Even as headlines announce White House and CMS plans to reopen nursing homes, many operators are already planning for a new normal. The COVID-19 pandemic is far from over, and still threatens older adults, but operators will have to find ways to protect residents and staff, facilitate social connection, and restart move-ins, likely while the virus remains at large. Some forward-looking decision-makers are planning to reinvent how they operate their properties. Some are going forward with existing plans to launch new properties, with similar operational modifications, on schedules that were determined months and years before the pandemic became our new reality.
But what will life look like in the seniors housing and care communities of the very near future? What will it take to protect residents and staff? And, how will it impact operating and capital budgets? Operators across the sector have already put many operational changes in place, as part of a massive effort to protect highly vulnerable residents. Most operators have announced what they’re doing to combat the virus, which in almost every case involves new protocols around testing, PPE, quarantining infected residents, and supporting frontline care workers and their families.
Brookdale Senior Living CEO Cindy Baier, in an online video message, states, “It’s been nothing short of extraordinary what our Brookdale associates have done to protect as much as possible tens of thousands of lives during this COVID-19 crisis.” Baier indicated that the company is planning for more normalized post-COVID-19 operations, even as they continue to fight to protect residents at the height of this pandemic: “We are all focusing on where we are right now, even as we start thinking about where we’re going.”
Many need-based seniors housing and care settings are purpose-built to protect this disproportionately high-risk population from viruses, such as the flu, while delivering the care and services residents often cannot access elsewhere. But COVID-19 is far more virulent than the flu, and has a disproportionately high mortality rate for seniors, particularly those with preexisting conditions, millions of whom call these communities home. Protecting residents and staff is further complicated by the fact that COVID-19 can be spread by asymptomatic carriers – often for weeks at a time.
Testing, therefore, has been an essential component of combating the virus, and for many operators, it will likely continue to be of paramount importance. In a recent NIC “Leadership Huddle,” on May 7, Atria Senior Living Chairman and CEO, John Moore, described how his organization was able to obtain testing in partnership with Mayo Clinic. In addition to obtaining sufficient PPE, their own source of hand-sanitizer, and new technologies for remote care and connectivity, testing has allowed Atria to detect the virus and combat its spread. Moore is not alone is his prioritization of testing. NIC, in coordination with industry groups, has issued a joint statement which lists access to testing as an essential component of the fight against COVID-19.
But there are many other details to consider. NIC spoke with Jonathan Cook, President/CEO of LifeSpire Living, an operator of four continuing care retirement communities (CCRC) in Virginia. Cook has already been planning for the lifting of travel restrictions and inevitable reopening of his properties to visitors and new residents. His target date is June 10, and he’s determined to be prepared when the time comes. He outlined his team’s “general work plan,” which he describes as a “brain dump of ideas,” which he hopes will evolve as his teams learn and adapt.
Planning includes a careful review of financial models, which have had to be modified to support the new operational plans. Although move-ins are down, Cook says they expect to pick up a backlog of deferred move-ins in the next few quarters. Medicare part A revenue is currently reduced, as hospitals have cut back on elective surgeries. Budgets, although different, aren’t expected to grow. “We’re going to redeploy our capital budget, so I don’t know that we’re going to have a huge impact there,” said Cook, “I don’t think we’re going to have large capital investments that we can’t absorb in the current budgets.
“Operationally, we’re doing things like the ‘hero pay’ and things like that…those are certainly going to have an impact on our operations.” But, at the same time, Cook said, “your dining rooms have been closed, so where you used to have 25 servers, you now only have 15, because they’re running food, so there have actually been some savings on that side…we have not seen these huge swings up or down in our payroll levels. We’ve been able to maintain and redeploy resources in ways that have really created a balance.”
Cook’s team conducted a complete assessment of their capital budgets, to understand where resources were being dedicated, and where they could be reassigned. They then created action plans for every discipline, such as housekeeping, and laundry. They sent out requests for proposals for professional housekeeping companies, to provide daily cleaning, and to meet additional cleaning standards, throughout each day. As Cook said, “cleaning your lobby in the morning and afternoon will likely no longer be sufficient.” Prior to reopening, the team plans to deep-clean every apartment in buildings that have had a case of COVID-19.
During COVID-19 lockdown, the community has limited engineering, transportation, and security services, to help reduce the risk of infection. A lot of routine work orders will therefore be backed up. Cook’s team reached out to construction partners, in order to get handy men on staff for 4-5 weeks to help catch up.
Every vehicle in the LifeSpire fleet has been equipped with sanitation kits, so they will be ready to safely transport residents. The company is also looking at redeploying existing staff, and using corporate cars, to accommodate the transportation needs caused by a backlog of deferred doctor’s visits. The company put a hold on the planned purchase of several busses this year, as they wait to see whether vehicles will need to be special-ordered or customized to accommodate residents post-COVID.
Another concern relating to transportation is handling EMS staff responding to emergencies on the property. Due to their heightened exposure to COVID-19, new procedures provide for a hand-off of the resident to EMS, who receive them at the building entrance and place them on their gurney there. “It’s not how we like to do things, but it’s what we’re trying to do to maintain a COVID-free environment for our residents,” said Cook.
Fitness classes are now available on residents’ TV’s and an exercise app. This change is already in effect, and has resulted in some residents participating more than before. Cook reported that his mother-in-law, a resident, had been self-conscious and avoided attending in-person sessions – but has now lost 14 pounds attending from her apartment. Post-COVID classes will be smaller, and more frequent, in order to accommodate residents who prefer to exercise in classes, and on equipment not available in their apartments. This will require more staff hours.
Another COVID-related adaptation is to move more activities outdoors, to help further reduce chances of transmission. Cook is looking into increasing patio dining, heated tents, and expanded use of outdoor areas as a means to maintain social distancing.
Beauticians, tested and screened daily, and equipped with full PPE, will visit residents in their homes. Visitors to the beauty shop will skip the waiting room and come when they receive a call, during which time the space will be sanitized.
Gift shops will no longer accept cash, cutting out another potential infection point. Resident outings will still be on offer, but mainly only to outdoor venues, such as baseball parks, outdoor concert spaces, and parks. Indoor activities, such as card games, will remain, but on a smaller scale, to accommodate social distancing protocols. A new lottery program will limit numbers of residents attending onsite performances, with spaced seating installed. Others will be able to watch on the in-house TV system.
According to Cook, the biggest impact, both on the resident community and the budget, will be the revamped dining program. Details such as grab-and-go packaging, separate entrances and exits, expansions of dining rooms into outdoor spaces and heated patio tents, will change how everyone approaches meal times. In addition to offering room tray service, like a hotel, and mobile and web ordering, previously public vending and snack options will be offered as individually wrapped options. Employee break rooms will receive similar consideration, and will also gain outdoor dining options.
New budgets also accommodate new gatehouses, designed to control access, and continued screening of all visitors. For residents who don’t already have smart devices, the budget provisions tablets for running Facetime, Teams, and other technologies that enable connecting with others remotely.
As move-ins are approved, the company will offer new residents incentives, such as paying for movers. Cook’s team is looking to negotiate with one corporate moving vendor who will be contractually obligated to learn and follow the correct procedures, properly sanitize equipment and maintain corporate standards. He sees having one vendor that is well-versed in operations as another means to reduce the risk of infection, while offering value and service to residents.
As staffing needs ramp up, new procedures for recruiting and onboarding will be in place, using facetime for interviews, and screening for COVID-19 as part of routine measures. Cook expects new staff will be needed soon. Using modeling to project his team’s planning, he sees a backlog of deferred move-ins, a return to some elective procedures, and a balanced reallocation of resources that will help his communities adjust to a new normal and still be able to keep residents safe, healthy, and happy. He said, “We think this is certainly going to represent some expenses, but its not anything we’re not going to be able to recover from.”