The senior living industry deserves more in its efforts to stop the spread of Covid-19 — and yet, crucial resources and recognition are often in short supply.
Take Columbus, Ohio-based Ohio Living as an example. CEO Larry Gumina wrote a fiery opinion piece last month in which he wrote he was “frustrated and angry” that the organization did not have the personal protective equipment (PPE) it needed to care for residents at risk of Covid-19.
At the beginning of April, Ohio Living had four campuses with 53 residents and 48 staff members who had a positive or presumed positive case of Covid-19. And, the non-profit is not a small provider of senior housing, either. It operates 12 life plan communities in the state, and has total annual revenues of about $240 million.
Gumina wasn’t just frustrated for his own organization, but for the plight of an industry that is helping bear the load of a deadly pandemic.
“[The lack of PPE] is a big hardship for some small not-for-profit and for-profit providers,” he said on the latest episode of the Senior Housing News podcast, Transform. “But yet, there’s an order in Ohio that you cannot refuse an admission [to skilled nursing]. It’s concerning.”
While Ohio Living’s PPE shortages have since abated, Gumina thinks the country as a whole could do a better job recognizing the value that the senior living industry provides in slowing the spread of Covid-19. Today, Ohio Living has reduced its positive Covid-19 cases to just two campuses, and has teamed up with other senior housing stakeholders to offer rapid testing for more residents in the Columbus area.
On difficulties finding PPE:
Hopefully you could feel my emotion [in the op-ed]. It’s safe to say I was infuriated, because there was a Sunday afternoon conference call with the Ohio Department of Health. And I’m going back to our hotspot in Akron, Ohio, [our community] Ohio Living Rockynol. We were affirmed by the Department of Health and by the Summit County Health Department that there was absolutely nothing we could have done to prevent what took place. And we were doing everything that we could do to mitigate the scenario to protect the affected residents and our team members.
We’re an organization of 3,000 team members. Our total revenues are about $240 million a year, and we’re the largest nonprofit provider of life plan communities in the state of Ohio. And we were having a hard time getting personal protective equipment. On that conference call, we said, we know we need additional PPE to care for our residents. And, it was kind of a silence on the line. It was clear there were no resources out there. And later on that evening, 10 o’clock on a Sunday evening, I saw that there was a load of PPE that was being delivered to an area hospital here. And I just got infuriated because it’s all of us that are dealing with this pandemic.
We had some school districts in Delaware County that called the executive director at Ohio Living Sarah Moore and said ‘Hey, we shut down our schools, we have PPE, we have thermometers, please take them. We want to give them to you.’ So that had created a lot of attention. And fortunately, we’ve benefited from that. And I hope that other not-for-profit or for-profit providers in the post-acute realm have benefited from that, as well. Because, yes, hospitals are important and I have a hospital background, but yet, our team, 24/7, 365 [days a year,] we’re dealing with the most compromised population in the country.
We’ve [also] enhanced our partnerships with organizations like Medline, and we’ve explored other other ways to get PPE. And we’ve continued to build up our stockpile. We’re not seeing, fortunately, the [Covid-19] surge that we envisioned. But even though we built up a good supply, if that surge comes, we can go through that very, very quickly.
On why the senior housing and care sector deserves much more recognition for its part fighting the Covid-19 pandemic:
We’re a segment of this health care delivery system that is deserving of increased recognition for all the work that we do. And I’ve spent 30 years in the health care industry, the first half being on the hospital side of the industry. I started in post-acute, went into acute, and then back to post-acute.
The recognition certainly needs to be enhanced. And here’s an example: While I think [Ohio Gov. Mike DeWine] and [Ohio Department of Health Director] Dr. Amy Acton are doing a very good job here in Ohio, their directive to publish the skilled nursing and assisted living providers with Covid-19 residents is, in my view, creating undue media attention to what we do, inappropriately. In my opinion, if we’re going to publish the skilled and assisted living providers with Covid-19, we should publish the hospitals, too.
I serve on the LeadingAge Ohio board, and I’m humbled to serve on the LeadingAge national board of directors. We’re providing support to over 6,000 providers throughout the country. And what concerns me right now is that I know there are providers out there — for-profit and not-for-profit — that don’t have the balance sheet strength of Ohio Living. And the economic impact that this virus is creating for organizations on the post-acute side, and even on the acute side, is crippling. And yet, we’re caring for the most vulnerable segment of our population in Ohio.
On launching a new effort with National Church Residences, LeadingAge Ohio and Ohio Geriatrics to test residents for Covid-19:
We had this idea to say, what can we do as four organizations to proactively test residents in assisted living and skilled nursing operations through the greater Columbus market? Our intent was, if we can identify Covid-19 residents in these existing communities, maybe we can treat in place and prevent the surge that’s happening that could overwhelm the hospital system.
Well, we’re up and live. We’re doing this right now. Any provider in the greater Columbus market — in Franklin County and the surrounding peripheral counties, for-profit or not-for-profit — if they would like us to come on in and test their residents, they have one phone call to make and we can launch a team of clinicians to go test those residents. Two of Ohio Living’s 12 communities fall into the footprint that I described. If we have a resident who we suspect is Covid-19 positive, they have to send out to the hospital or to a physician’s office to get tested, which was incredibly inconvenient for the residents. So now, we can go to them.
We’re working with the Columbus Health Department, the Ohio Department of Health, the Franklin County Health Department and Ohio State University’s Wexner Medical Center [to procure tests]. And I also want to put a plug in for The Columbus Foundation, which has committed resources to make this idea become a reality.
On Ohio Living’s new physicians services business and an update on its membership in the Perennial Consortium:
We launched a new vertical last month. Ohio Living Physician Services includes two physicians and nine nurse practitioners up in the northwest part of the state. The vision there is to continue to move that throughout the rest of our organization, eventually.
Having that physician and MP support, we can provide more care bedside with the intent of mitigating or eliminating an emergent care episode in an emergency room or hospitalization. It’s in the best interest of the residents to skill in place, so we’re building up that infrastructure.
And through the Perennial Consortium, we’re launching two Medicare Advantage special needs plans — one in Ohio, one in Colorado — in partnership with Lynne Katzmann at Juniper Communities, Camille Burke at Christian Living Communities and AllyAlign. In Ohio, we’re really proud to partner with four other organizations who are launching this initiative as of January 1, 2021. That includes Graceworks Lutheran Services in the Dayton market, McGregor and Jennings in the Cleveland market and Continuing Healthcare Solutions, which is a for-profit provider. So, we’re moving this forward, and with the intent to do whatever we can to enhance the care delivery at bedside to prevent hospitalizations.
On what keeps him up at night as the pandemic drags on:
Many providers throughout this country … don’t have the balance sheet strength to pull themselves out of this mess. We’re caring for the most vulnerable population, but our reimbursement system is just horrific, horrific. And that continues to challenge us.
Two things keep me up at night as CEO of this organization. One is … we have 11.6 million people who live in Ohio, and we are the sixth most rapidly aging state in the country. We have a swell of demand coming at us. But yet our workforce isn’t climbing commensurate with that demand.
And, [I’m also worried about] reimbursement from our state Medicaid program. We have 22 million Americans right now on unemployment. Well, that’s going to tax our Medicaid program. We see a prevalence of Medicare Advantage plans in the marketplace. Their margins and the insurance market are just incredibly strong, strong as they ever have been. And what we’re doing is, we’re enabling revenue leakage to come out of our respective missions onto the balance sheet, these insurance companies. So in a way to mitigate that, or prevent that, we’d like to keep some of that margin ourselves to sustain the revenue pressures that we have in front of us.
I hope, going forward, that our legislators and our respective communities in a larger sense will further recognize the value proposition that we bring in a very expensive health care delivery system. And by highlighting the value proposition we make, we can enhance the care at the end of life and bend that cost curve, which I think is so critically important as we go forward as a society.