to wash the laundry due to not having the best size for the facility’s laundry equipment.

The best size for each facility’s laundry equipment varies, due to varying data of incontinence, hours operating in the laundry room, and total number of beds in the facilities.

Singer (2001) and Rockefeller (2002) have suggested that personal clothes are not picked up and washed frequently enough. Singer (2001) supported this claim by stating there are overflowing bins of laundry inside resident's rooms waiting to be picked up for cleaning.

Laundry bins are being filled with a large quantity of dirty clothing. Potack (2000) stated that while the laundry department tries to put a handle on the clothing situation, a mixing of clothing may happen. For example, Milch (1995) stated lost items occur when laundry staff includes residents’ clothes with all the linens. The issue may be the time constraint that may explain why certain periods of time laundry staff may unintentionally put one article of clothing in with the rest of the linen, which causes the loss of residents’ clothing. Milch (1995) reveals how smaller items often become lost in the folds of larger items. This reveals that sometimes when a staff member is not aware, the clothes may be hidden underneath the folds of the bed sheets. When the bed sheets are all neatly folded, it is placed on the cart, and is delivered to the storage room.

It would now be clearer to see more locations where laundry staff can start looking when

LAUNDRY SYSTEM 14 searching for residents’ clothes.

Ober (1979) and Potack (2000) stated there is a relationship between adequately labeling residents’ clothing and increased retrieval of the residents’ clothes. Residents change rooms frequently for various reasons. For example, the Connecticut Network for Legal Aid stated that it may be necessary to move one of the two females from separate bedrooms into a room together to allow admission of a new male resident. Ober (1979) revealed that a higher percentage of survey respondents have the belief that clothing was returned to the wrong resident by the laundry staff. Information from the survey by Ober (1979) reveals that the staff may deliver clothes by depending too much on the information on the clothing label. It is hard to predict what kinds of situations a facility will face with regards to accommodating the residents living at that facility. When the laundry department writes down the resident’s room number on the residents’ clothing, it would be hard to determine if that resident still stays in that room or if the resident has moved to a different room. Information about inadequate labeling of information on clothing labels shows how the possibility of a resident changing room contributes to how accurately the laundry staff is able to return clothing to the correct resident.

On-site versus off-site laundry services

The benefits of having an on-site laundry department taking care of all the laundry in a care home includes reducing the time it would take to drive to a commercial laundry company for laundry services and having complete control over the washing process and laundry agents, and having less effect on how long the linen could last. Disadvantages of having the laundry department taking care of all laundry essentials may include costs of equipment’s maintenance and the inadequate amount of staff who are knowledgeable in laundry services. Each service at a residential care facility should remain on site. It makes sense to have laundry service in the

LAUNDRY SYSTEM 15 laundry department within the care facility because of the size of the facility. The researcher has an assumption that there is increased risk of clothes being lost in an off-site laundry company due to not knowing how many other facilities rely on the off-site laundry companies to take care of the laundry. According to Berendsen (2015), 81% of surveyed care homes in the United

Kingdom revealed there is lost laundry when laundry is done at their on-site laundry department in residential care facilities. As an alternative, residential care facilities rely on the Berendsen company to handle the facilities’ linens, towels and residents' clothing (Berendsen, 2015). There is reassurance that all laundry tasks handed down to Berendsen company will be collected, processed and delivered regularly and on time. A big laundry company that may contract with at least five other care homes and is much larger than a care home, has been able to reduce the problem through advancements in technology and other resources. Experts in laundry services contribute knowledge gained from past experiences to help develop new ideas for a company to be this successful in being one of the laundry service providers.

Policies

According to Vista Senior Living, Inc. (2000-2005), specific policies are stated in regards to tenant laundry services. Certain laundry procedures have a particular order for the staff in that department to follow carefully and also includes a policy about tenant housekeeping/ laundry schedule that states a requirement to have a regular laundry schedule to ensure these services are provided to tenants on the same day each week.

Long-Term Care Homes Act, 2007, S.O. 2007, c. 8

Because Residential Care Facilities are organizations that serve elders, so many laws and regulations exist to protect the elders. According to Queen's Printer for Ontario (2016), the Long

Term Care Homes Act provides a detailed overview to define all rules, and residents will know

LAUNDRY SYSTEM 16 what to expect and any specifics throughout the entire time of residing at that facility. Different components exist in the Long-Term Care Homes Act of 2007. Part two of the Long-Term Care

Homes Act outlines information about the residents’ rights, care and services. In regards to laundry services, the Long-Term Care Homes Act states specifically the following:

“There is an organized program of laundry services for the home to meet the linen and

personal clothing needs of the residents.”

Many sources have indicated the current laundry systems vary in the outcomes of residents’ satisfaction after the resident experiences the delays or non-return of their personal clothing.

Supporting evidence may indicate that the existence of The Long-Term Care Homes Act rarely has much effect on retrieving residents’ clothing or changes a care home’s laundry system.

New Jersey Title 8 § 8:36- subchapter17.8

According to University of Minnesota (2007), a law established in New Jersey includes policies and procedures in each care facility should reflect the following principles:

1. Storage and transportation of laundry; 2. Collection and storage of soiled laundry in a

ventilated area; 3. Protection of clean laundry from contamination during processing,

transporting, and storage; and 4. Handling and laundering of residents’ clothing and

personal items separately from other laundry.

It is not just enough to have categorized steps and components involved in each step. Each residential care facility should have posted policies detailing its unique personal laundry service

The intention of the law is to have all facilities abide by the law on all occasions when the laundry department staff does the laundry. The complexity of following the policy occurs when other department staff are involved in one or more of the four steps mentioned above. For example, certified nursing assistants are around the residents to either help bathe the residents or

LAUNDRY SYSTEM 17 dress them before they go to the dining room. Each time the certified nursing assistants change clothes for the resident, the certified nursing assistants are involved with step 2, collection and storage of the process. The law in New Jersey indicates the laundry services are affected due to at least one of those four steps. The policies that facilities will develop will be limited to storage, collection, protection, and handling. If a facility only looks at the principles as guided by the law in New Jersey, it would not take into account any miscellaneous causes of the problem. There may still be a lack of knowledge of which area in the laundering process to modify when administrators take any part in modifying their current policies for their facilities.

Continuous Quality Improvement strategies such as using a Plan, Do, Check, Act model will be important to further help a researcher to move closer to developing a solution to the laundry problem (American Society for Quality, 2017). During the planning stage, all team members will identify the order of tasks and set goals. Doing involves having the planned actions take place and figure how to achieve desired goals. Check involves methods to determine how effective or ineffective the implemented actions actually were, and to report on worsening or improvement of the problem. Act involves team members to evaluate and to re-modify improvement plan to fit the residential care facility’s needs. Plan, Do, Check, Act model is a continual improvement plan in which the rotation will not just finish at Act after the first round, but will rotate all around the four steps over again multiple times.

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Figure 2. The model of Plan, Do, Study (Check), Act as a method for continuous quality improvement. Adapted from “Science of Improvement: Testing Changes.” Copyright 2017 by the “Institution for Healthcare Improvement.

Theory of Change and its Application

Dyck (2005) indicated the need of quality improvements in nursing homes. According to the 2006 National Survey of Resident and Family Satisfaction in Nursing Facilities, 73% of the families and the residents rated the meals, laundry services, cleanliness of the premises and management responsiveness, as excellent or good (My InnerView, Inc., 2007). The quality of services is too broad, which makes it hard to know exactly which areas out of all those components may have the lower ratings. The data from the 2006 National Survey of Resident and Family Satisfaction in Nursing Facilities also shows 32% of families and residents are dissatisfied with laundry services.

According to Learning for Sustainability (2017), the theory of change will be used to help understand the laundry system problem and reveal ways to improve the laundry systems.

The laundry system needs to last for a long time and needs to be evaluated often. Usage of the theory of change will help the researcher to make meaning of what will it all take and how to do

LAUNDRY SYSTEM 19 so with regards to planning and creation of a better laundry system. All efforts are focused in a way to bring about the ideal changes. In this case, the ideal situation is increased retrieval of residents’ missing clothing.

According to Learning for Sustainability (2017), the first component of the theory of change is stating the current situation is. The current situation in this case is reported cases of lost laundry. The inputs or what the facility must invest are time, money, equipment, policies, rules, experts in laundry services, commitment, professionalism, training, and education. In regards to efficiency, the necessary activities include serving all residents adequately in high quality care to ensure great output of having highly satisfied older clients receiving all the services they need.

The intermediate outcome would be decreased complaints about laundry services. The long-term impact is increased clients coming into one particular residential care facility. All aspects of the residents’ complaints have been addressed, no matter how small, and that should always be the main focus for a manager at any care facility.

Figure 3. Theory of Change developed by Chen, Rossi, Patton, Weiss, Kirkpatrick, and Stufflebeam to gain aspects of quality improvement. Adapted from “Theory of change,” Copyright 2017 by Learning for Sustainability.

There is limited information in the United States about different approaches to further understand why the current laundry process contributes to residents’ prior experiences of losing their clothes. More articles are being written related to worker’s injury during work and ways to

LAUNDRY SYSTEM 20 prevent the injuries for the employees working in residential care facilities. Residential care facilities in other countries are where residents’ problems, such as lost clothing is discussed. Not a lot of research articles discuss the problems faced by residents. Countries such as Canada and

United Kingdom have more sources available to increase the researcher’s knowledge of misplaced clothing. Based on research by Robertson, Gregory, and Jabbal (2014), the percentage of the population in the United States facing cost-related access to health care is 37%, as compared to the population living in United Kingdom or Canada. This may be due to the United

States not fully reaching the goal of patient centered care. Patient centered care actually focuses on more aspects of residents and ways to improve the resident’s quality while living in residential care facilities. This may have a direct correlation with other countries’ advancements compared to the United States in terms of quality of care.

Figure 4. Comparison amongst different countries whose residents faced Cost-related barriers to accessing needed health care in 2013, in percentage. Adapted from “The Social Care and Health Systems of Nine Countries, by Robertson, Gregory, and Jabbal, 2014. Copyright 2013 by the Commonwealth Fund. This shows the high expenses that United States residents are charged causing them to not be able to access health care in the United States, but shows that sometimes costs for health care access not reflecting the quality of how certain departments are run. The worth of time investment in the current laundry problem will eventually result in costs reflecting quality of services residential care facilities in any department.

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Conclusion

The purpose of the study is to search and analyze prior research on different aspects of the missing clothes to have improvements of the laundry process for residents living in residential care facilities. There may not be one standardized system of laundry service at residential care facilities; therefore, each facility may develop its own effective laundry system.

It is important to figure out whether there is an existence of one particular best practice for laundry systems. In the next chapter, the researcher has weighed in all of these existing factors and illustrated what kind of plan to implement for the improvement of the laundry system in residential care facilities. Now that all the factors contributing to the problem have been identified, the next chapter will show a plan that will show all details of what needs to be done and the required involved. The plan will be in of itself an orchestrated collaboration of a team all working towards a common goal of getting all the dirty laundry returned back to the right owner.

The next chapter will reveal what specific sets of actions and show the identified resources that will be beneficial in reducing the chaos of missing clothing. The researcher has compiled different articles and have suggested a strategy so that residential care communities will adopt so the laundering process will no longer be a hassle, but instead be a working long- lasting solution for a long time.

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Chapter Three

Project Plan

Background

So many different senior housing options exist for elders and their families to choose from. Seniors vary in how much they are able to do for themselves. Throughout time, it became difficult for different institutions to utilize one standardized laundry system that is effective for any institution. For example, when comparing an independent living housing option with memory care support, the levels of independence for senior citizens in two of these settings are extremely different. Administrators will consider these factors as well as other existing factors before determining the best strategy to improve the problem.

The researcher proposes a project called RSQIC for nursing facilities in general. RSQIC stands for Regular Scheduled Quality Inspection Control. This project aims to encourage more frequent department meetings to discuss the status of problems in varying departments.

Sometimes, if the problem is continuing, having more departmental meetings may help to reduce the incidences of misplaced laundry by having team members contributing with one another different perspectives and observations.

Mission Statement

Regular Scheduled Quality Inspection Control is dedicated to prepare organizations to providing extra attention to all of the residents and taking time addressing all of the resident needs.

Vision Statement

At RSQIC, our vision is to establish trust between the residents at care facilities and staff involved with removal and cleaning of the residents’ dirty laundry and to have all staff to

LAUNDRY SYSTEM 23 coordinate together to resolve issues together as a whole to make all residents feel comfortable.

Values

RSQIC values strong coordination, collaboration, cooperation among team members and continuous high-quality supervision and care for residents in residential care facilities. RSQIC values each resident in residential care facilities and are highly motivated to ensuring all residents are receiving adequate amount of care by all staffs in each department at the care facilities.

Objectives

The objectives of plan RSQIC is to reassure the residents will know administrators and all involved departments hear the residents’ voices, encourage ongoing staff to make time for meetings. In addition, RSQIC requires new staff to have training to be effective providers, prepares residential care facilities to be ready for any unexpected facility inspection, inspire the leaders in the facilities to be effective in how they communicate to their staff. Plan RSQIC aims for residents to increase their reliance on staff, to ensure any time the laundry staff cleans the residents’ belongings, and the laundry staff will return back all personal items to the correct residents. Efforts made by plan RSQIC will be geared so residents would rely less on their families regarding laundry, for residents to report fewer complaints about lost laundry after being re-interviewed again 6 months later, for residents experience they are in a safe, home, care- friendly environment, and to increase the overall life quality for all residents living in care facilities. Upon having all of these objectives met will decrease the incidences of permanently lost personal items.

The objectives that RSQIC has are staff to set reasonable time each day to keep track of the residents’ personal item inventory and to devote enough time in each meeting for different

LAUNDRY SYSTEM 24 department staff to contribute new ideas for each new topic introduced each day. Other objectives are to make sure each new staff will be well trained to be as observant, respectful and caring towards residents in all ways possible, place a limit on the number of times the resident changes clothes, increase participants of the meeting attendees to provide even greater aspects of the situation to compare all possible cases. Each department in the organization needs to identify which specific combination of hardware and software resources to use in order to have productivity and effectiveness.

Methods

To reach its objectives, plan RSQIC will ensure the facility will define the correct combination of tangible hardware and software to bring out an effective solution to the current laundry system at the facility. In addition, the members involved in improving this system improvement plan will be required to communicate effectively with one another.

Table 2 demonstrates the methods in order to reach the objectives of this plan. Objective

1 in table 2 has the difference it will make when all team members are familiar with how to do tasks and exactly the specific list of tasks each member are in charge of completing. It has been pointed out in a past study conducted by a chief executive officer in the United Kingdom that a key factor in making the laundry problem continue for so long is limited staff. Therefore, when there is an ideal number of staff hired, there is more synchronization of all tasks performed, reducing chaos.

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Table 2. Targeted objectives and methods for this project plan.

LEAD DEADLINE

Objective #1: To encourage cooperation among team members in different departments a. Assign tasks for separate involved departments

b. Hiring adequate number of necessary employees

Objective #2: To ensure that residents can rely on any healthcare team members a. Enforce utilization of daily service progress notes

b. Staff update inventory of clothing daily

Objective #3: To demonstrate the effectiveness of this project plan

a. After each quarter (every three months), have residents fill out surveys and figure if there are fewer incidences of complaints b. Check the lost and found daily; There should be few cases where clothing is being misidentified or misplaced. Records are recorded daily. Objective #4: To determine the effectiveness of training on all involved departments a. All departmental staff should have already familiarized with what their contributive duties are in improving laundry services. RSQIC team members will take notice and check frequently if each department involved only does their expected task. b. Compare the post-trainees’ progress with laundry with the pre- trainees’ laundry service knowledge. Testing and satisfactory scores must be earned after the training to measure how much information was actually absorbed

Designated Assignment of Responsibilities

Project RSQIC team members have a mutual goal of providing care based on the level of independence each senior citizen has regarding his or her ADL’s, activities of daily living.

Within this project, the leaders involved in making decisions for this quality improvement management plan involves the laundry specialist, accountant, licensed vocational nurse, laundry

LAUNDRY SYSTEM 26 manager, nurse assessment coordinators (MDS), ombudsman, facility management, and the project manager.

Table 3. Points of Contact to show which staff are involved in meetings regarding laundry.

Role Name Contact Number

Laundry Specialist

Licensed Vocational Nurse

Laundry Manager

Nurse Assessment Coordinators

Facility Management

Project Manager

Laundry Investigator

Inventory Recorder

Comparative Analyzer

Environment

All required hardware resources are tangible, which includes employees. Main specialists in laundry will be extra observant in all the times. All of these laundry specialists will be required to be on the lookout. The laundry investigator keeps track of how the staff is handling their duties. Managers have posted the policies where the team members can easily see, so now the laundry investigator is simply observing to see if the staff is following these procedures.

The inventory recorder writes down the specific clothing items each time the resident wears a new set of clothes, and which clothes are put in the laundry bins. The inventory recorder makes a difference in this setting because of the many residents living at these nursing homes

LAUNDRY SYSTEM 27 makes it hard for other team members to keep track of all updates throughout the day. The inventory recorder will also fill out a form titled a Laundry Procedures Form and make sure that form is filled out right after the laundry staff returns the laundry and to pay close attention to approved resident room changes to ensure the laundry staff returns the clean laundry back to the resident in their new assigned room. The comparative analyzer sees if there is a correlation between same certified nursing assistants and similar numbers of incidences of reported missing laundry. Another correlation that may exist may include same laundry staff doing the laundry and similar numbers of laundry complaints. A third possibility may include same resident repetitively losing or having misplaced laundry. The comparative analyzer would be in charge with using all the correlations to contribute ideas to the laundry department. Ideas may include assigning different staff to handle such task that has been known to keep the problem remain problematic. The comparative analyzer will just have to carefully monitor any progress after a substituted staff does a certain task and may suggest one designated staff for a certain responsibility. A paired combination of a specific worker and reduced complaints may become permanent if there are any patterns of repeated improvement throughout months. This comparative analyzer will be able to make weekly reports about laundry. The comparative analyzer is responsible for submitting these weekly reports to the chief executive officer. Each time the comparative analyzer prepares the final drafts for these laundry weekly reports, he must discuss with other team members during the quarterly meetings. The comparative analyzer will be in charge with making decisions of whether to keep the scheduled staff each week providing services to same residents or rotating amongst all the available staff to be in charge of different residents.

Another valuable asset the new laundry system needs to take advantage of is the

LAUNDRY SYSTEM 28 educational backgrounds of each department staff members, commitment in following through with the new system, and professionalism. Valuable resources to get tasks done are employees.

Without an adequate number of employees, there will be a burnout. For example, managers will expect the limited available employees to be responsible for many more tasks than the assigned duties the employees always have had because of the uneven distribution of work to the employees. Although the number of available employees is valuable, managers should not solely feel calm because more has to be done to these employees to get to the solution. Certain employees may excel in a task more than another so switching the responsibilities between those two staff can make a difference in bringing about change.

The manager will hang the posted sets of rules and guidelines in the hallways and in the laundry department to help remind the employees the actual steps they would take to improve the current situation. For example, a regular staff may have called in sick for one or two days. The alternative qualified employee to fill in for the absent staff should know how to do his job correctly. Without any written and posted sets of policies, it would be almost impossible for the temporary staff to know exactly how high of a standard his or her duties must be performed and how to get the responsibilities done as correctly as possible. Having actual sets of policy helps put a staff as having an obligation or the manager will replace that staff. Having a policy visibly hanging in the department and/or hallways indicates there will be consequences for failing to follow a policy, which holds all staff accountable with how the staff performs his or her duties in addition, be even more motivated if the staff is serious about keeping their job.

Another requirement is training for current and new employees. Managers will require each employee to have training and require a renewal of their training certification every two years. It is not enough for managers to make time to conduct a one-time required training. What

LAUNDRY SYSTEM 29 this does to the employee is only give the employees the impression that it is only a one-time session, and the employee will just go to the training just to get it over with. When the employees have the proper training and be certified every two years once the employees take the certification exams, more likely the employees will absorb and even do the tasks better than the last training. More likely, these employees will be serious and pay attention carefully to get the passing grade on the first attempt. At these training sessions for these various employees in the various departments, the training committee will discuss the importance of the floor staff and the laundry staff to write daily service notes.

The next section of the training will have the committee discuss the importance of the residents’ overall assessment process. The staff will learn that the resident will have the option to either have their personal laundry done by their families, be involved in the laundering process himself or herself, or depending entirely on the laundry staff to take care of laundry services. The training will go into the details of possibilities that the residents’ preferences may occur throughout the residents’ entire stay and the floor staff will write down the updates on the daily service notes, notify the administrator and laundry staff before the Admissions department can update the residents’ services plan.

The next component of the training will serve as informing the laundry staff how often to do laundry for residents and to show the staff how the residents’ health affects how often laundry staff should take the bins to the laundry room. For example, some weeks may have fuller laundry bins than other weeks, so the floor staff should not always assume the set frequency on the policy will always be the same and the laundry staff will already know to take care of the loads of laundry when the staff is aware of exceptions to the policies may exist. The laundry staff needs to do laundry more frequently when residents have urinary incontinence and when the residents

LAUNDRY SYSTEM 30 have a low supply of available clean clothes. All of these considerations will be passed down to the staff during this training.

Issues and challenges for implementation

Some challenges that I perceive will occur in the process are inadequate amount of time to cover all necessary information in the training sessions. Although quality of how things should be done and new components added to the training is necessary for all current and new employees to be reminded of, there are still other tasks to manage during the sessions, so the trainer may not get through all of the information. The remaining information will be delivered at the next session to resume the training information. This time limitation factor causes ineffectiveness because there is no way to measure how much information was absorbed by the employees from the prior session.

Deliverables

The conclusive evidence that this project will produce is increase in the staffs’ understanding of how much of an impact laundry services have on the residents. Each staff member will know exactly what responsibilities he or she has because the staff has successfully completed the training certification test. The education included in the training will remind the staff the importance of the service notes. Otherwise, there would be limited ways of knowing how the residents’ health changes in correlation with the additional help the resident will require.

The education included in the training will remind the staff the importance of providing accurate and updated service notes each time a staff provides services for residents. Otherwise, there would be limited ways of knowing the amount of health changes in correlation with their increase in age. The services notes will indicate how much more additional help the resident will require. Another benefit of having the service notes updated on a daily basis is to see how much

LAUNDRY SYSTEM 31 more the resident is capable of doing for himself. This minor change such as a resident realizing he can do more by himself will only help improve his mental well-being. Other times, this particular resident may even feel more energetic and try on his own first before asking for assistance.

Timeline

LAUNDRY SYSTEM 32

,.,, .. ., , . , .. n l RER NovEM I OcTORER I RER SEPTEM I AUGUsT i v Jul. . etion l comp of es t da ed t arge t and tasks of ine l me i T . 5 gure i

F

LAUNDRY SYSTEM 33

g n in oc ti f of this of can , on Jaundl hood ies i l closet ft care space e room a Term k e ation ance t others number reputation li k fi fam ones of the satisfaction choosing ta re of hesi mpleme n to C11/er i surveys necessary stocage Long loved ity ity l l thout om Resident absence increased increases r when wi faci faci their - - - other • residents because residents increases increase Mure f lt MEASURES u res of of from es ll nows i ng k ffocts i iti among in e w time m r t owners OUTCOME unity te regard tha the complaints members has responsibil department clothing l easonable ess Short L R Al CoDabo!ative esidents eam acility finding f the t - - each • • laundry increases r what outcomes the d an es i l ons MEASURES staffs i fami act S

LAUNDRY SYSTEM 34

Outcomes/Evaluation

To track the success of this project plan, RSQIC will take measures to ensure all of our continuous efforts have positive outcomes for our residents. To determine how well the efforts of all additional hired and all other involved team members have been working, the administrator will give out surveys to the residents and their families to fill out. The administrators will use these collected surveys to compare each survey result individually. If the same groups of residents still are not receiving back their correct pair of clothing, then we will evaluate why the residents who experienced missing clothes are the only ones who reported about this complaint.

If different combination of residents (i.e. residents from different wings in the care facility) states in the residents’ survey of this missing personal belongings, then we will evaluate why in this particular system will not work in this setting. This allows for focusing on other aspect to get closer to the resolution. Also, we will check thoroughly in the lost and found and compare how much less or more clothing are appearing. If it turns out more clothes are being added to the amount of clothing already stacked on top of one another, then we will evaluate why even with the addition of new added resources still is not enough to stop more clothes from being misplaced.

To track the progress of our project plan compared to plans similar to it the administrator will compare clothing handling process in our facility with the clothing handling process in residential care facilities in New York. We would compare the occurrences and rates of missing laundry. Our focus is to observe whether residents living in our facility have a lower incidence of missing laundry than the residents in New York care facilities.

We will also assess the knowledge of all the involved departments by first reviewing the post-training test results. Since these have a two-year renewal requirement, before these involved

LAUNDRY SYSTEM 35 departments are retrained and retake their certification training exam, we will assess whether the departments realize how important and the long-term effects of forming a stable laundry system.

If the results show that these departments still lack understand the importance of their contributions or ideas and still is unsupportive or rather invest more time and energy on other problems, then we need to review what changes need to be made before the employees retake the post-training certification exams.

To monitor the effectiveness of daily utilization of service progress notes, we will be able to increase trust a resident has on his or her provider. The resident is reassured all of his preferences are made known. For example, one day a resident may feel capable of putting his own laundry into the laundry bin. Because this note has been made in his service progress notes, whoever is his provider will be updated. The resident puts his own soiled laundry in the laundry bin. When it turns out the exact clothing put into the bin is the exact clothing combination returned after the laundry department does his laundry, it reveals to the administrators a correlation with reassurance of clothes placed in bins and safe return of all the dirty clothes. If we are seeing more accurate returning of clothes being done this way, similar handling of soiled clothing will be placed in bins individually by each resident.

We hope that our project plan will bring positive changes for each resident living in care facilities. If we are not seeing much changes after our contributed efforts of RSQIC, then we will work continually with the most affected residents to help that resident feels satisfied with how laundry services are being handled. We envision that the residents are protected and there would always be extra eyes always tracking the location of the residents’ personal clothing. We mainly look forward to see the pleasant smiles on each resident face and for them to have one less stress while staying in the facility and for them to further be aware all of their personal items are in

LAUNDRY SYSTEM 36 great hands. The aspects of the project plan focused on allowing the residents to know all employees attend to keeping the personal appearance of all residents at all times, so we see our project plan will be successful if we observe any positive changes in the residents overall emotional health. If more and more residents have been aware their self-respect is being maintained or improved throughout their stay at the care facility as year’s passes by, then we know we are doing our part to help create a better experience for these older adults. Overall, the whole intention of this project plan is to bring about changes in the quality of laundry services.

Budget

Table 4. Budget for the entire plan to improve the laundry status in care facilities.

RSQIC Cash Required In-Kind Total Budget Revenue

Fees $78,300 $78,300 Contract with state $14,590 $14,590 Donations $15,000 $150 $15,150

Total Revenue $107,890 $150 $108,040

Expenses Amount

Salaries/wages $74,880 Equipment $2,200 Advertisement $1,043.50 Transportation related fees $235.43

Total Expenses $78,358.93

Figure 7. Budget Narrative.

A. Salaries- $ 74,880

Staff a laundry specialist, laundry investigator, inventory recorder, and a comparative

analyzer to focus on laundry quality and improvement methods at $18 an hour. Staff will

work on average 20 hours per week. The project plan requires these specific staffs for 52

LAUNDRY SYSTEM 37

weeks yearly.

$18 x 20 x 52 = $18,720 per employee

$18,720 * 4 = $74,880

B. Equipment $ 2,200

Needed because a particular washer and dryer combination will help make the laundering

processes more efficient. All of the employees’ efforts using the ideal washer and dryer

set will be able to handle more clothes each cycle. If the current installed washer and

dryer size fits the minimal standards for compatibility with residential care facility, then

replacing the current equipment with new equipment may not be necessary.

Machine Washer: Maytag Bravos MVWB855DW, $1,000

Machine Dryer: LG WM8000HVA, $1,200

C. Advertisement $ 1,043.50

Needed occasionally to keep the steady increase of new admittance. As a way to measure

the current satisfaction of current residents and any effects on new referrals versus how

much more residents knowing more about growth and improved quality of services at a

particular care community. Also, advertisement will be needed to help other laundry

experts apply for position at the residential care facility.

Advertisement related fees on billboards: $1,000

In Newspaper: $43.50

D. Transportation $ 235.43

Needed occasionally for the volunteer driver to drive to advertising resources to post

about New carefully paid attention to laundry, as a method of marketing the organization.

Estimated total miles: 100, Average miles per gallon: 21, Average cost per gallon: $4.12,

LAUNDRY SYSTEM 38

Total vehicles: 1, Number of months: 12

(100 miles / 21 mpg * $4.12) * 12 months

Figure 4. Laundry system that shows an ideal design of the laundry department in long-term care facilities to maximize accuracy, efficiency and effectiveness in the laundering processes.

Adapted from “Laundry design for healthcare,” by the United Kingdom’s Girbau Knowledge

Base Global. Copyright 2017 by Girbau Laundry Equipment Ltd.

The next chapter will focus on what are the next recommended steps to fully have a more realistic and effective solution to the laundering process. All the recommendations will bring more knowledge to the on-floor staff as well as the in-department staff. The cooperation and communication between everyone may be one of the determinants in the success of the newly created laundry system.

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Chapter Four

Summary, Conclusion, and Recommendations

Summary

The study was used to show how significant the problem of lost laundry is in residential care facilities and to signal to administrators to make time and efforts to reduce or eliminate complaints of missing laundry. The problem of missing or misplaced clothing is complex because personal clothing affects a person’s dignity and many variables may affect the outcome of whether laundry is accurately returned to the correct resident. A sufficient number of employees and the even distribution of responsibilities are the starting point of where to begin.

This study reveals different factors that add to difficulties of coming up with long-lasting solutions. This study shows the importance of having dedicated, well-trained, and specialized employees working together to make powerful impact, emphasizing team-work, rather than an individual person working alone to solve the problem. These studies showed the importance of maintaining the self-esteem and dignity of residents living in care facilities, and to plan a project with a mission to help the residents maintain control and their identity.

The purpose of this study was to develop a new laundry system. In the past, new ideas have been utilized but it was not long until mix-up of clothing began to happen again. Instead of focusing on the labeling procedures, the modified focus is now placed on preparations even before the laundry process is started, in hopes of seeing much more improvement in the provided laundry services. This project will strive to get all employees more knowledgeable in quality of provided laundry services. With each passing year we strive to use our efforts to get maximized, improved ideal results.

Conclusion

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Project RSQIC is a plan that will have a significant impact on the experiences of the older adults living in residential care facilities. In the past, different ideas to fix the problem were on the labeling of clothes or non-fixture of sewn on labels. This project looks past the labeling and identifies other factors causing the problem to reoccur. The alternative approach this project had to improve the lost laundry situation looked at resources. Without having enough hired team members in charged with specific tasks places a limit on time each employee has complete them.

High quality of services depends on adequate time allotted for all tasks. With having more employees with designated titles and responsibilities, all other sorting of other complaints or problems faced between residents and their roommates still would leave time still available for quality improvement in laundry services. The motivation to plan a project at a facility was to ensure that state surveyors would not be convinced that the residents’ self-respect and dignity are protected. Another motivation for this project was to avoid conflict in care among laundry employees, residents, and family. Before an institution goes on with such changes, the way in which this project is organized reduces task shifting. Only particular employees will be involved with the laundry processes. Laundry and clothing are neglected issues, but one way to change the prioritization order on a daily to do list is to show the complexity of laundering processes and determining what changes may be necessary to reduce chaos throughout the entire laundering process. In order for residents in residential care facilities to experience healthy, dignified care it is not heavily stressed enough of the importance of each resident wearing his or her own clothes.

Residents are unique from one another. It is not always safe to assume all residents will react the same way after their clothes are misplaced.

Recommendations

- experienced laundry manager (highly qualified)

LAUNDRY SYSTEM 41

- Ensure there will be separate areas for sorting linens, washing and drying, ironing and folding, storage space.

- Having equipment that consists of continuous batch washers and industrial dryers

- Installment of cameras in laundry room, resident room, shower room, and anywhere else where residents receive help with changing their clothes

- Continue to require all involved team members involved in the laundry care to have quarterly meetings (January, April, August, and December)

o Contribute ideas of how to further modify the current laundry system, if necessary

o Discuss the status of project implementation

o Discuss any current concerns

o Be aware of current status reports (Evaluation/monitoring of project plan’s effectiveness)

- Consult with a laundry room specialist about the facility’s current laundry room space and layout (Feedback and advice for improvement details)

- Assess the results of the newly implemented laundry system by doing a program evaluation. It will be recommended to do the program evaluation one year after the new laundry system has took into effect.

- Adopt best laundry system practices from other countries (factor that comes into the capability of adopting laundry systems those facilities in other countries use may be technology).

Although the United States is one of the costliest for health care related fees, sometimes the pricing of what families/residents pay for do not always reflect how high the standards the laundry services are compared to other countries’ quality of laundry services. Therefore, learning about what is consistently working in other countries will help care facility administrators in the

LAUNDRY SYSTEM 42

United States to also gain valuable lessons of how to prevent the problem from recurring so often.

- Start to have laundry related concerns address in the facility’s weekly, monthly, or quarterly bulletin. This provides accountability between laundry care providers and residents.

Also, this will provide transparency for the organization to show exactly the challenges and know a plan is in store for improving the current situation. For example, in the United Kingdom,

Care Management Matters magazine puts various challenges dealt at the facilities. If certain problems occur in the United Kingdom, is also very likely to happen in the US. In terms of accountability and transparency, when laundering issues become included in magazines or weekly bulletins, administrators will have increased knowledge and can further highlight how big of a problem it is and how important it is for care administrators in facilities continuously modify strategies to improve the current problem.

In the future, if there will be anyone else interested in researching the same topic of laundry in residential care facilities should promote the high need to improve the situation. All gathered magazines from other countries exposing the public about a weakness of its own organization should be put aside to one another. Throughout the researcher’s journey, when a country admits its own weaknesses and have an idea of an impact it could make in a resident’s entire stay at the care facility, it shows unity and desire. This moves the care facility in the right direction, instead of staying constant as the status quo, leaving everything almost exactly the same and only having high hopes throughout time the problem could end up disappearing. There is definitely not any good outcome that would result when a care facility continues to repeat the same procedures over and over when the care facility already knows the current procedure still lack some minor missing ingredient.

LAUNDRY SYSTEM 43

Next, the researcher should do a comparison of the results after the new laundry system has been implemented. It is important to see the long-term changes to the care facility ever since the care facility adopted a new laundry system, compared to how much of a problem it always has been. There has always been a trigger to do something about the current situation. There should not be anything like technology, resources, teamwork, and problem-solving deficiencies that prevents any residential care facility from obtaining better reputation with regards to laundry complaints. After conducting this research, it has widened up to many more invisible aspects that were not apparent in the beginning. The complexity in solving the laundry system is much more than it appears.

LAUNDRY SYSTEM 44

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Appendix A. Protocol 16-125: Not Human Subjects Research

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CSU Bakersfield------Academic Affairs Mail Stop: 24 DDH Room I 08 9001 Stockdale lligh"a) Onice of Grants. Research, and Sponsored Programs (GRaSP) Bakerslield. California 9331 1-1 022 (661) 654-2231 (661) 654-3342 ~AX www.csub.edu

Institutional Review Board for Human Subjects Research

Date: 13 October 2016 Tony Alteparmakian, Ed. D. Department of Teacher Education To: Kim Thu Tran, PPA Student Nonscientific/Humanistic Concerns cc: Chandra Commuri, Public Policy & Administration Chandra Commuri, Ph.D. Roseanna McCleary, IRB Chair Department of Public Administration Scientific Concerns From: Steve Suter, Acting University Research Ethics Review Coordinator Anne Dur an, Ph.D. Department of Psychology Subject: Protocol 16-125: Not Human Subjects Research Scientific Concerns Thank you for bringing your Protocol 16-125, "Beyond Any Distance Ever Reached Steven Gamboa, Ph.D. Before", to the attention of the IRB/HSR. On the form, "/s My Project Human Subjects Department of PhiVRel Studies Nonscientific/Humanistic Concerns Research?', received on 10-12-16, you indicated the following:

Grant Herndon I want to interview, survey, systematically observe, or collect other data from human Schools Legal Service subjects, for example, students in the educational setting. NO Community Issues/Concerns I want to access data about specific persons that have already been collected by Roseanna McCleary, Ph.D. others [such as test scores or demographic information]. Those data can be linked to Masters of Social Worl< specific persons [regardless of whether I will link data and persons in my research or Scientific Concerns IRBJHSR Chair reveal anyone's identities]. NO

Colleen McGauley, MPA Given this, your proposed project will not constitute human subjects research. Therefore, it Community Issues/Concerns does not fall within the purview of the CSUB IRB/HSR. Good luck with your project. Executive Director. CASA of Kern County If you have any questions, or there are any changes that might bring these activities within the purview of the IRB/HSR, please notify me immediately at 654-2373. Thank you. Nate Olson, Ph.D. Department of Phil/Rei Studies Nonscientific/Humanistic Concerns

Isabel Sumaya, Ph.D. Department of Psychology Steve Suter, Acting University Research Ethics Review Coordinator Research Ethics Review Coordinator and IRB/HSR Secretary

James Velasquez, MSW, ASW Kern County Mental Health Community Concerns/Issues

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