ASHA, Argentum Chiefs: Frustration Mounts As Covid-19 Tests, Financial Support Slow to Arrive in Senior Living

About two weeks ago, American Seniors Housing Association (ASHA) President David Schless read a news article that has been “gnawing” at him ever since.

The article reported that bus drivers in Detroit would be among the first groups given rapid Covid-19 tests from Abbott Labs.

“We need those. Our industry needs access to that,” Schless told Senior Housing News. “I’m not saying that bus drivers don’t or the first responders don’t, but we desperately need access to those fast-acting testing kits.”

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In the weeks since the Covid-19 pandemic hit the United States, Schless and his team at ASHA — along with another industry group, Argentum — have been advocating for senior living providers on a host of issues, including the need for more testing.

“I think our teams have worked really well together,” Argentum President and CEO James Balda said in a joint SHN interview with Schless. “I’ve also been pleased to see our collective leadership come together and align, and I think fairly easily and quickly, on priorities for us, particularly from a policy perspective.”

This teamwork is notable for two groups that have not always agreed. However, no plans are in the works for the associations to merge in a formal way, Schless and Balda said. 

Among other top policy priorities, ASHA and Argentum have been pushing hard for senior living providers to get access to a $100 billion fund established through the federal CARES Act — Schless and Balda co-signed an April 13 letter to Vice President Mike Pence on this topic. ASHA and Argentum have shifted their messaging a bit, from pushing for a $20 billion senior living allocation to a focus on simply having access to the funds. Still, Schless and Balda have not given up hope that senior living providers could receive some of this money.

And then there’s the issue of personal protective equipment (PPE) and other supplies, which are hard to come by across the country. Senior living communities are in dire need of PPE, but are too often being overlooked.

So, there are many reasons for senior living providers to be frustrated with the level of support they’re receiving from lawmakers and administration officials, Schless said. One reason is that many federal lawmakers and officials still do not have a firm grasp on the role that private-pay senior living plays in the nation’s health care system, Balda noted. Educating them about the industry has been a big part of the advocacy effort in recent weeks.

ASHA and Argentum are working hard and “efficiently” to improve the situation, and Schless and Balda believe that providers are rising to the occasion despite not having all the tools they need.

The following has been edited for length and clarity.

ASHA and Argentum have been busy since Covid-19 struck the country. What have your work days been like?

Balda: The routine is no routine. Typically try to catch up on news early in the morning, then start the day. It’s getting better. Things are still moving fast, but early on, things were moving so quickly that it was really hard for there to be any routine … It’s hard to put together a schedule and stick to it, because things change so quickly.

Schless: I would echo that. It’s been probably as intense as anything I’ve been involved in, and I’ve been involved in association work for a long time — 20, 25 years, at least. And it’s all big issues. We’re not dealing with any small stuff. It’s all big, all day long, every day of the week.

It’s been really wonderful to be able to partner with Argentum. I think we’ve really been able to leverage our respective resources in a really effective manner for the collective good of the industry. From my perspective, it’s been easy to do — [there are] a lot of talented people in both groups, and we’ve been able to communicate through the whole process. The stress of the situation has not come at all from partnering.

ASHA President David Schless sitting at a conference table
David Schless

Balda: We have a lot of the same members, a lot of the same types of operating models … That has made it easier, I think, for us to focus on the issues that matter.

Schless: Also, because there are so many different layers to this, we’re not really duplicating efforts. So, we just have confidence that despite the magnitude of some of these issues … we’re being as efficient as we can, which we need to be.

What is the likelihood of senior living providers receiving CARES Act money? Are you looking toward the next stimulus bill at this point?

Schless: We still believe there are opportunities for the industry to receive relief from the Public Health and Social Services Emergency Fund, which was the $100 billion fund that was part of the third stimulus package. Some of the funds have been allocated at this point to Medicare providers, hospitals, and we’re awaiting additional guidance. I have not lost hope that there will be funding in that grant program that our members will be able to take advantage of.

The other part of that third bill was the PPP [Payroll Protection Program] — [the] SBA [Small Business Administration] program — which generally did not work out for our members, because it really was structured for small businesses, and the legislation really had pretty limited exemptions for restaurants and hotels. Having said that, there are folks in the industry that were able to apply for that program. We’ve looked at it carefully. We believe there are potential ways to make that program work for senior living in a subsequent stimulus bill.

You believe that providers can tap into the PPP as it exists, or that a new version in the next stimulus bill is needed for senior living?

Schless: Both ASHA and Argentum have reached out to the SBA, seeking a change in the way in which they interpret the existing language in the CARES Act. Realistically, I think it’s more likely that the opportunity to really make that a usable, workable program for most of our respective memberships would be in a subsequent piece of legislation.

The problem is that many providers are organized so that their communities roll up into a larger corporate entity, so they exceed the 500 worker threshold?

Schless: There are companies that sometimes have communities that are each distinct entities. But by and large, most of our respective company members are just too big [to participate in the PPP], and it would require a specific exemption in the language, which is what the lodging industry and restaurant industry have — an exemption from those rules for small businesses.

You’ve advocated for senior living providers to be top-priority to receive PPE. How is that effort going?

Balda: That’s been a priority from day one. The stimulus funding has been a highly visible priority for us, the PPE and testing, from what I’m hearing from members, has been just as critical if not more critical for them.

So, working with ASHA, we’ve been engaging with Congressional leaders on that. We’ve also been engaging directly with HHS [Department of Health and Human Services] and CDC [Centers for Disease Control & Prevention]. A lot of this comes down to guidance, in terms of prioritization. We’d like to see changes to that, ultimately — particularly on the testing side — increases senior living to priority one.

We’ve also been engaging with our state partners to work with their governors to — particularly on the PPE side — ensure that senior living communities are priority one status at that local level … We all know that’s the issue that needs to be resolved to ultimately be able to protect our residents and team members most effectively.

AHCA/NCAL President Mark Parkinson said nursing homes “feel like [they’ve] been forgotten.” If nursing homes have been forgotten, where does that put senior living communities?

Schless: I think there’s a lot of frustration from the industry. I share Mark’s comments about the nursing homes and certainly, it’s incredibly frustrating to know that if we had access to the PPE and the fast-acting test kits, we’d really be in a position to keep Covid out of these buildings and ensure that the vast majority if not all our residents were not going to get the virus. We’re taking care of nearly 2 million people who by very definition are very, very vulnerable to the virus.

So, I think there’s a lot of frustration there … Hopefully what we’ll see in the coming weeks is the supply chain getting better and the access to the PPE and hopefully those testing kits. I’ve been saying this, it would be a game-changer if you could know that your staff, when they came in to work, that they were not carrying the virus.

Clearly, it’s been really challenging and probably really frustrating for pretty much anyone serving the population we serve.

Balda: I would echo everything Dave said and certainly what Mark said with regard to skilled nursing. And I think senior living has gotten it even a little worse, in terms of prioritization for PPE and testing.

We’re a private pay model, and I don’t think policymakers tend to think about us when they think about needing to address challenges related to Covid-19. A lot of the work we’ve been doing is really having to educate policymakers at the national level about how we are the frontline protecting nearly 2 million seniors, as Dave said. We’re really helping to keep them safe and keep them in communities and out of the broader health care system. But there’s had to be a lot of education about that with policymakers.

I think the states are having similar issues, but not as profound because I think governors and their administrations — because senior living is appropriately regulated at the state level — have a better understanding of it. So, in Arizona, for example, assisted living has been prioritized along with skilled nursing and hospitals.

James Balda

What are other top priorities at the moment?

Schless: Another big area of concern is the liability side. That would go beyond senior living. There’s a broad range of businesses, certainly including our members, that would like to see some sort of tort immunity. That would be an issue that has both state implications as well as federal implications.

Are you referring to clarifying that the PREP Act provides immunity from liability related to caregiving for people with Covid-19?

Schless: That would be one element of this. That would be federal act. ASHA, Argentum, I think LeadingAge, AHCA, I’m sure many groups have reached out the secretary of HHS to seek clarification.

We believe, we like to think, that the PREP Act as it was promulgated back in early March provides that protection to our provider members. As far as I know, no one has received any response from HHS. The way the language is written now, I don’t think there’s 100% comfort that we would be fully protected by the PREP Act as it’s written.

Balda: Again, a lot of this is at the state level. We’ve been working to engage with governors, as they’re issuing executive orders to ensure that providers, including skilled nursing and assisted living, have protections related to Covid-19 issues. That continues to be a priority for us.

James, you have a background with the National Restaurant Association. What do you think of senior living providers trying to hire laid-off restaurant workers? Any tips for recruiting these workers?

Balda: Working with Dave and ASHA, we were pleased to launch Senior Living FastMatch, in partnership with Arena as well as OnShift, in terms of being able to try and connect operators with displaced workers out of not just restaurants but also hospitality and retail, which are three big categories that are being severely impacted.

Talking to some of our members, we’re hearing — not specifically through FastMatch, but in general — that they’re seeing increases in applicants, anywhere from 15% to 20%.

I think the opportunity for the industry long-term is we’ll pull these people in now, in the middle of a crisis … the opportunity is to keep them once they really understand the mission of the industry and the heart of the industry in terms of providing services and care to seniors, but also … the opportunities for making this a career.

Having been in restaurants and now in senior living, I firmly believe senior living [offers] a great opportunity for people who want to stay in this industry to progress and move up in communities and even someday run their own community, or run their own business for that matter. That doesn’t have to be the end goal, but I think that’s the opportunity that’s before us.

We know we’re going to get through this. We know this is a snapshot in time … but at the end of the day, the industry will come out of this and continue to grow and continue to need more talent.

It sounds like you’re working well together. Has there been any discussion of Argentum and ASHA combining?

Schless: Not that I’m aware of! I think, at the end of the day, both groups do important things and different things, really, in a lot of respects.

From my perspective, this underscores that sense that both groups can work collectively on important thing, but the two groups have real purpose in our individual missions. So, I think that’s where we are right now.

This is I think what both memberships would have liked to have seen under these circumstances, and I think we’ve very, very quickly and pretty, almost incredibly seamlessly been able to jump right in and with complete confidence and trust in the various professionals on the staffs. I think that’s exactly what our leadership and what Argentum’s leadership would have wanted to have happen.

Balda: I would agree with that. I think that’s what they should be able to expect to happen. I’m just glad that we’ve been able to work so well together through this and expect that to continue.

I would also say that we’ve been doing a lot of work together, ASHA and Argentum, but that doesn’t mean we haven’t been collaborating with other associations as well … Our membership is just more uniquely aligned with each other in terms of [members’] business models, but I think everyone’s coming together. Oftentimes, it takes a crisis to bring us all together, but I think everyone’s working well.

Schless: James is absolutely right. Several weeks ago, we set up a standing call with the leadership of various groups. So, Brian Jurutka from NIC and Mark Parkinson from AHCA and Scott Tittle from NCAL and Katie Smith Sloan [from LeadingAge] and James and I. We really have an open, honest discussion … I think it’s a testament to the quality of leadership in the industry.

Argentum had to change its annual conference to a virtual version. I assume that hurt the organization financially. Any update on how things are going, repercussions of that?

Balda: We’ll be getting out to members and the industry shortly — although I can’t put an exact date on it — the platform that we’re using and updates to the program. We’re still working through that.

Fortunately, because we moved the virtual event to the fall, we’ve got some time to put it together, but we want to be responsive to the membership and the industry and get them information as soon as possible.

You know, other organizations outside our industry had to move much more rapidly into a virtual environment. So, I’m just hearing positive things from our exhibitors and our members and our attendees about the decision we made. I think everyone agreed it was the right decision. And so we’re looking forward to what we hope will be a good program.

ASHA and Argentum secured a third-party analysis showing a potential financial hit to the industry of up to $57 billion. What was your reaction to seeing that analysis?

Balda: I wasn’t surprised by the numbers. I’ve been hearing early on from providers that they were concerned about the potential impact. As you talk to them, you start to get a sense of the potential scope, particularly as it related to increased labor costs, costs for PPE when they can get access to it, costs for tests when they can get access to it.

Schless: I would agree … There are significant costs there, and the [analysis] was based on actual numbers. We pulled together a group of providers and really looked at it carefully. Of course, there are assumptions.

I’ll give you an example. If the industry had access to quick-acting testing kits, that would change those numbers. So, there’s variables that are built into it, but certainly looking at the impact over six months to a year, it’s not insignificant. We’re all hopeful we can get access to the testing kits and PPE — and there’s been some really overly inflated pricing on some of the PPE … so, spread over the entirely of the senior living industry, there’s just a lot of costs there.

Do you have any other messages for senior living providers?

Balda: There’s an incredible amount of gratitude that should be expressed to the workers in senior living communities … at the end of the day, the country as a whole is going to owe them a debt of gratitude for everything they’re doing. I just don’t want them to get lost in this. We hear about the first responders and workers in hospitals, but we shouldn’t forget about those that are working in senior living communities.

Schless: I totally agree with that comment.

To add to that, we’ve seen some negative press in certain areas. I do think when all is said and done, when you look at how the industry is dealing with this crisis, I think the industry is doing incredibly well given the circumstances.

… We can’t let a bad article in the Dallas Morning News or somewhere else change the reality, which is these are really extraordinarily challenging circumstances on so many different levels.

We’re caring for a really vulnerable population without the tools we would like to see, and I think the industry has really risen to the occasion and obviously is going to have to stay resilient because this won’t end abruptly. This is going to have to be a sustained effort.

When you say tools, you mean PPE?

Schless: The PPE and the testing kits.

James has heard me say this 100 times, but somebody last week forwarded me an article about the bus drivers in Detroit having access to the Abbott Labs quick testing kits, which has just been gnawing at me for the past week. We need those. Our industry needs access to that. I’m not saying that bus drivers don’t or the first responders don’t, but we desperately need access to those fast-acting testing kits. My hope is we get them sooner rather than later.

Balda: I would agree with that. Early on, I talked to countless operators that were making decisions in terms of restricting visitors, screening visitors that needed to come into the building, rethinking their communal dining and group activities, and this was before states were even starting to issue guidance.

I think [operators] are doing an incredible job in dealing with this. [They’ve] got the infection control protocols in place. They’ve got professionally trained staff. They know what to do, but they need the resources. They need the tools. They need the PPE and testing. That’s what we know saves lives.

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