Covenant Health System started its environmental journey in 2003. The Catholic not-for-profit, which is headquartered in Tewksbury, Massachusetts, is made up of 14 facilities: nursing homes, hospitals, and assisted-living residences. Greening elder care has much overlap with acute care facilities, including energy, water, and waste opportunities, but some big differences also exist, including the absence of operating rooms and a residential community within the campus.

At Covenant Health System, system-wide oversight and local green teams have resulted in numerous accolades and leadership engagement.

To get things started, Nancy Mulvihill, vice president, corporate communications, was identified as the system-wide lead and reached out to Laura Brannen, executive director of Hospitals for a Healthy Environment (now Practice Greenhealth), to seek guidance. This led to an overall environmental assessment, identifying use of mercury-containing products, Styrofoam usage, and lack of recycling.

A first system-wide goal was set in 2005 to eliminate mercury. The development of an environmentally preferable purchasing policy led to identification and transition to mercury-free alternatives. Its 2006 goal was a 50% reduction in waste volume by 2010.

At the corporate office, a small fine is imposed on anyone who sends out a report that is not printed back-to-back. Recycled paper is purchased and used to print brochures and collaterals. The system-wide newsletter and annual report goes out electronically to 1,000 people, rather than through the mail. Water bottles are out, replaced with a bottle-less water cooler, and all “e-waste” is disposed of in an environmentally correct manner.

In 2006, green teams were developed at each site along with the first system-wide Earth Day activities. Leadership formed its own team and developed a philosophy statement, Covenant on Sustainable Design, Construction and Building Operations. Then, 2007 continued to be a really big green year when David R. Lincoln, president and CEO, signed the Healthy Food in Health Care Pledge for the entire system.

After news hit of the system-wide pledge-signing, Mulvihill assured staffers they would take baby steps and not tackle everything at once, focusing first on low-hanging fruit. One year later, much of the pledge was fulfilled.

“Some of us are now buying that low-hanging fruit—and vegetables, for that matter—from our local farmers,” she says. Plans are underway to expand the local and sustainable sourcing efforts, and to model the community outreach efforts around gardening and healthy food that St. Mary’s Hospital in Lewiston, Maine, has pioneered.

The system also worked toward eliminating Styrofoam, avoiding trans fats, using rBGH-free products, and introducing “meatless Mondays.” In addition, one of Covenant’s facilities has a garden where residents grow vegetables that are used for “delicious zucchini bread” for board meetings.

Youville Place Assisted Living Residences is a 92-unit, assisted living facility in Lexington, Massachusetts, that sits on a 12-acre site. Bob Salamanca chairs its green team. The facility has apartments that are cleaned each day, small kitchens, and a dining room and café. A lighting audit and retrofit has been completed, and the facility worked with its utility provider to seek funding to reduce operating costs.

In January 2010, a cogeneration plant (CHP) was installed and, currently, it is generating 1.1 million kilowatts of electricity and displacing 60,000 therms of heating from the boiler. The therms are used to heat domestic hot water and for heating.

Youville Place is in the process of installing meters to the CHP plant that will result in the receipt of 2,100 alternative credits. Through metering, it will know what will be produced and will start receiving $7,500 each quarter from the state for returning energy to the grid and selling it on the open market. The CHP plant had a two-year payback.

Other conservation efforts include installation of variable frequency drives on all heating and water pumps, and cooling tower fans. Energy efficiency controls were installed on refrigerators and the walk-in freezer. A 2010 water audit resulted in new shower heads reducing water use from 2.5 to 1.5 gallons per minute, with an annual savings of 498,000 gallons for the year and $5,000 per year. When the chiller required replacing, a more efficient replacement was identified.

Fluorescent light bulbs and battery recycling maintains a mercury-free waste stream, and a thermometer exchange with residents extends the education into the community. Composting started in 2009 at Youville, as the facility transitioned from everything going into the trash in a 35-cubic-yard compactor to a 10-yard dumpster for trash, 10 yards for commingled recycling, and 55 gallon totes for composting. This resulted in a savings of $3,800 per year. The recycler provides Youville with reports on materials and waste.

The staff also trained residents on recycling segregation in their apartments.

While activities take place through a local green team, Youville Place shares best practices with Covenant’s system-wide environmental committee. For construction and renovation, low-VOC paints and adhesives, and green label carpets are used. Green cleaning and a microfiber mop system also have been instituted.

The environmental stewardship activities at Mary Immaculate Nursing Restorative Center in Lawrence, Massachusetts, are led by Joe Levesque, director of support operations. Its biggest environmental win was a CHP plant, and the center points to leadership engagement and system-wide strategy for its local success. The CHP plant saved approximately $66,000 per year with a return on investment (ROI) of 2.2 years and a CO2 reduction of 346 tons per year, or 57 cars off the road.

The first energy audit was done at the beginning of 2009. An “energy miser” (sensor) was added to vending machines to turn them off when not in use. Re-lighting, re-balasting, and adding room sensors reduced energy use by 166,187 kilowatt-hours (kwh) per year and prevented 257,589 of CO2 emissions, which equated to 22 cars taken off the road. The ROI for these upgrades was 1.7 years.

Composting has led to two bags less trash each day, and education (as to where to put disposables) helps staff understand the impact of their participation. Adding a single stream recycling compactor facilitated recycling operations and increased compliance. Protected health information is shredded off-site and recycled.

Currently, the center is considering an update and replacement of all air intake and kitchen hoods with variable drive motors, and converting the kitchen hoods that run 24/7 and all nightlights to LEDs. Electricity reduction would be 98,132 kwh per year with an annual savings of $23,529 with a ROI of 1.99 years, which will be financed through the local utility. With the financing added to current utility bills for two years, the savings pay for financing.

Through the installation of an ozonator in the laundry, Mary Immaculate Nursing Restorative Center has drastically reduced its carbon footprint and utility usage/costs by decreasing demand for hot water and total water use. The ozonator reduces hot water usage because ozone works best in cold water, and because of its patented, clinically validated disinfection process.

Savings are $3,600 per year through water conservation and another $2,500 per month through hot water use reduction, resulting in an annual savings of $33,200.

In addition, Mary Immaculate has just earned the U.S. Environmental Protection Agency’s (EPA) ENERGY STAR certification with an 83 rating (minimum required is 75), which signifies that the building performs in the top 25% of similar facilities nationwide for energy efficiency and meets strict energy efficiency performance levels set by the EPA.

Senior care communities have only recently become eligible to receive an energy performance score by using EPA’s online energy measurement and tracking tool, Portfolio Manager, and to earn the ENERGY STAR certification for superior energy performance.

The installation of flooring that does not have to be stripped and refinished and the purchase of an auto scrubber resulted in 50% less water and chemical use, which reduces operational costs and improves air quality and environmental impact. HCD 

Janet Brown, EDAC, can be reached at jbrown@practice​