What Senior Living Can Learn from the NBA’s Covid-19 Bubble Strategy

Senior living can draw inspiration from other industries for ways to move forward during the coronavirus pandemic — with professional sports leagues among the organizations to keep an eye on.

All of the major sports leagues in the United States are attempting to start or finish their seasons in the wake of the crisis, with varying degrees of success. Notably, the National Basketball Association (NBA) is reporting initial positive results with its bubble approach, and some of the fundamental components of the plan could be adapted in senior living, Minnesota Timberwolves Vice President of Basketball Performance and Technology Dr. Robby Sikka said Tuesday on a webinar hosted by the National Investment Center for Seniors Housing & Care (NIC).

Meanwhile, innovations in testing can bring down costs, be scaled up, and be more reliable and less invasive once they hit the market. But there are still obstacles to implementing theses, particularly a lack of centralized policy to address Covid-19, and mixed signals on the need for, and importance of, smarter testing, Testing for America Governing Council Member Sri Kosaraju said during the webinar.


“There is an obvious recognition that we need more testing. But it’s not just about the magnitude of testing. It’s also about, can we get to the right people, the right high risk populations,” he said.

Lessons from the NBA bubble

The NBA’s protective bubble within the Walt Disney World complex in Orlando may hold some keys for other industries to reopen their operations, including senior living. While providers may not be able to create bubbles quite so aggressively as the NBA, some have already taken steps to create sealed environments, including by having staff live on-site.

But the initial results the league is touting would not be possible without the cooperation of everyone involved, including players, executives, staff and their families, Sikka said.


The league employs a data-driven approach to the bubble, much as it did when it decided to suspend the season in March. Coronavirus updates are shared with everyone and frequent discussions are held to address the impact of the virus on players. Sikka is a member of the NBA Sports Science Committee, and is involved with Minnesota state coronavirus task forces, working closely with state government on using the latest information to inform team decisions in keeping players and staff safe.

Frequent testing is one of the linchpins to the league’s bubble strategy. Each team participating in the truncated season has its own bubble, where testing is conducted. The league began testing every other day from June 23 through July 7. During that period, its Covid-19 positivity rate went from 10% rate to zero.

The cadence of testing was essential in helping the Timberwolves get what could have been a potential outbreak under control.

“Your testing cadence matters because you may not have testing every day. You may also have delays. You can’t have delays in your testing results and not react accordingly. You have to assume if there’s a delay that there are positives and you have to delay certain things,” Sikka said.

Families entering the NBA bubble are subject to a seven-day quarantine period, and are tested every other day, prior to entering. Then they are quarantined and tested for another seven days, before being allowed to stay with a person in the bubble. This establishes a contact tracing baseline for positive cases, and allows the league and teams to track the movements of people within the bubble, and restrict movements if someone is suspected of having Covid-19 symptoms.

The frequent testing had added benefits. Mainly, it allows the league to reduce its upfront cleaning costs and divert the savings to more testing.

But Sikka stressed that there is no uniform approach to fighting the virus; what works for the NBA may not work elsewhere.

“The reality is, there’s no one solution that’s going to get us out of the mess that we’re in across the country,” he said.

Wearables monitor movements, vital signs

The NBA is using wearable technology to monitor people within the bubble for Covid-19 symptoms, as well as to track their movements.

Wearables can be used to monitor the body temperatures of players, and Sikka cited a study from the University of California, San Francisco currently under review showing that 38 of 50 patients wearing Oura Rings recorded temperature spikes that were in line with contracting the virus. Oura Rings can also record changes in heart and respiratory rates.

Wearables hold solid potential to monitor senior living patients for Covid-19, due to their low price points and adaptability to a wide range of health care and wellness platforms, but Sikka acknowledges that higher priced models such as Oura Rings may not be for everyone.

The league is also using proximity trackers which remind wearers if they are too close or spending prolonged amounts of time next to someone, or in tight indoor quarters. These trackers can be used as contact tracing tools, in the event of a positive test or if someone shows symptoms. But it would not be possible unless everyone is on board with the plan.

“We have 100% compliance in contact tracing, we have 100% compliance with our wearables. And it’s because we forced our folks to really understand, it’s not us trying to control your behavior. But it is about you participating in a group here that needs every person to step up. We cannot have any weak links,” he said.

Simpler, more reliable testing

Although testing has improved from the pandemic’s early weeks, more still needs to occur if industries intend to fully reopen. New testing platforms that are reliable and low cost hold the potential to make that happen, Kosaraju said.

One promising testing advancement involves rapid antigen testing conducted by gathering saliva samples. The NBA provided funding and partnered with Yale University to create the test, which is currently in the midst of being authorized for emergency use by the Food and Drug Administration (FDA). The test would cost around $1, is reagent agnostic, and provides reliable results in a shorter amount of time than the current swab test.

Senior living thought leaders such as Aegis Living CEO Dwayne Clark and Juniper Communities CEO Lynne Katzmann have championed saliva testing as the future of Covid-19 testing. As the pandemic endures, scientists have discovered that nasal swabs will return with a negative test when the virus may still be incubating in a host.

As with wearables, saliva testing may not work for all industries, but the potential for senior housing is untapped. The industry, however, must contend with other obstacles before scaling up testing.

The biggest obstacle is a lack of a centralized plan to address the pandemic, and probable future epidemics and outbreaks. State and local governments are making decisions about testing independently, based on what they see in their areas.

“That might be right because the virus has different attributes in different geographies, locations and communities. But it’s also left up to people to make their own decisions. That’s hard in an area that we don’t necessarily understand that well,” Kosaraju said.

The lack of a coordinated response contributes to mixed messaging on the importance of, and need for, testing. Some view testing as an essential component to reopen; others consider it voluntary, if they allow testing at all.

“We still are debating and still trying to understand [testing],” he said.

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