Covid-19 Bulletin: A Framework for Reopening Senior Living Communities; Some Nonprofits Face $3M to $5M Revenue Gaps

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Bulletin for June 29, 2020:

Reopening senior living communities is an exercise in risk management, given that the Covid-19 pandemic is still raging across the country, but operators must mitigate the toll that isolation takes on residents.

Senior living providers across the country are trying to strike that delicate balance in their reopening strategies, and best practices are emerging, according to a new Special Issue Brief from the American Seniors Housing Association (ASHA). To compile the brief, ATI Advisory CEO Anne Tumlinson worked with the firm’s researchers to engage in case studies and interviews with providers across the nation.

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“There is no easy answer for when and how much to loosen highly restrictive protocols, especially when residents, staff, families and states often have differing opinions about risk tolerance and desire for safety,” Tumlinson wrote. “However, given that long-term isolation poses grave risks to residents as well, the industry is moving ahead pro-actively to prepare for and manage Covid-19 transmission risk in a long-term non-zero risk environment.”

Senior living providers are taking a phased approach to reopening, with restrictions gradually being lifted as infection rates and other risk factors allow. Broadly speaking, these phases can be broken down into an “initial phase” followed by a “maintenance phase,” according to the brief.

The brief includes a chart showing various examples of practices that providers are adopting in each phase across a variety of domains, such as what transmission and monitoring measures are being observed, what infection prevention steps are being taken, what visitation protocols are in place and how new residents are being welcomed.

Courtesy ASHA, ATI Advisory

For instance, in the domain of “Programs, Meals, and Services,” providers are often serving one or two meals in a communal dining room, with 10-15 residents per seating, in the initial phase. That ramps up to more meals and more diners per meal in the maintenance phase.

Furthermore, reopening a community is not a linear process. Rather, providers are prepared to cycle between phases as needed, given how Covid-19 infections surge and retreat in a given market area or within a particular building.

Also in the news:

— Nonprofit senior living provider Samaritas is forecasting a $5 million revenue gap on its $120 million annual operating budget due to Covid-19, Modern Healthcare reported. Other nonprofit senior living providers are also facing shortfalls due to rising expenses and falling revenue, with United Methodist Retirement Communities and Porter Hills — recently affiliated — facing a $3 million to $3.5 million gap.

ABC News reported on the lack of federal financial support for assisted living communities during Covid-19. “Officials with the [Centers for Medicare & Medicaid Services] told ABC News that they have been less engaged with assisted living because they only regulate nursing homes,” Allison Pecorin reported. “Nursing homes have far more residents dependent on Medicaid, and as a result, rely more heavily on federal funding and face more federal regulation.”

— A sweeping senior living reform bill passed the Georgia House of Representatives last week and is expected to be signed into law by Gov. Brian Kemp. The House unanimously signed off on an updated version of the bill with requirements related to Covid-19 data reporting.

“Kemp has said he strongly supports the legislation, which will bring dramatic changes to the state’s assisted living communities and large personal care homes,” the Atlanta Journal-Constitution reported. “Memory care units would have to get certified and have more staff, directors would have to be licensed and homes that break the rules would face higher fines. Assisted living homes would be required to have nurse staffing. Homes would also have to disclose financial problems to residents and families.”

— Senior living integrated tech platform K4Connect has partnered with artificial intelligence company Pryon. Caregivers in senior living will be able to ask the AI assistant questions and receive answers related to company policies and procedures, government regulations and best medical practices. “Our Pryon Answers-based Staff Assistant is designed to enable caregivers to stay up-to-date with the latest Covid data, treatments, regulations and more, so they can deliver the safest, highest quality care to their residents,” K4Connect Co-Founder and CEO Scott Moody said. “Our vision is to harness the power of AI to better serve and care for older adults; Pryon is the perfect partner to begin this journey with.”

— The location of a nursing home is more closely correlated to Covid-19 infection rates than the home’s historic quality of care metrics, according to a Washington Post op-ed penned by researchers from Harvard Medical School, the University of Chicago and Brown University.

“The most important factors influencing whether and how large an outbreak occurs in a nursing home are the population density of the county in which the facility is located, the prevalence of the virus reported in the county and the racial distribution of the nursing home, which are all correlated,” they wrote.

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