Step 1: Assess the Threat of Wildfires in Your Area

The first and most critical thing you can do to maintain your indoor air quality during wildfires is to protect your community from the fires themselves. Pay attention to local news sources and government agencies for advice on how to prevent fires, what fires may be in your area and what you should do in response. The USDA Forest Service maintains an online map, but local services will have more detail and the most relevant information for you.

But beyond the fires, the smoke itself can be a real issue. According to the Centers for Disease Control (CDC), wildfire smoke can cause persistent coughs, headaches, shortness of breath, asthma attacks, and even cardiovascular issues such as chest pain and heart attacks. This is especially critical in Senior Living, as the smoke may worsen symptoms for people over 65 years of age, or with respiratory or cardiovascular diseases.

Even if you aren’t near a fire, the jet stream and natural air currents can carry the smoke chemicals and debris from the fires thousands of miles from their source. Bookmark this site to monitor up-to-date maps on fires, smoke coverage and air quality in your area.

Step 2: Protect Your Residents & Staff from Wildfire Smoke

When wildfire smoke lowers air quality in your area, there are several important steps you can take. The American Society of Heating, Refrigeration and Air-Conditioning Engineers (ASHRAE) has created a framework for protecting building occupants from smoke, published in the March 2021 edition of the ASHRAE Journal. Below are some of the activities you may consider taking: 

Plan ahead if you can

Assess your filters and MERV ratings, ensure your system is running properly for the level of filtration and ventilation it was designed for, and weatherize your building envelope to prevent smoke intrusion. If you need help preparing your building, contact TELS Building Services. 

Improve your filtration

If your HVAC systems allow for it, upgrade all filters in your system to at least MERV 13. Assess your air intakes to determine if you can temporarily add supplemental filtration with MERV 13 filters, tape and temporary ducting materials. Consider adding additional types of air purification products, such as portable HEPA air filters installed in rooms where air quality is a concern.

Balance the outside air coming into your building

An indoor air quality monitor that measures PM2.5 particles can help you determine if you need to take further steps, such as lowering the amount of outside air coming into your building. It may be beneficial to recirculate more air within your building rather than bringing in additional contaminants from wildfire smoke.

Keep pathogens in mind

Increasing ventilation is important for diluting the amount of infectious particles there may be in the air, but decreasing ventilation prevents wildfire smoke from entering your HVAC system. Portable air filters can reduce both exposure to pathogens and smoke in the air, and thus may be a good way to balance between these two requirements.

How to improve your current indoor air quality system

Your current filters may be having an impact on the pollutants associated with wildfire smoke, but they can be doing better. Needlepoint bipolar ionization can help air filters do a better job.

According to GPS®Air, a leading manufacturer of this technology:

One approach to helping air filters do a better job capturing particles of concern (including MPPS) found in the MERV Curve is to make them larger.

A safe, effective and proven way to accomplish this is through needlepoint bipolar ionization (NPBI™). This patented technology creates and releases ions into the airstream using a building’s existing HVAC system as the delivery method. When these ions disperse throughout a space, they seek out and form bonds with particles in the air through a well-established process called agglomeration. This process creates a snowball effect in which particles begin to cluster together. The larger a cluster of particles becomes, the easier it is for an HVAC system to filter it out of the air.

The benefits of ionization by including NBPI as part of a multilayered solution (ventilation and filtration) are many. Aerosolized particulate matter is removed faster. Indoor air spaces are cleaned more thoroughly.

When IAQ grant funding opened up in Oregon in 2021, Avamere seized their opportunity. They knew that excellent IAQ was essential to support the day-to-day health of their residents and staff. With the threat of wildfires and airborne infectious disease swirling in the air, they chose to act on a major scale and sought the help of Direct Supply to bring their vision of improved IAQ to life. Here’s how they did it.

CUSTOMER SPOTLIGHT:

THE BACKGROUND

Who: Avamere Family of Companies Inc.

What: 40+ Long Term Care facilities in Oregon offering independent living, assisted living, memory care, skilled nursing, respite care services, and more

When: 2021-present

THE PROBLEM

“The pandemic kept residents in their rooms more often than they were used to and we needed to be able to control each room’s air in a cleaner way. We needed to make the air there as healthy as possible when someone was sick and in their room not only for them but for the care staff and other residents.” – Albert Castaneda

THE GOAL

Albert Castaneda and his team placed their focus on individual rooms first. Then, they sought to upgrade rooftop units and other facility-wide systems that would impact the entire community environment. The overall effort was to ensure the healthiest indoor air possible for their residents and staff.

“Our focus in all care settings is air flow and air quality in individual rooms first because [residents] were spending most of their time in their rooms during the pandemic. Then we addressed the rooftop units themselves. We wanted to make them more efficient to provide cooling and heating in a better way so we decided to replace units—and we have replaced an insane amount of units!” – Albert Castaneda

THE TECHNOLOGY

Each building received a tailored set of technology. For example, the Suzanne Elise Assisted Living community in Seaside, Oregon, was the only facility to receive UV-C light technology as part of its upgrades. This individualized approach allowed Avamere to tend to the unique needs of each community. Avamere also leveraged NPBI, PTAC, and rooftop units in their IAQ improvement strategy.

 It took the hard work of many to bring new technology to Avamere’s Oregon Long Term Care communities. Here are some of the Direct Supply partners who worked with Albert and Avamere to support their IAQ improvement effort.

THE RESULTS

Avamere is in the process of installing and implementing their new technology across all their Oregon buildings. While it’s too early to measure the direct impact of the changes on the IAQ of their communities, Direct Supply brought ease to what could have been a tedious and frustrating pre-installation and installation process.

“Direct Supply just made things easy. If I had to go out to independent vendors and manage independent site visits and independent contracts across all our buildings, I’d still be working on them. Our community based care and skilled nursing division leaders recommended working with Direct Supply as a one stop shop, and all but two or three buildings in Oregon were serviced by our Direct Supply relationships. Dealing with two to three people at Direct Supply versus nine or ten different companies was just so much easier.” – Albert Castaneda

HVAC Solution #1: Dilution and Filtration for Particulate Matter Reduction

According to ASHRAE: “Ventilation and filtration provided by heating, ventilating, and air-conditioning systems can reduce the airborne concentration of [viruses] and thus the risk of transmission through the air.”³

Cons:

• Unconditioned spaces can cause thermal stress to vulnerable seniors and increase risk of infection
• Increasing outdoor air intake in high-pollutant areas can contribute to poor air quality
• Full make-up air capabilities not standard on many Senior Living HVAC systems

Cons:

• Does not trap VOCs (odors)
• Requires regular replacement
• May decrease HVAC system efficiency if HEPA or higher MERV rating filters are installed

HVAC Solution #2: Ultraviolet Germicidal Irradiation (UV-C) for Disinfection

Ultraviolet light has long been known for its disinfection properties. UV-C products emit a specific band of UV light (radiation) that can break down pathogens, and is available in many applications to treat water, surfaces and indoor air. It can be installed in several ways.

Cons:

• Requires regular cleaning and replacement to maintain efficacy
• Reactive: only kills what it “sees”
• Harmful: precautions required to avoid exposure to skin and eyes

HVAC Solution #3: Needlepoint Bipolar Ionization (NPBI™) for More Efficient Filtration

Cons:

• Some older versions of ionization technology could create harmful ozone; confirm with the manufacturer that their technology is certified to not create ozone (Note that Direct Supply’s bipolar ionization technology is UL 2998 Certified to be ozone-free)

1 “Long-Term Care Facilities | CDC.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://www.cdc.gov/longtermcare/index.html. Accessed 25 June 2020.

2 Times, The New York. “43% of U.S. Coronavirus Deaths Are Linked to Nursing Homes.” The New York Times, 27 June 2020, www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html. Accessed 30 June 2020.

3 “COVID-19: Resources Available to Address Concerns.” Home | Ashrae.Org, https://www.ashrae.org/technical-resources/resources. Accessed 25 June 2020.

4 “What Is a MERV Rating? | Indoor Air Quality (IAQ) | US EPA.” US EPA, 19 Feb. 2019, https://www.epa.gov/indoor-air-quality-iaq/what-merv-rating-1.

5 Inactivation results based on sensitivity testing conducted by independent third-party testing laboratory using control chambers. Multiple data points are used to formulate performance validation statements. The technology is used in a wide range of applications across diverse environmental conditions. Results in non-lab environments will vary; clients should evaluate their individual application and environmental conditions when making an assessment regarding the technology’s potential benefits. For all independent laboratory results, contact your TELS representative. The use of this technology is not intended to take the place of reasonable precautions to prevent the transmission of pathogens (including COVID-19). Comply with all applicable public health laws and guidelines as well as CDC guidance.

Lack of Staff Efficiency and High Turnover Rates in LTC

Turnover, absenteeism, and low worker productivity cost time and money¹ that could be better spent on improving your resident care to drive up census and improve your facility’s rating.

Present staffing challenges may leave you constantly searching to fill vacated positions or shifts, training new staff, and struggling to maintain a high facility rating that draws more prospective residents to your business. 

Poor indoor air quality only exacerbates these pressing LTC issues.

In the case of absenteeism, research shows that employees are more likely to miss shifts due to illness or job dissatisfaction when they are chronically exposed to poor indoor air quality at work². 

Additionally, poor IAQ contributes to diminished cognitive function, which in turn lowers productivity and performance at work³. In fact, this study shows that indoor air quality and productivity are directly correlated; as IAQ deteriorates, so does worker productivity⁴. 

Long-term exposure to particulate matter (PM) 2.5 (a type of exceptionally harmful PM common in indoor spaces) in indoor settings has been shown to have a drastic effect on employee decision making abilities⁵. Along with poor ventilation, PM exposure can result in more errors at work⁶, which can be costly or even fatal in situations like resident medication administration.

The Cost of Avoidable Hospitalizations

Poor IAQ causes 3.8 million early deaths each year⁷ and 50% of all instances of human illness are attributed in total or in part to poor IAQ⁸.  

Poor IAQ is an invisible health crisis for Seniors. They are particularly susceptible to the adverse effects of poor indoor air quality, yet they spend more time indoors than the average person (over 90% of each day)⁹. This can be a serious issue, as even short-term exposure to elevated levels of indoor air contaminants can result in hospitalization¹⁰. Additionally, chronic exposure increases the risk of otherwise avoidable hospitalizations¹¹ for illnesses such as COPD and pneumonia¹². 

Avoidable Hospitalizations May Impact Census

Avoidable hospitalizations cost billions of unnecessary dollars each year¹³ and can lead to health care-associated infections or other hospital-related illnesses upon return to the LTC. In fact, 4 of 10 hospitalized residents develop post-hospitalization health complications¹⁴, some of which can be infectious and spread throughout the facility to both residents and staff.  

Hospitalizations in general (and the potential health risks that come after) are financially taxing. Avoidable hospitalizations, however, can also reduce trust in your facility’s quality of care. In fact, research shows they may even elect one facility over another based on a commitment to indoor air quality alone¹⁵. This lack of trust in your facility’s safety can deter prospective residents, which could impact census.

IAQ Solutions to Help You Improve Business Outcomes

If you have been struggling with the previously discussed business challenges, you may benefit from exploring the following indoor air quality solutions.

Ventilation and Filtration Solutions May Help Increase Staff Productivity

IAQ improvements such as increased ventilation and higher grade air filtration (MERV-13 filters or higher) have been shown to result in a 9-20% annual reduction in sick leave¹⁶. When implemented appropriately, these improvements can result in up to 60x return on investment in the form of worker reliability and productivity¹⁷.

Air Purification Technology May Improve Resident Health Outcomes

The number of avoidable hospitalizations could likely be lowered with better indoor air quality solutions¹⁸. For example, air purification technology such as a portable UV-C device and Needlepoint Bipolar Ionization may help reduce the amount of contaminants in the air and neutralize harmful pathogens. 

These, along with other solutions such as HVAC planned maintenance and humidity control, can work together to help you create a powerful, comprehensive defense against IAQ-related threats. 

A Final Note: Demonstrate Your Commitment to Indoor Air Quality

Your commitment to IAQ is a choice in service of your LTC community. When you invest in IAQ solutions, let your staff, residents, and prospective residents know about it. They will appreciate communication about your IAQ improvement efforts as well as regular updates about the air quality of your facility¹⁹. 

^{1 CDC.gov} 

^{2 Stefanovska Ceravolo, Ljubica & Mirakovski, Dejan & Polenakovik, Radmil & Ristova-Drewanz, Emilija & Sovreski, Zlatko. (2012). Indoor air quality (IAQ) as a parameter affecting workplace productivity.} 

^{3 https://gps.ucsd.edu/_files/faculty/graff-zivin/graff-zivin-publication-2019-01.pdf&sa=D&source=docs&ust=1647634356892134&usg=AOvVaw1vr7pjqHPhfhh8vwycB_yJ}

^{4 Stefanovska Ceravolo, Ljubica & Mirakovski, Dejan & Polenakovik, Radmil & Ristova-Drewanz, Emilija & Sovreski, Zlatko. (2012). Indoor air quality (IAQ) as a parameter affecting workplace productivity.}

^{5 http://www.publichealth.columbia.edu/public-health-now/news/columbia-researchers-study-effect-air-pollution-investor-behavior-sp-500&sa=D&source=docs&ust=1647634356894312&usg=AOvVaw0YiKRtTwG2hR6H9UQ-AyAe​​}

^{6 Hawkins,, V. R., Marcham, C. L., Springston, J. P., Miller, J., Braybrooke, G., Maunder, C., Feng, L., & Kollmeyer, B. (2020). The Value of IAQ: A Review of the Scientific Evidence Supporting the Benefits of Investing in Better Indoor Air Quality. , (). Retrieved from https://commons.erau.edu/publication/1500​​}

^{7 Vijayan, V. K., Paramesh, H., Salvi, S. S., & Dalal, A. A. (2015). Enhancing indoor air quality -The air filter advantage. Lung India : official organ of Indian Chest Society, 32(5), 473–479. https://doi.org/10.4103/0970-2113.164174​​}

^{8 https://www.indoorairhygiene.org/knowledge-center/facts/&sa=D&source=docs&ust=1647634356881182&usg=AOvVaw31iMO2-pFo_LjhwHQdptSS​​}

^{9 U.S. Environmental Protection Agency. 1997. Exposure factors handbook volume 3: Activity factors. EPA/600/P-95/002Fa. Washington, DC.​​}

^{10 https://www.reuters.com/article/us-health-airpollution-hospitalizations/air-pollution-tied-to-hospitalizations-for-wide-range-of-illnesses-idUSKBN1YD2ES&sa=D&source=docs&ust=1647634356866584&usg=AOvVaw3k5sEOcabCPrB5KD61ng1C​​}

^{11 O’Malley AS, Pham HH, Schrag D, Wu B, Bach PB. Potentially avoidable hospitalizations for COPD and pneumonia: the role of physician and practice characteristics. Med Care. 2007 Jun;45(6):562-70. doi: 10.1097/MLR.0b013e3180408df8. PMID: 17515784.​​}

^{12 Marion Hulin, Marzia Simoni, Giovanni Viegi, Isabella Annesi-Maesano
European Respiratory Journal Oct 2012, 40 (4) 1033-1045; DOI: 10.1183/09031936.00159011​​}

^{13  https://www.cms.gov/mmrr/Downloads} 

​​^{14 Kapoor A, Field T, Handler S, et al. Adverse Events in Long-term Care Residents Transitioning From Hospital Back to Nursing Home. JAMA Intern Med. 2019;179(9):1254–1261. doi:10.1001/jamainternmed.2019.2005.​​}

^{15 https://www.mcknightsseniorliving.com/home/columns/marketplace-columns/the-importance-of-indoor-air-quality-for-prospective-residents-of-senior-living/&sa=D&source=docs&ust=1647634356846642&usg=AOvVaw36dAI8ABxT4gzLB5MSRfMy​​}

^{16 Hawkins,, V. R., Marcham, C. L., Springston, J. P., Miller, J., Braybrooke, G., Maunder, C., Feng, L., & Kollmeyer, B. (2020). The Value of IAQ: A Review of the Scientific Evidence Supporting the Benefits of Investing in Better Indoor Air Quality. , (). Retrieved from https://commons.erau.edu/publication/1500​​}

^{17 Hawkins,, V. R., Marcham, C. L., Springston, J. P., Miller, J., Braybrooke, G., Maunder, C., Feng, L., & Kollmeyer, B. (2020). The Value of IAQ: A Review of the Scientific Evidence Supporting the Benefits of Investing in Better Indoor Air Quality. , (). Retrieved from https://commons.erau.edu/publication/1500​​}

^{18 Manasa Reddy, Mohammad Heidarinejad, Brent Stephens, Israel Rubinstein,
Adequate indoor air quality in nursing homes: An unmet medical need, Science of The Total Environment, Volume 765, 2021, 144273, ISSN 0048-9697, https://doi.org/10.1016/j.scitotenv.2020.144273​​}

^{19 https://finance-yahoo-com.cdn.ampproject.org/c/s/finance.yahoo.com/amphtml/news/honeywell-survey-reveals-72-office-125900755.html%26sa%3DD%26source%3Ddocs%26ust%3D1647063365275526%26usg%3DAOvVaw3jjrhHbE0y1WIG6YNyA00b&sa=D&source=docs&ust=1647634356876771&usg=AOvVaw1CcN79xT8DhdmajTuiMgsB​​}

What Does it Mean to Have Poor Indoor Air Quality in Your Long Term Care Facility?

78% of Senior Living Administrators believe their indoor air quality is good or excellent but 81% of LTC facilities suffer from poor ventilation⁴. 

Air quality is typically considered poor when there are elevated levels of contaminants in the air. Some common sources of contaminants in Senior Living buildings can include:

• Airborne infectious disease particles such as SARS-CoV-2 and the flu
• Volatile organic compounds (VOCs) which can be found in both personal products such as nail polish and hairspray and building materials such as cleaning products and paint
• Particulate matter from cooking and vacuuming 
• Carbon dioxide from exhalation
• Smoke resulting from environmental events like wildfires
• Odors 

While most air pollution is invisible, that does not mean it is not there. These and other contaminants are in the air your staff and residents breath every day. It is important to address them and remove or reduce them so that your staff and residents can experience a healthier environment.

How Poor IAQ Impacts Your Long Term Care Staff

There are multiple ways poor IAQ can impact the health, wellness, and performance of your Senior Living staff. Some of these include:

• Spread of airborne infectious disease can make caring for LTC residents one of the most deadly jobs in the country⁵
• Chronic headaches and gastrointestinal distress associated with exposure to odors in poorly ventilated facilities⁶
• Decrease in job satisfaction and increase in stress when exposed to foul odors and other environmental pollutants for long periods of time with no power to change their environment⁷
• Decrease in productivity due to long-term exposure to a poorly ventilated work environment⁸
• Short term effects such as dry, itchy eyes and throat as well as increased risk of developing serious health issues such as respiratory illness, heart disease, and cancer⁹

Your staff members work long, hard hours inside your facility. When those hours are spent breathing air with increased levels of harmful chemicals and particulate matter, the health and performance outcomes are likely to be worse than if your air was cleaner.

What Outcomes Can Better IAQ Produce for Your Long Term Care Staff?

If your facility suffers from poor IAQ, improvements are likely to reduce or remove the negative health and wellness symptoms your staff may face. Moreover, communicating your IAQ improvement efforts demonstrates your commitment to their wellbeing at work – something increasingly important to staff¹⁰. 

When you both invest in air quality products and keep your staff informed of the quality of the air they breathe, it is possible that you will see a boost in your staff retention rates. You may also see new prospective staff members excited to work with you, as they will know that their health and wellbeing matters to you.

In addition, improved health and wellness as a result of cleaner indoor air can lead to better decision making, less workplace stress, and less absenteeism^{11, 12}. That’s a win for your staff, your residents, and your business.

^{1​​ https://skillednursingnews.com/2021/03/nursing-homes-have-94-staff-turnover-rate-with-even-higher-churn-at-low-rated-facilities/} 

^{2 https://finance-yahoo-com.cdn.ampproject.org/c/s/finance.yahoo.com/amphtml/news/honeywell-survey-reveals-72-office-125900755.html&sa=D&source=docs&ust=1647063365285498&usg=AOvVaw0oS6iL_7JNRj_UmZRPf65k}

^{3 https://pubmed.ncbi.nlm.nih.gov/11089326/&sa=D&source=docs&ust=1647063365285762&usg=AOvVaw1bYAqdTVrOoXmtmLutaouf} 

^{4 National Library of Medicine. “81% of Senior Living Buildings have insufficient HVAC systems”, https://pubmed.ncbi.nlm.nih.gov/33401060.}

^{5 https://www.scientificamerican.com/article/nursing-home-workers-had-one-of-the-deadliest-jobs-of-2020/&sa=D&source=docs&ust=1647063365274933&usg=AOvVaw33wOE151a8HSIRbSyeWXjZ ​​}

^{6 Prior D, Mitchell A, Nebauer M, Smith M. Oncology nurses’ experience of dimethyl sulfoxide odor. Cancer Nurs. 2000 Apr;23(2):134-40. doi: 10.1097/00002820-200004000-00010. PMID: 10763285 ​​}

^{7 Applebaum, D., Fowler, S., Fiedler, N., Osinubi, O., & Robson, M. (2010). The impact of environmental factors on nursing stress, job satisfaction, and turnover intention. The Journal of nursing administration, 40(7-8), 323–328. https://doi.org/10.1097/NNA.0b013e3181e9393b​​}

^{8 Wyon DP. The effects of indoor air quality on performance and productivity. Indoor Air. 2004;14 Suppl 7:92-101. doi: 10.1111/j.1600-0668.2004.00278.x. PMID: 15330777.​​}

^{9 https://www.google.com/url?q=https://www.epa.gov/indoor-air-quality-iaq/introduction-indoor-air-quality%23longterm&sa=D&source=docs&ust=1647063365281844&usg=AOvVaw2yL6FI-j7tj7aE74X30w70 ​​}

^{10 https://finance-yahoo-com.cdn.ampproject.org/c/s/finance.yahoo.com/amphtml/news/honeywell-survey-reveals-72-office-125900755.html&sa=D&source=docs&ust=1647063365275526&usg=AOvVaw3jjrhHbE0y1WIG6YNyA00b​​}

^{11 https://www.investopedia.com/terms/a/absenteeism.asp&sa=D&source=docs&ust=1647063365280407&usg=AOvVaw0xjvTZprs2Mh8FYfX8HjMw ​​}

^{12 Wyon DP. The effects of indoor air quality on performance and productivity. Indoor Air. 2004;14 Suppl 7:92-101. doi: 10.1111/j.1600-0668.2004.00278.x. PMID: 15330777.​​}

Indoor Air Quality: An Invisible Contributor to Resident Health

It is not always easy to identify poor IAQ. As shown in this recent survey of Senior Living administrators, 78% of admins believe their indoor air quality to be good or excellent. However, studies show that 81% of Long Term Care facilities suffer from inadequate air ventilation and circulation³. This is a serious issue, considering that indoor air is often 2 to 5 times more polluted than outdoor air⁴.

Read on to explore the health implications of poor IAQ for residents and indoor air solutions to help you improve the quality of your facility’s air for better resident health outcomes.

What is Indoor Air Quality?

Indoor air quality refers to the quality of the air in any indoor environment. Typical measurements include size/quantity of particulate matter (PM) and presence of volatile organic compounds (VOC). 

Air quality indoors can range from excellent to poor. The difference between excellent and poor IAQ can be drastic and noticeable. However, even “adequate” IAQ may not optimize the health of your residents, as indoor standards of air quality are not as highly regulated as outdoor or ambient air⁵. Instead, administrators should consider solutions that help create excellent air quality in their facility.

What Contributes to Poor IAQ in Long Term Care Facilities?

A wide variety of factors can impact the quality of your facility’s air. Common pollutants include:

• Airborne infectious disease particles
• Volatile organic compounds, which can be found in cleaning products, paint, flooring, upholstery, foam, carpets, caulk, adhesives, soaps, hairspray, nail polish, etc.
• Poor ventilation causing air to stagnate and become more polluted over time
• Odors
• Particulate matter as a byproduct of combustion (a common source of this is cooking)
• Carbon dioxide from exhalation
• Off-gassing from a number of different sources ranging from personal use items to building materials
• The introduction of unclean outdoor or ambient air to an indoor environment 
• Mold
• Airborne infectious disease particles
• Pet dander
• Pesticides, lead, and asbestos
• Ozone, which is created by chemical reactions of multiple pollutants in the air

How Does IAQ Impact Your Residents?

Indoor air pollution is nearly always invisible. This can be true even in highly polluted indoor environments and even in cities or towns where there is visible outdoor air pollution such as smoke or smog. Because of this, it can be easy to believe that your facility’s indoor air isn’t polluted, and therefore could not contribute to acute and chronic illness in your residents.

In reality, the health impacts of your facility’s air on residents can be quite serious. We breathe 2,000 gallons of air every day. If each breath introduces any number of the pollutants listed above into the lungs of your residents, the health outcomes will likely be worse than if they breathed clean air every day.

Let’s take a look at some common health risks associated with poor IAQ.   

Negative Health Effects of Poor IAQ

The World Health Organization (WHO) states that 7 million deaths each year are caused by exposure to air pollution⁶. Moreover, the WHO attributes causation of certain noncommunicable diseases such as stroke, heart disease, chronic obstructive pulmonary disease (COPD)⁷, and lung cancer specifically to indoor air pollution⁸.

A recent study also shows that older women residing in high pollution environments are nearly twice as likely to develop dementia⁹. It has also long been understood that poor air quality both indoors and outdoors worsens symptoms of asthma in individuals of all ages¹⁰. 

Airborne infectious diseases are also a greater risk when indoor air quality is poor. As the COVID-19 pandemic showed, it is essential to provide clean air to Senior Living residents to reduce the risk of spreading SARS-CoV-2 and other airborne communicable diseases such as Pertussis, Respiratory Syncytial Virus (RSV), and Influenza. 

Not every resident will experience these more severe health outcomes, but they may live with minor physical symptoms of poor air quality such as post-nasal drip, rhinitis, cough, wheeze, itchy eyes, and more¹¹. While indoor air quality is not the only factor that can contribute to these health issues, it can play a significant role in the development or worsening of these and other illnesses. 

Positive Health Outcomes Resulting From IAQ Improvement

The Environmental Protection Agency plainly states that improved air quality reduces premature death and many serious health issues¹² including some of those listed above. This is true for people of all ages, and even more true for vulnerable populations prone to health complications such as the Senior Living residents in your facility.

How Can You Improve Indoor Air Quality in Your LTC Facility?

Residents, prospective residents, and their caregivers are more concerned about indoor air quality than ever before.

A recent Delos survey found that 63% of prospective residents and their caregivers would choose one facility over another based on the facility’s proven commitment to bettering their indoor air quality¹³. 

Administrators who hope to both improve health outcomes for their residents and increase census should consider the following indoor air solutions as an important investment in their facility.

Indoor Air Solutions for Long Term Care Facilities

Ventilation

Ventilation dilutes particulate matter in the air of your facility by introducing new outside air. You can create natural ventilation by opening windows and doors in your facility at regular intervals and portable fans can help circulate the air out of the space. 

In instances when opening doors and/or windows is not possible, installing and using exhaust fans can also help to ventilate your facility.

Filtration

Your HVAC system can help you remove particulate matter from your facility’s environment through the use of proper filters. MERV-13 filters or higher are recommended for use if your system is designed to handle this type of filter. In addition, portable air filters are a simple way to help clean the air from room to room in your facility. 

Purification

Air purification devices clean the air itself, rather than circulate it or remove it. Devices devoted to air purification include:

• UV-C light devices: This technology leverages UV light to disinfect airborne pathogens such as viruses as well as bacteria and mold
• Needlepoint Bipolar Ionization (NPBI™): Bipolar ionization technology works with your HVAC system to pump millions of ions into the air that can inactivate up to 98.33% of SARS-CoV-2¹⁴. (Our NPBI solution is certified in accordance with UL 867 and UL 2998 as ozone-free)
• Portable air scrubbing devices: These multi-stage devices can work with HEPA filters, UV-C, and ionization to help your staff clean the air from room to room

Humidity & Conditioning

Creating the right level of humidity in your facility can be a delicate task. Humidity that is too high can tax the hearts of your residents¹⁵. In addition, too much humidity in a space can promote mold growth, which can contribute to negative health outcomes. In contrast, humidity that is too low can cause wounds to heal more slowly¹⁶. 

Keep tabs on your humidity levels with a humidity monitor. This device can be used in multiple spaces including resident rooms, kitchens, and storage rooms and helps you identify areas where humidity improvements need to be made.

A Final Note on IAQ for LTCs

It is clear that the worse your indoor air quality is, the more health issues your residents may face. In contrast, IAQ improvements will likely boost the health and wellness of your residents. These improvements may even encourage prospective residents to choose your facility over others based on your dedication to the quality of the air they breathe.

^{1​​ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587002/} 

^{2 https://www.alz.org/aaic/releases_2021/air-pollution-dementia-risk.asp&sa=D&source=docs&ust=1646684968149062&usg=AOvVaw2JKqZuzKwKa3NOfZBqwXoo} 

^{3 National Library of Medicine. “81% of Senior Living Buildings have insufficient HVAC systems”, https://pubmed.ncbi.nlm.nih.gov/33401060.}

^{4 https://www.epa.gov/report-environment/indoor-air-quality&sa=D&source=docs&ust=1646684968161987&usg=AOvVaw18eYFsZnA2eWhF-gxAx-68} 

^{5 https://www.epa.gov/regulatory-information-topic/regulatory-and-guidance-information-topic-air%23:~:text%3DIndoor%2520Air%2520Quality%253A%2520EPA%2520does,other%2520indoor%2520air%2520quality%2520issues&sa=D&source=docs&ust=1646684968164314&usg=AOvVaw24aqhiMChd213PkB5lL-HI ​​}

^{6 https://www.who.int/data/gho/data/themes/air-pollution&sa=D&source=docs&ust=1646684968142971&usg=AOvVaw0dWDVF274v1UV7mvb6FXOO ​​}

^{7 https://www.airnow.gov/sites/default/files/2020-02/ahbe-english-100-f-09-045.pdf&sa=D&source=docs&ust=1646684968143693&usg=AOvVaw0Zvg5OKC1bE8jCbofRLMgG ​​}

^{8 https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health&sa=D&source=docs&ust=1646684968144361&usg=AOvVaw2-zb7A8TsFs3pNuV64KV7B ​​}

^{9 Cacciottolo, M., Wang, X., Driscoll, I., Woodward, N., Saffari, A., Reyes, J., Serre, M.L., Vizuete, W., Sioutas, C., Morgan, T.E., Gatz, M., Chui, H.C., Shumaker, S.A., Resnick, S.M., Espeland, M.A., Finch, C.E., Chen, J.C., 2017. Particulate air pollutants, APOE alleles, and their contributions to cognitive impairment in older women and to amyloidogenesis in experimental models. Transl. Psychiatry 7, e1022. ​​}

^{10 https://www.aafa.org/air-pollution-smog-asthma/&sa=D&source=docs&ust=1646684968147094&usg=AOvVaw2KGWTCOAvNKMAgitwnIEuW ​​}

^{11https://erj.ersjournals.com/content/early/2015/03/11/09031936.00082414&sa=D&source=docs&ust=1646684968155109&usg=AOvVaw01cKlkWPKUaJwIYpEb-vtS ​​}

^{12 https://www.epa.gov/clean-air-act-overview/progress-cleaning-air-and-improving-peoples-health#:~:text=Americans%20breathe%20less%20pollution%20and,the%20costs%20of%20reducing%20pollution ​​}

^{13 https://www.mcknightsseniorliving.com/home/columns/marketplace-columns/the-importance-of-indoor-air-quality-for-prospective-residents-of-senior-living/ ​​}

^{14 Inactivation results based on sensitivity testing conducted by independent third-party testing laboratory using control chambers. Multiple data points are used to formulate performance validation statements. The technology is used in a wide range of applications across diverse environmental conditions. Results in non-lab environments will vary; clients should evaluate their individual application and environmental conditions when making an assessment regarding the technology’s potential benefits. For all independent laboratory results, contact your TELS Representative at IndoorAirQuality@Directs.com. The use of this technology is not intended to take the place of reasonable precautions to prevent the transmission of pathogens (including COVID-19). Comply with all applicable public health laws and guidelines as well as CDC guidance (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html).​​}

^{15 https://www.webmd.com/heart-disease/news/20060712/high-humidity-boosts-heart-attack-risk ​​}

^{16https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842869/%2523:~:text%253DA%252520moist%252520environment%252520has%252520been,the%252520wound%25252C%252520while%252520decreasing%252520pain%26sa%3DD%26source%3Ddocs%26ust%3D1646087714678935%26usg%3DAOvVaw0JeM8ADbz_S75AQaXfeX44&sa=D&source=docs&ust=1646684968141075&usg=AOvVaw2EwaUZ-IxXfWuRRKKn7olH ​​}

Indoor Air Quality and Long Term Care

The Desire for Increased Safety in Senior Living

According to a recent survey of our customers and their residents, when it comes to selecting a long term care facility, demonstrated safety is a top concern. A second recent survey reinforced that this concern is shared by many Senior Living Administrators, and that creating safer, healthier environments that protect against COVID and other infectious diseases remains a primary focus for Admins. 

The IAQ Disconnect

Indoor air quality (IAQ) impacts the health and safety of residents and staff. Despite this, some operators believe improving IAQ is unnecessary, and don’t give it the focus it deserves. This lack of acute attention paid to improving a building’s indoor air quality could be due to one startling statistic:

While 78% of surveyed Administrators believe their facility’s indoor air quality is good or excellent, the reality is that 81% of Senior Living facilities demonstrate inadequate levels of ventilation and air circulation due to insufficient HVAC systems¹.

Why Improving Your Facility’s Indoor Air Quality Matters

Poor ventilation and air circulation can hasten the spread of infectious disease. Faster spread can lead to more hospitalizations and overall decline in the health, wellness, and safety of both residents and staff². Many administrators cannot afford these and other complications that come with poor IAQ, yet without a strategy to improve a building’s air quality, the situation is likely to get worse, not better.

Moreover, a commitment to excellent indoor air quality can be the difference between a facility gaining or losing a resident as prospective residents and their families continue to place a high value on safety and health.

What you can do to improve your IAQ

If you are looking to demonstrate a commitment to excellent indoor air quality, you should apply a combination of proper ventilation, filtration, circulation, HVAC maintenance, and air purification solutions. Some of these solutions may include:

• An HVAC maintenance plan
• Appropriate MERV filters for your HVAC system
• Portable air purifying devices
• UV lights
• Bipolar ionization (also known as needlepoint bipolar ionization, or, NPBI(™))

Bipolar Ionization: A Powerful Air Purification Solution

While each of the previously mentioned solutions could be the right fit for your building based on your specific situation, in this article we’re going to take a deeper look at bipolar ionization as an air quality solution that integrates with your current HVAC system. 

This emerging technology has already seen success in reducing risk for COVID-19 in buildings³, and it may be just what you need to demonstrate a commitment to excellent indoor air quality in your facility. 

Let’s address some common FAQs that can help you determine if a bipolar ionization system is the right solution for your building.

Bipolar Ionization FAQs

What is Bipolar Ionization?

Bipolar ionization is a cutting-edge indoor air quality solution that reduces certain viruses and bacteria, such as SARS-CoV-2, influenza, and MRSA⁴. It works with the building’s existing HVAC system and can be used in addition to other IAQ solutions such as portable air filtration devices.

How Does Bipolar Ionization Work?

NPBI creates and releases ions into the airstream using the existing HVAC system as the delivery method. When these ions disperse throughout a space, they seek out and form bonds with particles in the air through a process called agglomeration. This creates a snowball effect in which particles begin to cluster together. The larger a cluster of particles becomes, the easier it is for the HVAC system to filter it out of the air.

Does Bipolar Ionization Create Ozone?

While there may be some ionization products on the market that do create some level of ozone, the NPBI solutions are UL 2998 certified.

Does Bipolar Ionization Work With MERV Filters?

Yes. When you use needlepoint bipolar ionization, you give your filters a bath of millions of ions per second. We recommend a combination of bipolar ionization with the highest rated filters compatible with your HVAC system. 

How Does Bipolar Ionization Impact HVAC Systems?

Bipolar ionization devices are available in several options that can be retrofitted into any HVAC system. The whole process, from specification to installation and post-install ion monitoring, is professionally managed by the expert team at Direct Supply® TELS™ solutions.

In some cases, you may even extend the life of your HVAC system by using bipolar ionization. Some HVAC systems cannot withstand the pressure certain high-grade filters create. Bipolar ionization allows you to use a filter that creates less pressure, such as MERV-13 instead of MERV-16, thereby removing excess stress on your HVAC system that could cause it to breakdown prematurely.

Is a Bipolar Ionization System Right for You?

If the basic information about NPBI outlined in this article got you thinking about how to implement bipolar ionization in your facility, it’s time to speak with an account manager. This is the best way to determine exactly which solution or combination of solutions is ideal for your unique situation.

Fill out the form below to get started. We’ll be in touch with you shortly to answer any additional questions you may have as well as to learn more about your facility so we can help you determine the right IAQ solution.

Contact Direct Supply for options and pricing on NPBI

Send us your contact information and a helpful TELS representative will get in touch with you to discuss options and pricing for your organization.

^{2 Reddy M, Heidarinejad M, Stephens B, Rubinstein I. Adequate indoor air quality in nursing homes: An unmet medical need. Sci Total Environ. 2021 Apr 15;765:144273. doi: 10.1016/j.scitotenv.2020.144273. Epub 2020 Dec 24. PMID: 33401060.}

^{3 The use of this technology is not intended to take the place of reasonable precautions to prevent the transmission of pathogens (including COVID-19). Comply with all applicable public health laws and guidelines as well as CDC guidance. Estimated reduction in risk of COVID-19 infection up to 41% for residents in Skilled Nursing Communities with NPBI installed in both common areas and resident rooms. Data estimates modeled from data self-submitted by communities to The CDC National Healthcare Safety Network system COVID-19 Long Term Care Facility Module and matched against our database of over 400 NPBI technology installations in Oct 2020 – Jan 2021. Outside factors such as new variants, cleaning practices, and vaccine rates vary over time and may impact the reduction in a particular community; results not guaranteed. 4/21/2021}

^{4 Inactivation results based on sensitivity testing conducted by independent third-party testing laboratory using control chambers. Multiple data points are used to formulate performance validation statements. The technology is used in a wide range of applications across diverse environmental conditions. Results in non-lab environments will vary; clients should evaluate their individual application and environmental conditions when making an assessment regarding the technology’s potential benefits. For all independent laboratory results, contact your TELS Representative at IndoorAirQuality@Directs.com. The use of this technology is not intended to take the place of reasonable precautions to prevent the transmission of pathogens (including COVID-19). Comply with all applicable public health laws and guidelines as well as CDC guidance (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html).}

Survey basics

This survey was designed by Direct Supply and conducted independently. It was sent to 1,262 total respondents in mid-June of 2021. The respondents were grouped as follows:

• Skilled Nursing Facility: 348 respondents (27.6%)
• Assisted Living Facility: 502 respondents (39.8%)
• Memory Care Facility: 222 respondents (17.6%)
• Other (includes CCRC, Independent Living and other Senior Housing): 190 respondents (15.1%)

Our objectives

Our question set was developed with specific objectives in mind:

• Provide benchmarks for Administrators
• Reveal safety trends and drivers
• Provide insight to suppliers to the industry.

The question set covered 6 basic topics:

1. Resident Safety
2. Concern Over OSHA and CMS Citations
3. Air Quality: Perception and Practice
4. Infection Prevention and Control
5. PPE Policies and Procurement
6. Screening and Education

What you will learn

• Which area of senior living facilities is most neglected when it comes to infection control. 
• What percentage of facilities say their PPE practices meet CDC conventional use standards.
• Discrepancies in perception versus reality as pertains to Indoor Air Quality (IAQ) in Senior Living facilities.
• Actionable steps you can take now to lower your safety risks and increase resident health.