“The whole month of March was a blur, everything was happening so fast.”
These are the words of Seasons Living President and COO Dan Williams, but they reflect an experience that many, if not all, industry leaders went through last month.
Within the space of just a few weeks, Williams went from concern and confusion to a recognition that Covid-19 is a crisis demanding an unprecedented response, he said on the latest episode of the Senior Housing News podcast, Transform.
Williams joined the podcast just one day after Covid-19 struck Seasons for the first time, infecting a 40-year-old caregiver who had to be hospitalized and put on a ventilator. Williams spoke frankly about his own reactions to this troubling news, and the fear, trauma and grief that Covid-19 is inflicting on workers at every level of senior living. In this difficult time, he’s taking heart in how the industry is pulling together.
Based in Lake Oswego, Oregon, Seasons operates 15 communities across seven states and has several under development.
On creating a Covid-19 task force:
I think it was in late February or early March when the Life Care Center of Kirkland made the news. I was familiar with that area. I used to have a building right down the street from that particular Life Care. So, at that point, we formed a kind of task force at Seasons — our director of health services and other key people. We divided up things into procurement, health services, prevention, various areas. We have a company-wide intranet, so we designed a page on the intranet, and we call it a command center. We post all our strategy, all our policies on there. The latest from the CDC, the latest from every state on prevention precautions, and just the latest information they’re putting out on the virus. It’s a place where all our executive directors can go ask questions to the task force and get those questions answered, and a notify us of different things going on.
I’ve been in touch with several [other operators during this time. We’ve all come together and we’re all helping each other. It’s been great to see, and we’re all trying to help each other get through this. But, we put a strategy plan in place during the time it was happening at Life Care. What we did was, you have CDC recommendations, which we follow, and then we’re getting updates on CMS [the Centers for Medicare & Medicaid Services]. Even though we’re not a skilled nursing company, we felt that CMS was putting out some pretty good guidelines. So, if they’re putting them out for skilled, we were going ahead and instituting those into our assisted living and memory care communities.
While that was unfolding, we were one step ahead of the game as far as when the states and the DHS [Department of Health Services) would put out different things, such as screening [guidelines] and only essential visitors and things like that.
It’s almost like the whole month of March was a blur, everything was happening so fast. We were updating strategy and policies very quickly and getting that information out to our buildings. We did task force calls every single day with just the task force, and then after that, we’d do all the executive directors and nurses on the phone with the task force … we still do that every single day, now.
So, quite a lot’s changed about how we do business in a short period of time.
On the company’s first associate to be diagnosed:
At this moment, my mantra has been we’re just going to do everything we can to keep [Covid-19] out of the buildings, keep our employees and residents safe, so that’s being very diligent in our screening process with employees every shift. Allowing only essential visitors in, defined by, really, only if you have an end-of-life resident on hospice … then, they can have visitors, and we’ll screen those and probably have them wear PPE.
I probably shouldn’t do this, but I did: I set a Google news alert for “assisted living coronavirus.” So, every day I get an email alert and news media stories about outbreaks and positive residents and positive employees across the country. It’s helped me be diligent, and we were doing great, but we had our first employee show positive in our Kansas City building yesterday. We have some residents out testing now, and we did get results back that a second employee in that building has tested positive.*
So we’re experiencing at Seasons what a lot of other companies are experiencing now. My mantra has stayed the same with the EDs about being diligent, about enforcing what our strategies are, what our policies are to keep this virus out. And then we just yesterday got a drill in what do we do when we do have an outbreak? The task force came together and we helped our community in Kansas City navigate what’s going on with the local health department and so forth.
So, it’s hitting home now.
In this case, the executive director tried to get in touch with this employee and couldn’t get in touch with her. And then the health department called us and notified us she was in the hospital and had tested positive for Covid. And, unfortunately, we’re talking about a 40-year-old, single nursing school student, female, who has a four-year-old child at home. She’s on a ventilator, and she’s fighting for her life. And, frankly, we spoke to the hospital this morning, and it doesn’t look good. The prognosis is not good.
So, of course, she and her family [are] in our thoughts and prayers right now.
On the response when Covid-19 strikes a community:
At the time we knew we had a positive case, we started isolating any residents that were having any kind of symptoms — which we kind of already had done. We also went and got tests from the health department. They were kind enough to give us 10 tests. So, we have three residents that are showing symptoms of being ill. Some of them aren’t respiratory system [symptoms], so we’re not sure. And then we actually had five other employees that are showing some symptoms. So, we’re testing all those residents and employees. So far, the tests have not come back. It’ll probably be tomorrow or the next day before you get results on those.
We shipped overnight — we’re requiring all caregivers and employees in the building to wear PPE — so we overnight shipped them a lot of protective gear. They had some on-site, but we shipped them extra so they would be covered.
We notified all family with personal phone calls … notified all the employees, let them know what steps were taken to keep them safe. [We] put in PR plans. We have someone on retainer for PR, just in case media comes. So, we squared away everything with that.
And we had a critical staffing plan that we planned to introduce if we had a break out, that would call for extra wages per hour, shift differential wages, bonuses for completing shifts in a week … so that we could give employees that are currently there a little bit more for sticking with us and helping us through that. We’ve seen a good response from our employees.
On the fear and stress for employees at seeing a colleague get sick:
This is a standalone memory care, so you do end up having a lot of end-of-life situations year after year — that’s what a lot of memory care is. So, the caregivers and the med aides and the employees in these communities are used to dealing with the death of a resident. It happens quite a bit.
But now, the [infected] caregiver is intubated. It’s serious. [Her colleagues] are faced with, it’s happened to her, she’s in good health, this can happen to me. So, there is a traumatic link there. It was a very eye-opening experience for me. I was taken aback, and of course, we’re trying to do anything we can for her and her family. But, it was quite a shock, and it’s certainly a wake-up call that this coronavirus is not just going after people that are old and have underlying conditions. It can be devastating for anyone who gets it at a younger age.
We’re engaging a psychologist to be available for any of the staff to talk to.
Another thing, this caregiver worked for three days and showed no symptoms, but I’m pretty sure during that time, she was asymptomatic. That’s another devastating factor about this disease. She may have been working in our place for three or four shifts, showing no symptoms, she passed all the screening protocols that we’re doing and all the other operators are doing. She didn’t show any symptoms, yet she could have been in there spreading the virus, unbeknownst to anybody. Then, the screening caught her on the fourth day, and here’s the tough thing — how do you defend against that? That’s very difficult to defend against. One thing we’re doing now is everybody’s going to wear a mask. All our employees in our company are going to wear a mask, because at the very least, if you’re infected and you’re asymptomatic right now, at least you can cover your mouth and droplets that get into the air.
It’s a very difficult, complicated time and situation in the buildings right now.
On their current supply of masks:
We’re doing good. We just secured an order of 20,000 face masks. We secured another [order] that are coming, they’ll be here Friday. And we secured another 20,000 that’ll be here mid-April. We’re running low on gowns. Gowns seem to be in demand.
The great thing is, I’m communicating with Isaac [Scott] over at Anthem Memory Care, with Compass Senior Living, with JEA Senior Living, with Koelsch, with Frontier, and we’re all together looking for PPE and helping each other … we’re all chipping in and helping, and that’s good when it comes to the PPE.
My hope is that a lot of the masks and gowns and PPE that we need will become more available since it’s all ramped up, making it, but sometimes it’s very difficult to find. We can’t find gowns right now. So, we’re looking at alternatives like just buying scrubs and having the caregivers wash them every night.
On occupancy trends and admission protocols:
Our traffic has slowed down. We are taking an approach, as of today, that we still are taking admits. Now, we have very stringent protocols and screening in place before we take a person as a new admit, a new admission, or even a readmission that’s been in the hospital or skilled nursing facility and needs to move back to us.
I don’t see a lot of move-outs. I think a lot of families are saying, all right, let’s just hold tight, let’s just stay in place.
We still have move-ins coming, but not near on the pace as if there was no virus … I suspect we’ll see a decline in move-ins during the peak of this virus. And all our protocols for moving in people are changing. It’s risky to move somebody in now. If you move somebody in with the virus and they spread it through the building — which has happened, I’ve read the stories recently in the news media about that happening — the families are all upset at the operator, and there’s all kinds of negative press going on with that. They’re calling them greedy. Saying, you shouldn’t be moving anyone in during this crisis.
If we can get rapid testing, that’s kind of a game changer as far as our screening of admits going forward. So, I’m really looking forward to that and read every article I can get about that. Like I mentioned, there are these other operators and we all communicate and are trying to find tests right now. We’ve actually found some tests, and our community down in Arizona has some tests. We wrote a whole new admissions/move-in policy surrounding different benchmarks of testing a person, then isolating them seven days, then testing them again, and then moving them in. So, we’re writing procedures on how we’re going to do move-ins, and those are going to hold true for a long, long time I think, in our industry. The way that we move people in is changing.
On how Covid-19 is affecting Seasons’ planned expansion:
It’s interesting. We have two projects under construction in Los Angeles, and California was one of the first states to lock down, but they excluded construction … so, our projects are still moving forward there.
I’ve seen capital kind of stepped back a little bit. Some, not too much. We just signed the purchase sale agreement on another site yesterday, so things are moving ahead, but they’re moving ahead cautiously.
On when he realized that Covid-19 was a crisis for the nation and the industry:
I think it was the Kirkland situation … Watching the Life Care Center unfold, where you had employees and you had residents [infected], and knowing it was an upper respiratory type of virus, where the lungs fail and give you pneumonia.
At the same time, I think I was trying to reconcile in my mind — and I think a lot of people were — is this really going to be as bad as some people [say], or is it just a lot of hype? Because you watch CNN and you watch Fox News, you get two total ends of the spectrum on how this thing’s going to roll out, back at that time. So, I had to start looking at the whole big picture. In that Life Care Center, it just spread through everybody, a lot of people, and it was a lot of death. It was quite eye-opening.
So, at that time, I sort of changed my tune. We’ve got to be on top of this. We can’t let the virus get in our building. But I was still having friends in conversations where they were saying, this is just like the flu. It’ll go away when the heat’s up. All those things were going on at that time, and people weren’t taking it as serious as it could be.
I think watching Life Care was the moment I said, holy cow, we’re dealing with something here that we haven’t seen before, and this could get really, really bad.
And then I have to say, yesterday it really hit home when I found that one of our employees — a 40-year-old, healthy, female nursing student with a four-year-old child at home — is fighting for her life in the hospital on a ventilator … that’s quite a shock, actually.
Those are two events that have had a big impact on my perspective of the whole coronavirus situation.
On how Covid-19 will affect senior living going forward:
I think our industry will be okay. I think we will weather this storm. The sooner the vaccine can come, the better.
It’s going to change the way we move in people, in our admissions process. It’s going to change our margins for all of our investors. We’re going to have more expenses now.
I think that coming out of this, when the peak has occurred and it’s starting to come down, you’re going to have a longer move-in process with a lot of screening.
I think you’re going to see memory care will probably do the best, followed by assisted living and then independent living. If this drags out for several months, I think that the worse the economy gets overall, I think that’s going to affect senior housing and especially the independent living section of it.
But I think there’s always demand. I think there will be pent-up demand. Once the stay-at-home orders are released in all the states, I think that we’ll see an influx of move-ins at that time.
There’s a lot of uncertainty. I wish I had a crystal ball. We don’t know how long this is going to last … in the industry, we’ve been through lots and I think we’ll get through this, but it’s going to be some pain.
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*Editor’s Note: At the time of publication, three residents and five staff members at Seasons’ Kansas City memory care community had been diagnosed with Covid-19. One resident on hospice had passed away, and one resident and one staff member were hospitalized. There were no other confirmed cases of Covid-19 across Seasons’ portfolio.