In mid-April, Transforming Age evacuated an assisted living community near Minneapolis due to a Covid-19 outbreak. Last week, the provider announced that the building, Meridian Manor, will not reopen.
Other closures are “absolutely” likely to become more commonplace in the senior living industry as Covid-19 testing becomes more widespread, Transforming Age President and CEO Torsten Hirche told Senior Housing News.
With headquarters near Seattle in Bellevue, Washington, Transforming Age is based in the first Covid-19 epicenter in the United States. The organization moved early to safeguard its buildings against the coronavirus, Hirche said, and so far has had few cases outside of Meridian Manor.
Hirche is aware that Transforming Age could experience further challenges, given that Covid-19 outbreaks can occur rapidly and despite precautions being in place. Still, he believes that the Covid-19 situation will prove out the strengths that the nonprofit developed in recent years as it expanded its footprint, diversified its services and invested in technology.
And, he thinks that the coronavirus crisis could serve as a “wakeup call and inflection point” for the senior living industry at large, showcasing that scale matters and tech-forward, sophisticated operations are a must.
Meridian Manor and the case for more testing
Covid-19 is an insidious foe, and the situation at Meridian Manor unfolded despite Transforming Age’s proactive and structured response to the coronavirus crisis, Hirche said.
Indeed, he believes that Transforming Age formulated a robust response to Covid-19 before most other senior living providers. The response was driven in part by the early reports of coronavirus coming out of China; Hirche viewed those reports with concern and skepticism.
“I grew up in East Germany, which was communist at the time, so I know how communist governments treat health emergencies,” he told SHN. “They’ll do their best, but they’re also going to fudge the numbers.”
Fearing that coronavirus was “going to be a beast,” Hirche and other Transforming Age leaders began to prepare a crisis response in late January, as soon as the first case was reported in Seattle. The first memo regarding Covid-19 went out to residents on Jan. 31, he said.
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The response ramped up dramatically after news broke of the outbreak at the Kirkland skilled nursing facility, which is located just a few blocks from a Transforming Age community. On Feb. 29, Hirche and Transforming Age’s infection control expert debated for several hours about whether to put communities on lockdown and take other steps that went beyond the measures being recommended at that time by the Centers for Disease Control and Prevention (CDC). Early on the morning of March 1, they made the decision to do so.
“Our main goal as an organization from the beginning has been to remain clear-headed, looking at these challenges that are thrown at us as problems that can be solved, and deploy critical thinking and the strength of our system as a whole,” he told SHN.
The approach has so far proved largely successful in Washington. Only two cases have cropped up in Transforming Age’s retirement communities in the state, and both those residents were on the road to recovery as of last week. Unfortunately, two residents of Transforming Age affordable housing communities contracted Covid-19 and died.
“Our prayers and thoughts are with the families,” Hirche said.
He also credits the citywide response in Seattle with helping control the spread of the virus there — but just as the curve appeared to be flattening in the Pacific Northwest, infections were increasing elsewhere in the country, including in Minnesota. Transforming Age operates eight communities in the Gopher State, including both affordable apartments and assisted living.
To this point, there have been no outbreaks of more than two people diagnosed with Covid-19 at any of the company’s Minnesota communities, Hirche said — with the notable exception of Meridian Manor. Located in the suburb of Wayzata, about 15 miles west of downtown Minneapolis, Meridian Manor is an assisted living community that had a census of 59 residents when Covid-19 struck.
Hirche, like many other leaders in senior living, has been frustrated at the lack of available Covid-19 testing. After the first cases appeared at Meridian Manor in mid-April, he wanted widespread testing at the building, including of asymptomatic residents and workers. To procure those tests, he and his team had to get creative, he told SHN. He contacted people via Twitter, and the organization’s vice president of housing operations reached out to labs in the area. Through those efforts, tests were administered, revealing the scope of the outbreak.
“I want to stress that, and I think that’s one of the lessons we need to learn as providers and also as a country — we need to test asymptomatic people,” he said.
Other senior living providers have also called for or are making moves to implement testing of asymptomatic residents and workers. In some cases, such testing has uncovered wider outbreaks at communities than was previously apparent. Permanently closing a community as a result is an extreme step, but Hirche does expect that some other providers will be faced with this decision as testing ramps up — and there have been other instances of assisted living communities being evacuated due to Covid-19 outbreaks. Even if they haven’t evacuated or closed a community, providers have faced negative press when testing has uncovered a more extensive outbreak than was previously recognized. So, providers must prepare themselves for the repercussions of testing all residents and staff, but doing so is imperative to preserving health and safety.
“I cannot overstate this, like double-bold, underlined,” Hirche said. “What I’d love to do is test literally every single one of our 8,000 residents and clients and program participants, and our 2,200 team members … and then if someone turns positive, you can contact trace, you know where they’ve been, who they’ve been in touch with.”
As of April 18, with 18 Meridian Manor residents having tested positive, the Minnesota Department of Health Emergency Covid task force ordered the relocation of all remaining residents. Transforming Age agreed that this would be the right course of action, and worked with area providers such as Presbyterian Homes & Services, Interlude and Ebenzer to find temporary housing, Hirche said.
On April 27, Transforming Age decided to permanently close the community. As of that date, 21 residents had tested positive for Covid-19 and two had died, while 13 team members had tested positive and were in home quarantine, the company announced.
Several factors led to the decision not to reopen Meridian Manor, Hirche told SHN. With so many team members infected, and some deciding to leave their jobs, staffing up the building would be a challenging and time-consuming proposition. Meanwhile, relocated residents would be living in limbo in their temporary housing.
“We’re trying to remove uncertainty and act in the best interests of the residents here,” Hirche said.
Several people have made reservations to move into other Transforming Age communities, he said, and the organization is also supporting resident moves to other providers in the area. Transforming Age is covering costs such as moving expenses and in some cases rent, and is working to keep friends and neighbors together.
As for the future of the Meridian Manor building, Transforming Age is “considering all options,” but divestiture appears most likely, Hirche said.
“We express our deepest gratitude to our heroic team members and our partners for keeping our residents safe,” he stated in a press release. “We thank the Minnesota Department of Health for their vital assistance. Our thoughts and prayers go out to the entire Meridian Manor community, our residents and their families.”
Inflection point and wake-up call
Transforming Age acquired Meridian Manor in a 2018 portfolio deal, as part of a growth push that Hirche led after becoming CEO in 2014.
Even though the expansion effort means that Transforming Age is now combating the coronavirus in multiple markets, Hirche does not regret the strategy — in fact, he believes that the nonprofit is better positioned to weather Covid-19 as a larger organization, and he think the current crisis will drive consolidation in the industry as other providers see the benefits of scale.
When Hirche became CEO, Transforming Age was known as Presbyterian Retirement Communities Northwest and exclusively served the Seattle area. Today, in addition to establishing its Minnesota portfolio, Transforming Age has expanded through building projects and affiliations in Seattle, and serves 10 times as many seniors as it did six years ago.
As a result, the organization has the cash reserves and overall financial wherewithal needed to mount a robust Covid-19 response, Hirche said.
“We have a strong balance sheet, we’re financially a very strong system,” he said. “We’re seeing still, especially on the CCRC side, move-ins and strong cash flow.”
In addition to gaining scale and diversifying service lines, Hirche has made technology a priority during Covid-19. Tech is a pillar of the nonprofit’s Covid-19 response as well.
For example, the company invested in four Skytron UVC disinfecting robots, at a cost of $80,000 each.
“Essentially, you put this thing in a room, it senses the contamination, and then nukes the room,” Hirche said. “It makes it squeaky clean.”
In addition, Transforming Age affiliate Full Life Care has created a virtual adult day program after Covid-19 forced the closure of its in-person centers. About 800 people a day are taking part in the program, which is conducted via tablets, smartphones and other personal mobile devices. The state of Washington has provided some financial support for that program.
Transforming Age also now has a deeper bench of talent and a larger and more well-connected professional network to tap, which has been a crucial advantage during Covid-19, Hirche said. For example, the company’s national infection control control consultant is an infectious disease expert with a “direct link” to Dr. Anthony Fauci, who is helping lead the government’s coronavirus response.
Going in to 2020, Hirche was among the industry leaders calling on nonprofits to embrace scale and find new, faster, bolder ways to grow. Transforming Age is still moving ahead with its own expansion plans, including the construction of a $150 million Seattle highrise.
One silver lining of the pandemic could be that more providers understand the need to gain size and sophistication, not only to meet unexpected challenges like Covid-19 but to meet market expectations once the crisis has passed, Hirche said. He also believes that Transforming Age and senior living providers across the board must evaluate their technologies, systems and processes to become more efficient and better operators in the long run.
“I think this is a big wake-up call and inflection point for not just the United States and the world but also for us as an industry,” Hirche said. “I think good things will come out of this.”