A surge of Covid-19 cases in locations across the United States is putting pressure on senior living providers that are eager to pivot to a “next normal” after months of strict protocols.
Nearly four months after the virus spread quickly across the country, confirmed Covid-19 cases are rising in 40 states, and new hotspots have emerged in states that either delayed shutting down or eased shutdown restrictions, notably across the Sun Belt and the west.
Those states include Florida, which averaged nearly 8,800 new cases per day over the past week; Texas, with a record 10,000 new cases reported on July 7; Arizona, where confirmed cases crossed 100,000 cases earlier this week; and California, which is experiencing a resurgence in cases after flattening its initial curve in April.
The resurgence in positive coronavirus cases is notbeing reflected in senior housing. In Florida, people between ages 15 and 34 account for 31% of new Covid-19 cases. At the beginning of June, the 18-to-49 age bracket averaged 43 new cases per 100,000 people nationally, compared with 28 cases per 100,000 people over 65.
But the surge in cases is leading some providers, such as MBK Senior Living, to slow their reopening plans and re-implement stricter protocols, mirroring actions being taken by state and local governments.
Compared to the pandemic’s early weeks, however, senior living providers find themselves in better positions to manage through this resurgence. Notably, providers have better and more ample access to testing and personal protective equipment (PPE) stock and supply chains have stabilized.
But there are long-term concerns about resuming move-ins and maintaining staff morale and staffing levels as positive cases continue to climb, MBK Senior Living President Jeff Fischer told Senior Housing News. The resurgence can prove to be an opportunity for the industry to show that senior housing is a safe haven for residents needing to transition from their home environments.
“People don’t shop for senior living because they have nothing better to do on a Saturday afternoon. They shop because they have a need, and those needs don’t diminish just because of the pandemic,” he said.
Communities in states with resurgences in coronavirus cases are feeling the impact most notably on staffing.
Bridge Investment Group has seen an uptick in staff testing positive for Covid-19 in Arizona, California and Texas, Robb Chapin, CEO of Seniors Housing and Medical Properties, told SHN. Based in Salt Lake City, Bridge has been aggressive in the senior housing space in recent years, through its $1 billion Bridge Seniors Housing Fund. It acquired the real estate and operations platform of Somerby Senior Living in January 2019, and has a total portfolio of 90 communities in 25 states.
The majority of these cases at Bridge communities have been asymptomatic, and workers who tested positive returned to work after a 14-day quarantine and a negative test, Chapin said. The company has been incentivizing workers with hero pay, extra personal time off and sick days.
Bridge has also seen some attrition from staff reticent to work in an environment where they may contract the virus. The flip side to that is that job applications have increased substantially, as unemployment numbers continue to rise.
“In our communities where we might get 10 to 15 applications, we’re getting probably triple or quadruple that amount of interest in jobs today,” Chapin said.
MBK implemented hero pay across its communities early on, which was set to end in June. That policy is being extended on a community basis moving forward. Irvine, California-based MBK operates 33 communities in six states. California accounts for the bulk of MBK’s portfolio with 14 communities, and another three communities are centered in the Phoenix market, an epicenter of Arizona’s surge in positive cases.
The movements of employees outside a community is the biggest risk for introducing the virus to a facility. With this in mind, providers have taken steps to remind workers that, even as businesses reopen, they have a responsibility to avoid crowds and maintain a cautious lifestyle.
To improve accountability among workforces, MBK launched a safety pledge for associates and community leadership to hold themselves and each other accountable for their movements and safety protocols within and outside of the work environment.
Better testing capacity
Providers were scrambling in the pandemic’s early weeks to arrange for testing of residents and staff, but many now have readily available access to testing. MBK is implementing serial testing across its portfolio to ensure it is identifying positive and asymptomatic cases and prevent further spread, Fischer told SHN.
Bridge was proactive early to secure testing for its residents and staff, according to Chapin.
As the pandemic continues, Bridge sees no shortage of testing capabilities and receives frequent calls from vendors looking to become preferred partners, and Chapin expects this to continue as more states mandate testing in senior living.
“Testing has become a lot more widespread and available, and more effective,” he said.
Providers such as Ohio Living are allowing the National Guard into their communities to test residents and staff, CEO Larry Gumina told SHN. The Columbus, Ohio-based nonprofit provider operates 12 continuing care retirement communities in the state, totaling over 3,000 units, and ranks 18th on the 2019 list of the largest nonprofit senior housing operators from LeadingAge and Ziegler. Additionally, Ohio Living operates a holdings division for its home health and hospice services.
Ohio was one of the earliest states to respond to the pandemic and, while it has managed to flatten the curve overall, positive cases are rising in markets in the southern part of the state, such as Cincinnati. Ohio Living operates a CCRC, Ohio Living Llanfair, in the market.
The Ohio National Guard conducted testing on four Ohio Living campuses. One staffer at Ohio Living Breckinridge, near Cleveland, tested positive.
Gumina expects the National Guard will eventually conduct testing on all of Ohio Living’s communities.
PPE supply logistics stronger
Access to PPE, as well as having sufficient inventory, remains a concern. But the mad dash to acquire safety equipment that marked the pandemic’s early weeks appears to have subsided. Larger providers have solidified vendor relationships, streamlined logistics, and are building centralized stockpiles to be meted out to communities as needed.
Ohio Living struggled initially to acquire extra PPE, but inventories across its portfolio are healthy for the time being, Gumina said. The provider also has vendor relationships in place to acquire more, should a resurgence occur across the Buckeye State.
“Should we have an outbreak or resurgence, that inventory is going to go down, obviously. But I feel confident that we can bolt back up because we’ve developed some good relationships with some suppliers,” he said.
MBK began bulk purchasing PPE as the virus spread across the country, and established a centralized logistics network to distribute equipment to communities, which now serves as a backup stockpile if needed. As PPE vendors replenish their inventories, the provider is allowing communities to order directly from local suppliers, as necessary.
“It seems at this point that PPE is much more accessible. We have some good contacts with different vendors that we can get what we need when we need it. So we won’t have the long delays or the outages that were troubling early on,” Fischer said.
Birchwood Healthcare Partners established a PPE tracker to account for existing inventory, as well as estimated burn rates of supplies so that stock can be distributed to communities with the greatest needs, founder and CEO Isaac Dole told SHN. The Chicago-based health care investment firm specializes in senior housing and post-acute health care investment.
Occupancy challenges persist
Operators in states where cases are surging believe that this is an opportunity to show that senior housing provides a safe environment for seniors and their families considering a needs-based move, and that procedures adopted during the pandemic will keep new residents safe and healthy. The industry at large recognizes that move-in and occupancy rates will not immediately return to pre-pandemic levels, but even a slow and steady stream of move-ins — along with stabilized PPE and staffing expenses — can help improve margins.
Bridge reopened nearly all of its communities to new resident move-ins. Tours remain on a virtual level, but have inched up to near pre-coronavirus levels. Moreover, occupancy declines and move-out rates have not reached worst case scenario projections, Chapin told SHN.
Bridge believes the value of its communities will bear out and that prospective residents and their families will recognize that, when it is time to make a move.
“The thing that we’re most encouraged about is, the market continues to embrace [senior] housing as the safest place for their loved ones, and even more so now. It’s just now a matter of when’s the right time to do it,” he said.
Ohio Living discontinued admissions in its skilled nursing wings in March and April, despite an executive order from Governor Mike DeWine, because of PPE shortages. As the provider built up its stockpiles, it is now admitting Covid-19 positive patients into its communities safely and returning them home, as soon as they test negative.
MBK has seen occupancy fall 4% across its portfolio, and new leads slow, during the crisis, but the situation rate is improving month over month. That has been buttressed by fewer than normal move-outs, and sales teams main priorities are nursing solid leads while overcoming apprehensions to a move from new referrals.
Some communities, particularly with assisted living components, have seen residents move out, only to move back in a couple weeks later after recognizing that the care levels they receive are more consistent and better than living at home with loved ones.
“This demonstrates that it is safe to move to a senior living community — and potentially may be safer to be here — than at home where some of the same protocols may not be in place,” Fischer said.