Covid-19 Changes ‘All Protocols’ For Senior Living Admissions, Creates Legal Gray Areas

The Covid-19 pandemic has disrupted just about every facet of senior living operations — including when to allow admission of new residents and how that process is handled.

On one hand, senior living providers must maintain occupancy levels to keep revenue flowing, and that means admitting new residents. Particularly in assisted living and memory care, denying an admission also means denying needed care to an individual.

On the other hand, new admissions can act as a disease vector by bringing Covid-19 into the community.

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In admitting new senior residents in the middle of a pandemic, providers must balance safeguarding their residents from Covid-19 with simply keeping the lights on, according to Dan Williams, president and COO of Lake Oswego, Oregon-based Seasons Living.

“All our protocols for moving in people are changing,” Williams told Senior Housing News. “We still have a business, and … any business can go out of business if it doesn’t have customers.”

Some providers so far have ceased admitting new residents altogether, according to a new Senior Housing News survey about Covid-19. But, only 32% of that survey’s respondents said they had done so.

The complexity of admitting new residents in the middle of a pandemic has sometimes led to a legal gray area for assisted living providers, according to Hedy Rubinger, who chairs the national health care practice at the law firm Arnall Golden Gregory.

“Many of our clients are finding themselves getting requests for new admissions, because family members are determining that they can no longer care for their loved one at home,” Rubinger told Senior Housing News. “[They are asking], should they still be admitting residents? Can they admit someone who was discharged from the hospital? What happens if someone’s been diagnosed with Covid-19, do they bring them back into the community?”

While the answer to those questions depends on a variety of factors, Rubinger suggests providers stay in close contact with their state and local governments for guidance on how to best admit new residents.

But local and state governments aren’t always of help in this regard, as some have offered conflicting or frequently changing guidance for dealing with the rapidly spreading pandemic. And while the CDC has issued guidance for senior living communities, these measures include things many senior living providers are already doing, such as limiting social events and non-essential visitors, disinfecting common areas and screening workers and residents for Covid-19.

“If there’s an impediment on the state side to [admissions], you need to really see where that impediment comes from, and dig into it, because it may or may not be enforceable,” Rubinger said. “There are plenty of gray areas, and we’ve been helping our clients work through those on a fact-specific basis.”

Whether or not they are currently admitting new residents, senior living providers should at least be thinking of the legal risks surrounding admissions now. That’s because there is likely to be a “surge” of new potential senior living residents in the days and weeks to come as hospitals discharge patients and free up beds to handle more Covid-19 cases, according Gabi Sanchez, who co-chairs the senior living and long-term care team at Seattle-based law firm Lane Powell PC.

“A lot of hospitals — and we’re seeing this now — are starting to discharge people that they think can be cared for in skilled nursing or in assisted living communities,” Sanchez said. “So the question becomes, how do we deal with this surge, and how do we ensure that … we are protecting current residents?”

Like Rubinger, Sanchez also recommends providers stay in close contact with state regulators and agencies. In fact, doing so may even benefit the senior living industry, at least when it comes to census.

“Hospitals are calling them and asking if they can take patients and admit them as residents,” Sanchez said. “We’ve been working with the state agencies to carefully screen these residents and admit them so that there is space in either the hospitals or in other settings.”

Ramping up testing efforts will likely be the key to handling more new admissions in the future. Currently, at Seasons communities without available Covid-19 tests, newly admitted residents are placed into a 14-day quarantine and screened often for symptoms. But widespread availability of testing could help streamline the admissions process.

“If we can get rapid testing, that’s a kind of a game-changer as far as our screening of admits, going forward,” Williams said.

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