Invisible Industry: Patience Wears Thin As Senior Living Pleads for Government Support

As the Covid-19 pandemic drags on and the industry worries its hardest weeks still lie ahead, many are wondering when — or even if — they will receive more support from federal, state or local governments. And, their frustration is rising.

Senior living providers and industry associations have been clamoring since the outset of the crisis for more access to personal protective equipment (PPE), testing supplies and financial support. These resources are still sorely lacking, even as some senior living providers are subject to increased regulatory and oversight requirements, frontline caregivers are working hard with limited supplies while seeing senior living blasted in the press, and other industries have received substantial dollars. At the same time, there is a fear that, as the national death toll climbs, senior housing communities could be treated as a scapegoat or face new federal scrutiny.

Some organizations, like non-profit senior service provider association LeadingAge, believe the federal government can and should do much more to aid senior living residents and workers during this unprecedented time. The organization has had sharp criticism for the Trump administration in recent weeks over what it views as a lackluster response to protecting senior service providers and older adults amid the Covid-19 pandemic.

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Others, like the leaders behind Fanwood, New Jersey-based Chelsea Senior Living, wish local regulators were more lenient and understanding in setting guidelines for dealing with Covid-19. And frontline workers — like some at Hickory, North Carolina-based Affinity Living Group — want more recognition that their fight is as important as the ones playing out in hospitals and nursing homes all across the country.

The federal government on Friday announced the distribution of almost $4.9 billion in Covid-19 relief funds directly to skilled nursing facilities. This is the first specific tranche of stimulus money for the sector, and it’s a welcome step, according to LeadingAge — but it’s still just a start, as there is a much greater need for support within the larger senior housing and care landscape.

“These funds are a start in covering nursing homes’ extraordinary expenses related to this public health crisis, but will only go so far in addressing providers’ growing financial needs as this pandemic continues,” LeadingAge president and CEO Katie Smith Sloan stated in a press release.

‘No acknowledgment’

On April 30, Sloan attended the White House’s “Protecting America’s Seniors” press conference. She left feeling disappointed.

Though the event culminated in an announcement that FEMA would supply every U.S. nursing home with approximately two weeks’ worth of PPE, Sloan felt as though the Trump administration had offered “practically nothing” in its efforts to protect seniors in other parts of the care continuum, such as assisted living, affordable housing or home-based services.

“Two months into this, and we were seeing absolutely no change in the level of support, we were seeing a lack of recognition for what we were doing and the role that we were playing,” Sloan told Senior Housing News. “We’re a critical part of the healthcare system, and there was simply no acknowledgement of that.”

Providers have faced lofty challenges procuring personal protective equipment (PPE) and testing kits for their staff and residents. For one, these supplies have been in short supply. And even when providers can find them, they’re often sold at a high markup, resulting in thousands or millions of dollars in unplanned expenses. Lucky senior living providers have been able to turn to financial or real estate ownership partners for help, or have received government funding. Still, many others have had to dig into cash reserves or rely on credit to tide them over during a tough time. And even for those that receive federal dollars, there is a sense that the money will only last for so long.

In the days after the White House event, LeadingAge asked its members about what they needed in order to protect older adults. That effort resulted in a list of five essential actions for protecting older adults from Covid-19:

  • An assurance that states will not reopen without ensuring older Americans are safe and protected first.
  • Access to enough PPE for all care providers who serve older Americans, not just in nursing homes.
  • On-demand access to rapid Covid-19 testing for older adults and caregivers, with senior housing and care providers on the same priority tier as hospitals.
  • More recognition for frontline workers in nursing homes, assisted living, affordable housing, and home- and community-based settings, including hospice.
  • Roughly $100 billion in additional financial support to cover Covid-19 needs. These include hazard pay for frontline workers, federal housing assistance, more support to deliver telehealth, more access to loans and increases to Medicaid.

Sloan doesn’t believe the federal government has made much headway addressing these items since LeadingAge released the list earlier this month. And the organization has asked the federal government for more support with regard to PPE and testing for months.

One bright spot came in the form of the $3 trillion Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which would provide appreciation pay for frontline workers if passed into law, among other provisions. But that legislation is now seemingly stalled in the Senate, with Republicans and U.S. President Donald Trump opposed to the bill as written.

Nursing homes have begun to receive some support from the government in the form of advanced payments that are generally not available to private-pay senior living communities. And despite senior living being predominantly a private-pay business, Sloan sees no excuse for the lack of federal help for these communities, particularly with regard to equipment and testing.

“As we’ve said many times, it is the government’s role to provide adequate supplies of PPE and tests with quick results in a national emergency,” she said.

Senior living is not the only private-pay industry to seek or receive federal help. For instance, the Trump administration bailed out the U.S. airline industry, and more federal help may be on the way for other struggling businesses. Senior living industry groups Argentum and the American Seniors Housing Association (ASHA) pointed out the support flowing to these other sectors as they made a plea in March for senior living to be allocated stimulus funds.

“While Congress is looking to bail out cruise lines and airlines, they need to prioritize the seniors who are disproportionately impacted by the virus and the frontline staff and caregivers who are working diligently to keep our seniors from this terrible virus,” ASHA President David Schless stated at the time.

Though LeadingAge’s Sloan is still optimistic that the industry will receive the support it needs in the end, she is not counting on the White House or federal agencies for help. Instead, she sees a bigger lift coming from Congress, and from the leaders of states around the country.

“We have 38 state partners who are in touch with their governors and elected officials constantly,” Sloan said. “Governors are much closer to the action … and in many cases are quick to act.”

One size doesn’t fit all

Though LeadingAge’s membership includes only not-for-profit senior housing and care providers, those on the for-profit side are running into similar problems.

Chelsea Senior Living, which operates 18 communities in hard-hit New Jersey and New York, said the states have at times conflated nursing homes and assisted living communities, resulting in general guidance that muddies the waters or creates new operational burdens during an already challenging time. The company’s business model is about 75% private-pay, with the rest Medicaid.

“Our governor, our department of health, hasn’t reacted to the difference in the two kinds of environments,” said Herbert Heflich, CEO of Chelsea Senior Living. “One is very medical, and can take very sick people, and the other is a more residential setting that takes people that need help with activities of daily living.”

Early guidance from the New Jersey Department of Health recommended that assisted living communities and nursing homes check all residents’ symptoms and vital signs every shift, Heflich said. For well-staffed hospitals or nursing homes, this wouldn’t be as much of a problem. But for an assisted living provider faced with staff shortages and other new responsibilities in the pandemic, this seemed like a lofty task to complete every shift of every day. So, the provider had to cut back in other areas to meet the guidance.

“If you had 80 residents in assisted living, it would take 12 hours to do that,” Heflich explained. “So, we made a suggestion: For a month or two, don’t give out vitamins. We now save the nurse … 20% of her time [for] something that’s more necessary.”

As of May 11, the company had spent about $200,000 to $300,000 mitigating Covid-19, according to Chelsea Senior Living President and COO Roger Bernier. The company has also received some help from its partners, such as Welltower (NYSE: WELL), Capitol Seniors Housing and Kayne Anderson. And some of the local Offices of Emergency Management (OEMs) have been helpful to the extent that they can, given their limited resources.

Chelsea believes that New York and New Jersey must do a better job of talking to senior living providers before crafting guidance or new regulations. Obtaining rapid Covid-19 testing is another crucial area where Chelsea sees a great need for support as states across the country reopen for business. Indeed, testing mandates have begun to come down for assisted living, raising significant questions about how providers are supposed to access and pay for these tests.

“This is our biggest need,” Heflich said. “We can’t make decisions about people coming into the building — residents, families — without having that instant test, and it’s not available. We’ve gotten some, but … we need hundreds of these tests.”

Bernier is also dismayed that, even as the company is subject to more oversight from the state governments, it has not received the same level of support.

“I believe if the government mandates you close your doors and adds many additional restrictions/regulations, they have an obligation to offer relief,” Bernier said.

‘Fighting the same fight’

No one knows Covid-19 better than the workers who deal with it on the front lines every day. But some caregivers who have helped battle the disease in senior living communities feel as though their struggle has not been recognized.

That is the case for Spring Neal, an area operations director with ALG. When the Covid-19 pandemic hit, she was moved out of her “home base” in Mecklenburg County to work at Cherry Springs Village, an ALG community in Hendersonville, North Carolina.

Cherry Springs had 45 cases among residents and 17 cases among staff, and is currently in the process of healing and de-isolating after a long and hard effort to stop the spread of the disease. In interviews with SHN, three of the community’s staffers have described watching residents who seemed fine deteriorate in a matter of hours, calling a resident’s family members for a final goodbye and caregivers having to put some of their residents in body bags because the funeral home didn’t want to handle someone who had Covid-19.

For Neal, one of the most challenging aspects of the pandemic came early on, when newspapers and TV programs were full of headlines centering on the high rate of infections and deaths.

“How the news media portrayed it … put everybody into a panic,” Neal told SHN. “I felt that my job as a leader was to try to kill some of the hysteria, and make sure that we’re taking care of our residents in the safest way possible.”

Another frustration is that some among the general public do not view Covid-19 with the seriousness it deserves. This is particularly relevant as states across the U.S. reopen and people flock to restaurants, bars and beaches, and it’s a top worry for Jodie Brackett, a life enrichment director with ALG who works at Cherry Springs.

“Take things like this seriously, and listen to what medical professionals are saying,” Brackett told SHN. “Stay at home. Don’t worry about your nails and hair.”

ALG invited its caregivers to sign a “hero’s pledge” signifying they understand the threat that Covid-19 presents and will uphold the company’s infection control protocols at all times in their daily lives. And the company has taken the threat seriously by providing Cherry Springs with anything it needed to get ahead of the pandemic, according to D.J. Buff, a family liaison who also works at the community.

“I feel like the staff are much more appreciative of each other, and that we’ve come together as a team,” Buff told SHN. “And for the residents that are still with us, I feel like we’ve made a tremendous difference.”

Neal (left) and Buff (right)

While Cherry Springs’ residents are no doubt appreciative of the effort, Neal still wishes there was more support and recognition for the senior living industry’s arduous and heroic task.

“We’re all here fighting the same fight,” Spring said. “It doesn’t matter whether you’re skilled or you’re AL, we’re still taking care of residents, we’re still taking care of staff, and we should all be treated equally.”

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