This article is sponsored by Willis Towers Watson. In this Voices interview, Senior Housing News sits down with VP of Clinical Risk Services JoAnne Carlin to learn how senior living operators can manage infection control in the age of COVID-19, whether in independent living, assisted living, memory care or with communities that cross the continuum.
Senior Housing News: You have an interesting career with both nursing and executive leadership within senior living. Explain your career journey. How did you reach this point at Willis Towers Watson?
JoAnne Carlin: I’ve had a wonderful nursing career as a clinician and advanced into executive roles in health care systems early in my career. My practical experience in acute care, long-term care, home health, hospice and leading resident care and quality for a national senior living company informs my ability to help our clients, and serve the senior living industry.
The operational experiences that I’ve had help me work with our clients in a practical way so that when risks, exposures and liabilities are identified, the recommendations that are provided are compatible with the organization’s culture, goals, structure and resources in order to support sustainable solutions that make sense for their organization.
Infection control will be hugely important in this new normal. What are the best practices for senior living operators handling exclusively or predominantly independent living populations?
When I think about independent living, it’s important to remember that the residents are intelligent, self-directing adults who, when informed, will usually do the right thing. Once they are made aware of risks to health and safety they will do what they can to help their community.
Communication with the residents is especially important with COVID-19. The residents should hear directly from the community leadership. Whatever we know about the spread of the disease and how the community is responding should be shared with residents and their families. With this situation we need to be very clear about the virus, how it spreads, the precautions and any kind of restrictions we put in place. Also, be sure to give them the rationale for the restrictions. Don’t assume that what you know they know. Make sure your communication with them is clear and frequent.
The other aspect to consider is how the staff interacts with the residents. We tend to want to protect the residents so our interactions can seem authoritarian. Take time to make sure staff treat the residents in a respectful manner — not talking down to them or just ordering them to comply with new rules. Let your staff know how to respond to questions and provide information to residents and families by sharing talking points that you have developed that help with the messaging. All staff and the leadership in independent living need to be on the same page. Talk the same way, reinforce, explain and make yourself available. And make sure you’re listening.
What are the best practices for senior living operators handling exclusively or predominantly an assisted living population?
With assisted living, the first thing that you have to consider is, what are my state, local and licensing requirements, and what are they saying that we have to do? Those agencies must be monitored for new information and direction daily, especially during this pandemic.
Most of the residents in assisted living do have some underlying health conditions that could put them at risk. If nothing else, their age puts them at a higher risk for bad outcomes with COVID-19. We want to be very cautious and protect them from getting the infection. The same treatment of them as mature, intelligent people is important. Even if they’re not totally self-directing, they need some assistance with way-finding or medication reminders, that doesn’t change the need to communicate all information in a respectful manner.
Communication becomes important both with sending the message and listening to the feedback. Explain what’s happening and why we’re doing this. A lot of explanations, a lot of rationale, and taking time to listen. What’s the feedback? Did the resident hear what was said? Does he or she understand? What are they worried about? Is there anything concerning them?
Of course, the infection control best practices include screening the residents. Because most of our population are older adults over 80 years old, the symptoms they might be displaying are going to be different than in a younger person. They may not show a high fever right away, if at all. They may already have coughs because they have some other underlying medical condition. Really knowing your residents and monitoring them for subtle changes for symptoms and documenting that screening every day is critical.
And now the trickiest one: memory care.
Memory care is challenging because of the way the resident may perceive what is going on around them. They’re probably not going to wear a mask or face covering because it would be scary for them. When staff or others wear a mask or face covering, it could cause them to respond with difficult behaviors because their perception is distorted. We don’t really understand what they’re seeing, but they’re not seeing the same faces that they’re used to if we have masks on. Taking some time with the residents in memory care, and making sure that nothing we’re doing that’s new is going to trigger any behaviors, is paramount.
Memory care is designed to be in smaller neighborhoods that are secured and have consistent staff, and that is serving them well when it comes to infection control. The reason this type of environment may be beneficial is because it’s like a family — you all live together. There are times in memory care when residents are not going to socially distance, but staff have been very creative on ways to keep people engaged in activities that are going to keep them separated. Symptom identification is very important with memory care residents. Getting them tested and getting them care as soon as they show symptoms is probably going to be a little more efficient than it would be in either assisted living or independent living.
The other thing that came to light about COVID-19 is that sunshine and fresh air is good for killing the virus. Many memory care units have outdoor gardens where residents can sit in the sunshine, and they can open the doors and circulate fresh air in the unit. Doing this is a good idea, especially as the weather improves. Getting residents some fresh air and sunshine and keeping them active and engaged in some exercises and meaningful activities should help overall.
We’ve talked about each of these in a vacuum but the reality is that most senior housing operators will be managing multiple acuity levels, populations with different needs. What is the most important best practice for senior living operators to manage infection control across a care continuum?
Transparency is very important. I touched on this earlier: We need to educate, inform and take time to communicate with residents, while telling them what they can expect and what they should look out for. This comes under the umbrella of transparency, but the best thing you can do is to let the residents and their families know what you know when you know it.
Don’t hold back. Don’t try to spin things. Don’t overly sugarcoat facts. Of course, don’t be brutal, but tell them how a fact manifests itself in your community. Tailor the message to each resident’s ability to understand the message. Then allow for feedback and questions about what you’ve explained and what you’ve conveyed.
That’s great. How can senior living operators manage infection control amongst staff?
The managers and supervisors have to be vigilant and observe how the staff are going about their daily tasks. A concern that I heard from an insurance carrier was that if a community is short-staffed, they might take shortcuts and skip things like hand washing after they remove gloves. We know that doing infection control practices correctly can be a little more time-consuming. Washing your hands before and after putting gloves on and off may be thought of as double work.
The best way to reinforce the behaviors that we want with staff is to observe, to congratulate and recognize people who are doing a great job, and then coach, educate and support your staff when they’ve missed a step or they’ve taken a shortcut. Let staff know that it’s one thing to make a mistake, but it’s another thing to be risky and do things wrong repeatedly.
We recommend to routinely observe staff’s performance and the environment using a checklist for what you want to observe regarding safety and risk management. Remember to recognize and reward staff for doing things right, both on the spot and even in staff meetings. Call out good performers, reward with simple gifts like a candy bar or gift certificates. This reinforces your culture and what is considered a good job, well done. We have to be there and do this nonstop. No letting down.
What would you say is the biggest challenge in infection control around family members?
I think the biggest impact on family is that they miss being in physical contact with their loved one. It’s often hard on families when their loved one goes into a senior living community, but not being able to visit during this time is upsetting. I think as we figure out how we’re going to ease restrictions that it’s going to be important to get families back into visiting their loved ones. There, again, we have to have a solid plan to keep infection control practices in place.
Everybody needs to have a face covering when they come in and visit. The number of visitors at one time should be limited. The visit should take place in the resident’s apartment, a room in the community that is disinfected after each use or outdoors. It is important to make sure that visitors follow all of the other measures, such as hand washing upon entry, screening for symptoms and whether they have been around individuals with COVID-19. The grief around not being able to visit your loved one is something we should acknowledge. Let families know your plan, including gating criteria and timing for visitation.
There’s a lot of focus today on the new normal, and while no one can predict the future, it seems a safe bet that much of what operators are implementing today will be relevant beyond the end of the pandemic. What is the most important aspect of infection control that senior living might be changing today that will remain relevant past the pandemic?
One of the important measures is restricting access to the buildings so that the community knows who’s coming and going in their building. That allows them to not only screen for people who have infectious disease, but it’s a bigger measure for overall security and managing the communities.
We’ve been telling people to limit the access to your community through one door. Make sure that the door is monitored, and that you have signage as to what visitors need to know and do. Establish a way to screen any visitor for whatever their purpose is in the community, and give them instructions and information about how to conduct themselves while they’re in the building and while they’re visiting.
Editor’s note: This interview has been edited for length and clarity.
To learn more about how Willis Towers Watson can help your community manage the risk inherent in infection control, visit WillisTowersWatson.com.
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