Inside Atria Senior Living’s Covid-19 Response

With more than 180 communities across the United States — including many in the hard-hit New York City metropolitan area — Atria Senior Living has had to get creative to develop and execute a large-scale Covid-19 response.

There have been lessons learned along the way, but the Louisville, Kentucky-based company has hit on innovative approaches to meet challenges that can seem impossible, CEO John Moore told Senior Housing News.

In particular, the provider has been proactive in forging new partnerships with a variety of organizations while also leveraging existing relationships to meet key needs. For example, Atria secured 17,000 Covid-19 testing kits from Mayo Clinic Laboratories in order to test every one of the company’s employees. That effort will be completed in three days, and the provider intends to also test all of its memory care residents and incoming residents. 

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While it’s not unusual for a large senior living provider to work with other large health care organizations such as Mayo Clinic, Covid-19 has also spurred more unusual partnerships — such as one with a Kentucky distiller, Cardinal Spirits, that produced 5.1 million ounces of hand sanitizer. Cardinal is also producing 1,000 one-gallon foaming soap refills, 5,000 foaming hand soap dispensers and 3,000 rolls of sanitizing wipes that are packaged under the Atria brand, according to an update on Covid-19 efforts that the company issued as an e-book on April 28.

The leadership team at Atria is also focusing on data related to infection rates to calibrate the company’s ongoing response, including how it marshals personal protective equipment (PPE) and other resources, Moore said Thursday in a webinar hosted by the National Investment Center for Seniors Housing & Care (NIC).

And, although the Covid-19 crisis is still unfolding and the future is hard to predict with any certainty, the pandemic has not fundamentally altered Atria’s strategic direction, including its ambitious development plans.

“We’re a little over two months into the world changing — at this point, I’d tell you that all the things we were talking about doing would seem to make even more sense,” Moore told SHN, in a followup interview after the NIC webinar.

Mobilizing for a crisis

In its recent update, Atria laid out a timeline of its crisis response efforts. February 28 was “kickoff day,” or the first full day and night of the response, which involved developing the first protocols and ordering the first Covid-related shipments of PPE and N95 masks.

Between March 3 and March 22, protocols were escalated five times, ultimately resulting in full quarantine of communities and a “quarantine management” footing across the company. As new policies, practices and restrictions were put in place, Atria was “racing the regulators” and in several cases implemented measures — such as stopping large gatherings and instituting masking requirements — before government guidance to do so. Still, there were challenges.

“On Friday, March 13 at 7:15 pm, 25 Support Center staff were on a conference call trying to take in a sudden avalanche of executive orders and directives from state and local departments of public health, governors, the federal government, the CDC and others,” the update reads. “Many of the deadlines were ‘Effective Immediately,’ and many of the rules did not cover the same circumstances in the exact same way. We had to do the best we could to keep up, knowing everything was critically urgent.”

Another key development came in late March, when Atria went to a “strict” protocol for the use of PPE when interacting with residents suspected of having Covid-19. The PPE usage, along with quarantine measures, have allowed Atria to continue moving new residents in while operating “as normally as possible.”

While securing communities and escalating infection control protocols, Atria also was adapting its programming and resident engagement given new social distancing requirements. One example was a “Take Me Out the Ballpark” day on what would have been opening day for Major League Baseball, involving ballpark concessions, baseball-themed trivia, and a baseball-themed Spotify soundtrack.

In the midst of its broader crisis response, the situation in the New York City area warranted special attention. This is a key market for Atria, which is one of the few providers that operates a community in the Big Apple itself. The data paints a picture of the unique and daunting situation in New York, Moore said on Thursday’s webinar.

In terms of total cases per thousand people, the New York metro area is running to 21.3 per thousand, and Westchester County is at 31 per thousand, he said. Excluding the New York metro area, the rate for the rest of the United States is about 2.8 cases per thousand people.

“The reality is, with this disease, it’s New York City, and mostly its suburbs, and everywhere else,” Moore said.

The situation in the New York area demanded a particularly robust response. Steps taken include providing N95 masks for New York City employees and their families as well; providing workers with masks for use during their commutes; providing scrubs and shoes for workers to use during their shifts; and hiring private ambulance services with trained EMTs, who advocate for residents to be treated upon arriving at hospitals, many of which are overburdened and triaging aggressively. In this effort to advocate for residents, oxygen saturation levels are a key data point that EMTs share, as this is an important indicator of how Covid-19 has advanced in someone who is infected.

“We have tried to both passionately protect our residents and also act as responsibly as possible with the strained hospital resources in our most affected markets,” the e-book update states.

Enabling residents to avoid trips to the hospital or other health care settings is ideal, not only to reduce burdens on the health care system, but to reduce the risk of someone becoming infected with Covid-19 while being treated for an unrelated illness or injury. Telehealth is a key solution, and Atria has come to an arrangement with Northwell Health, the largest health system on Long Island. Northwell is providing telehealth consultations to Atria’s New York area communities, and there are plans to expand the partnership to another 60 communities.

Atria is not publicly disclosing the total number of residents and employees who have tested positive for Covid-19. This information is being disseminated to the proper public health authorities and is being shared in communications with residents and family members at affected communities, Moore said.

Results are coming in from the company-wide employee testing, and Atria plans to share some of those findings in the future.

“The results are not creating any operational issues for us,” Moore told SHN.

Further testing of associates could be done in the future, as he is sensitive to the fact that staff members run the risk of becoming infected when they travel to and from work and in certain other situations. Meanwhile, the company will continue its policies of aggressively screening for symptoms, including checking temperatures at least three times a day.

Atria’s workers have had to adapt quickly to new ways of working, and their performance is what Moore said he is most proud of, in terms of the company’s response to Covid-19.

“What I’m most proud of is our frontline staff, particularly in New York,” he told SHN. “In the face of withering noise from the press and disease penetration, they’ve been stellar.”

Business continuity and future strategy

With pandemic response efforts driving up expenses while occupancy is eroding and new move-ins have stopped or slowed, Covid-19 has put the standard senior living business model under pressure.

It’s too early to discuss financial impacts of Covid-19, Moore told SHN, but he observed that expenses are rising in some areas while being curtailed in others.

For instance, Atria has hired more than 1,000 workers in the last eight weeks and raised wages through bonus and support pay programs. Staff are seeing increases of up to $18 an hour more than their standard wages, depending on factors such as whether they are providing direct care to residents suspected of having Covid-19. Atria has also provided more than 12,000 “pantry bags” of food and household items to workers.

However, many of the new hires have replaced workers who have left their jobs, Moore said. And, the extra pay is helping Atria fill shifts without resorting to even more costly temporary staff provided through agencies.

The ultimate goal is to be able to grow revenue, Moore said. And, Atria is continuing to move forward with efforts to expand the business, including by opening a new building in the Philadelphia market within the next three weeks. Testing capabilities are crucial to this effort, in being able to ascertain the Covid-19 status of all the workers and new residents at that location, Moore observed on the NIC webinar.

Two high-profile projects in New York City and San Francisco are also still moving forward, with construction ongoing thanks to essential services waivers. These communities are part of a planned $3 billion pipeline of luxury urban developments that Atria is creating through a partnership with New York City-based developer Related Companies.

“We still feel very good about that,” Moore said on the webinar.

The communities created through the Related joint venture will be operated under a new brand name — part of a larger strategy at Atria to create a multi-brand portfolio. A middle-market product is also being developed under the Gladwell brand.

This strategy still makes sense, in Moore’s view, and in fact he believes that Atria will emerge from Covid-19 having learned valuable lessons that will help the company operate buildings on various models.

For example, the pandemic has demonstrated certain efficiencies that can be achieved in streamlining staff roles, and also on the culinary front. Atria has been working with its food suppliers on more prepared, commissary items to supplement its offerings in this time when typical dining venues are closed or curtailed. Through this effort, the company is learning about how to keep food quality high and consistent, but at a lower price point than is possible in its restaurant-style, chef-driven dining programs.

This type of “culinary transformation” is something that Atria has been contemplating for some time, Moore said on the webinar, and these lessons will hopefully translate into “big changes that are value-creating [in the] long-term.”

It’s a theme he reiterated when speaking with SHN, noting that Atria should emerge from Covid-19 as a stronger operator with a clearer understanding of how to “smartly segment the business and run it more efficiently.”

While keeping in mind these considerations for the future, Moore emphasized that he is focused on the day-to-day effort of managing through a crisis. He’s cognizant of the steep toll that Covid-19 is taking on residents, their families and loved ones, and Atria’s workforce, and the difficulties of keeping them informed about ongoing challenges and the company’s response.

“What I hope comes across in this update is a sense of our intent on real communication, even if we didn’t understand fully how to communicate something in this vortex of events and effort,” he wrote in an introductory note to the April 28 update.

The vortex continues to churn, as do Atria’s efforts.

“It’s not over, but we’re still fighting,” Moore said.

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