Atria Senior Living is shifting gears in its Covid-19 response and its leaders have their eyes on the future.
The Louisville, Kentucky-based company relaxed full quarantine measures for the majority of its 216-community portfolio as of June 11. Going forward, the provider plans to execute a gradual, phased process leading up to a “Post Covid-19 Protocol.” The hope is to reach that stage within a year, according to a recently released update.
The biggest challenge at the moment is to be “really smart about how we take next steps,” Atria CEO John Moore told Senior Housing News.
There are multiple challenges and risks involved in easing restrictions within senior living buildings. Covid-19 remains an active threat across the nation and world; infection rates — and regulations governing senior living communities — vary across markets. But public officials are lifting or relaxing stay-at-home orders across the country and businesses are starting to reopen. Atria has been able to drive down the number of residents and associates who test positive or display symptoms of the coronavirus, and the time has come to move forward, Moore said.
Atria plans to leverage its scale to support a safe progression through reopening phases and evolve its operations to be even more adept at responding to future communicable disease threats.
Like some other senior living providers, Atria has created a phased reopening plan.
Since Covid-19 began to spread across the United States in mid-March, the company has been in what it calls “Quarantine Management,” with residents largely confined to their living units, non-essential visitors barred from communities, and other lockdown measures in place. The provider is calling the first phase of reopening its “Interim Protocol.” The interim protocols are defined in part by what state and local regulators allow and in part by elements Atria controls, such as its policies around use of personal protective equipment (PPE).
The stage after Interim Protocol is called “Covid-19 Watch.” This stage would allow for a “restorative sense of normalcy,” including residents gathering in groups of up to 20 people, family member visits in resident apartments, full-service dining, and fitness centers and swimming pools operating at 50% capacity. Finally, a “Post Covid-19 Protocol” would involve having “an even greater array of engagement and quality of life opportunities with a new shield of safety,” according to the recent update. Atria leaders hope to reach this phase within a year.
In early June, Atria leadership evaluated the company’s portfolio of 216 communities and identified 170 that had gone at least 28 days without any Covid-19 exposure on the premises. As local and state regulations allowed, these 170 communities began to enter the Interim Protocol as of June 11. The remaining communities are set to enter the Interim Protocol by July 2, barring any new exposures.
Atria already has been piloting its relaxed protocols. Starting with 17 Canadian communities in early May, and ramping up with independent living buildings in Texas and Arizona, the company has been gaining insight into operationalizing new practices. For example, dining rooms have been adapted to facilitate social distancing for small groups of residents.
Still, even in the Interim Protocol period, many stringent infection control measures will remain in place, such as limited visitor access, robust and routine screening for symptoms, and strategic Covid-19 testing.
Testing has been a particular focus for Atria, which forged a relationship with Mayo Clinic Laboratories. Before May 10, Atria completed an initial round of testing of employees and third-party workers in its buildings. By the end of June, the provider anticipates that more than 40,000 Covid-19 tests will have been administered to residents and associates. These tests are being paid for in a variety of ways, but Atria is confident that resident tests will be covered by government insurance programs such as Medicare.
While the Mayo Clinic partnership has been crucial, Moore noted that local counties and states have become “much, much better” at testing and are also important allies in this effort. On June 11, the state of Massachusetts conducted 1,600 tests of Atria residents and employees, he said.
Employee testing has correlated with improved Covid-19 infection rates across Atria’s portfolio, data show.
For instance, the New York metro area has been a particular epicenter for the pandemic in the United States and is also a key market for Atria. In early April, nearly 12% of staff in New York were in self-quarantine due to Covid-19 symptoms. In early May, as the comprehensive testing program rolled out, that percentage had fallen to around 6% — it spiked slightly as testing revealed asymptomatic positives, but then both resident and employee positive cases declined steadily, with employee cases near zero on a per capita basis as of late May. A similar pattern played out in other markets across the country as well.
While stressing that he is not an epidemiologist, Moore said he believes data suggests the value of testing as a component of controlling the spread of Covid-19. And while tests do only provide a snapshot of one moment in time, creating a baseline by testing all employees is useful, he said. Ongoing testing is also occurring, in part due to government mandates in certain states and localities. As of June 4, 260% of the Atria employee base in the New York City metropolitan area had been tested, meaning some people had been tested multiple times. Several Atria buildings in New York — including its community in Manhattan — were among the first 170 that were eligible to enter the Interim Protocol phase.
Targeted testing of residents, particularly in memory care, is also taking place. However, Atria has focused primarily on testing employees because their coming and going from communities makes them more likely to be disease carriers than residents who are quarantined, Moore noted. And, he views testing employees as part of a larger and ongoing effort to support the company’s employee base, particularly frontline caregivers and staff, many of whom have been putting themselves on the line in heroic ways during the pandemic.
Going forward, the company is communicating with regulators about the potential for testing to support more visitation at communities. For instance, residents’ loved ones might be able to visit with proof of a negative Covid-19 test result and an attestation that they have self-isolated since that test.
Atria of the future
While Atria is putting in place some temporary protocols specifically to combat Covid-19, the company is also adopting new tools, processes and capabilities intended to be long-lasting.
“It’s our goal to take lessons learned from the unprecedented Covid-19 quarantine to build a company for the future,” Moore stated in the latest business update.
As one example, he highlighted an iOS mobile app that Atria created as a way to track residents’ Covid-19 symptoms and communicate with their families and loved ones. The app provides visibility into residents’ vital signs such as temperature as well as updates on any Covid-19 symptoms that a resident is experiencing.
The app was already in development when the pandemic struck, and Atria fast-tracked it in response to Covid-19. The app was released to iOS users shortly after the first round of testing was complete, and it has 4,000 users to date, Moore said. In the coming weeks and months, Atria plans to add more capabilities to it, such as dining menus and more communication features. By August, an Android version should be available. The idea is that even after the immediate threat of Covid-19 passes, the app will remain a valuable tool to residents, and will already be in place should another infectious disease crisis arise.
Also on the technology front, Atria is testing a prototype digital sign-in system and automated temperature checks for visitors, creating a more touchless environment to bolster infection control.
Similarly, Atria secured a warehouse for PPE and other supplies in the early days of Covid-19, and plans to maintain a warehouse on an ongoing basis, having seen the benefits of a central distribution hub. The company’s home base of Louisville is also the primary global hub for UPS, and so Atria benefits from the city’s strong logistics infrastructure, Moore noted.
Atria already is a vertically integrated company in many respects, including having an internal marketing agency and building its tech backbone in-house. Covid-19 has reinforced the value of this approach, and Atria is building up its capabilities further for the future. The provider has forged a partnership to produce its own brand of hand sanitizer and foaming hand soap, and is planning an Atria Lab/Workshop to prototype other products and supplies.
In one example of what is possible through this initiative, Moore pointed to the company’s expanding telemedicine capabilities, including through a partnership with New York-based health system Northwell Health. The Atria Lab/Workshop could create standard telemedicine carts that are assembled in Louisville and shipped to communities.
This type of approach creates more operational uniformity through the portfolio, takes the burden of acquiring or assembling the carts off of local communities, and is less costly than working with a variety of third-party vendors, Moore said.
Atria is also evaluating and updating policies related to pets; Covid-19 underscored the important role that pets play in the lives of residents, and the provider is seeking ways to make pet ownership easier. The company recently sent “Wag Bags” of pet treats and supplies to the roughly 800 dog owners and 800 cat owners living in communities.
Overall, the goal is to maximize the value of Atria’s scale without sacrificing nimbleness, in order to drive quality as a competitive differentiator for every community across the portfolio.
“That’s the big mission,” Moore said.