SRG Senior Living came into 2020 with momentum, having raised the bar on its wellness model while pursuing several other innovative initiatives in recent months and years. The Solana Beach, California-based provider is now benefiting from that hard work in its response to Covid-19, Founder and CEO Michael Grust told Senior Housing News.
Notably, its wellness program dubbed Zest is serving as the framework for its reopening plans — creating what the company is calling “no-touch wellness.” And, its partnerships with organizations such as Medicare Advantage health plan and clinical services provider CareMore are proving valuable.
But SRG and the industry as a whole are still in the midst of a tough battle, Grust emphasized. With Covid-19 infection rates surging in states across the country, providers are scaling back their reopening plans. Making the call to do so at SRG communities was another moment of reckoning for SRG’s leadership, after months of tests and challenges.
“We all sat down and recognized this is going to be incredibly deflating, that we’re walking some of this back,” he told SHN.
However, he is heartened by the response that he has seen within SRG since the pandemic first struck, saying that the company pulled together and that Covid-19 was a test of character.
“There’s been a 90-plus percent revelation that there’s been strong character everywhere I look in this company,” he said.
Not just managing communities
Like the senior living industry as a whole, SRG found itself in “uncharted waters” when Covid-19 began to spread across the United States in mid-March, Grust said.
SRG put in place protocols and procedures that are now commonplace across the industry, including limiting visitors, increasing infection control practices, and forming a Covid-19 task force that met every day. The company also moved aggressively to obtain testing capabilities, offered “hero pay,” and adjusted its approach based on regional variations in regulations and requirements.
While senior living providers are experienced in responding to infectious disease outbreaks such as the seasonal flu, Covid-19 demanded that operators rapidly expand the skillsets of their management teams, Grust pointed out.
“We’re in a situation where we’re not just managing the communities,” he said.
For example, he pointed out that “contact tracing” was a phrase he had never used before this year, and now he and his team are having to become experts. Similarly, SRG Senior Living has had to become adept at supply chain management to obtain the necessary personal protective equipment (PPE) and other supplies.
Communication and transparency are also key components of the ongoing response, Grust said. That includes sharing information about Covid-19 infections within communities, but extends to a wider effort to keep the whole company unified by sharing information and stories. SRG uses an app called Sonic Boom in this effort, enabling associates to share a variety of information, from how they are serving meals to creative adaptations to resident engagement programs.
“It became great, because I do feel the ‘we’ really did rise up,” Grust said.
In fact, “The Power of We” has become an SRG motto throughout Covid-19. This is not a top-down effort at corporate messaging, Grust emphasized, but a “real and authentic” expression of how SRG’s associates, residents and families have pulled together.
Starting in May, SRG took its first small steps toward easing lockdown protocols. To highlight how cautious the process was going to be, the company dubbed the effort “Opening 0.5.”
As that approach implies, Grust was aware that easing Covid-19 protocols came with serious potential consequences, considering that the pandemic is still raging across the nation.
However, he realized that isolation also causes harm to residents, and that comprising their well-being through an overabundance of caution could erode the basic value proposition of senior living.
“I think every CEO has been wringing their hands in terms of, when we come out of this, what’s the perception of senior living?” he said. “Ultimately, we needed a message that this is a safe place, and more importantly, it’s a place that not only are you protected, but where you’re stimulated and engaged.”
SRG’s Zest wellness program, developed over the last several years, created a framework of programming based on measurable outcomes, and this wellness roadmap has guided reopening efforts. Programs that are deemed most valuable in enhancing residents’ wellness have been prioritized over other activities — these other activities may also have benefits, but the risk versus reward ratio makes them lower priorities.
“We recognized that we had to educate residents that, really, playing bridge wasn’t going to be one of those activities,” Grust said.
Residents did provide “interesting pushback,” but Grust estimates that 95% of residents understand and appreciate the approach.
With the leadership of the company’s wellness director, SRG created its no-touch wellness approach to reopening. There are multiple facets to this, but no-touch wellness includes adapted exercise programs meant to prevent decline, mitigate stress, alleviate depression and lift people’s mood. A “measured” approach was taken to engaging residents in outdoor activities, recognizing that safe socializing also is key to overall wellness. Dining has also been a key component of Zest, with menus developed to emphasize fresh, local ingredients. Throughout Covid-19, the culinary team has been able to adapt these menus for in-room delivery, while also providing comfort food.
Prior to the pandemic, many providers were already transitioning their operations to focus on proactive wellness rather than reactive health care. Aging boomers have a long-held interest in wellness-driven lifestyles, while providers also have operational and financial incentives to keep residents healthier for longer periods of time.
Still, having the right blend of proactive wellness and robust clinical care is a hallmark of senior living, and likely will become even more imperative due to Covid-19. To that end, Grust is pleased with SRG’s partnership with CareMore.
CareMore is an affiliate of insurance giant Anthem (NYSE: ANTM). Through an initiative with real estate investment trust Welltower (NYSE: WELL), CareMore is bringing interdisciplinary teams of medical professionals into senior living settings to provide more robust and coordinated care, with a component of Medicare Advantage insurance coverage. SRG was one of the first Welltower operating partners to participate.
Working primarily through telehealth, CareMore teams have provided support to manage the ongoing health care needs of residents throughout the pandemic. While CareMore is not active in every SRG community, the organization has been a “global resource” for SRG, Grust said.
“We’ve been in constant contact with them,” he said.
And CareMore is just one of the organizations that SRG has been collaborating with in developing its Covid-19 response and its no-touch wellness reopening approach; other partners include Johns Hopkins and the University of California, San Francisco. Welltower has played a helpful role in convening various people and institutions, Grust noted. Every Friday, he was on calls with other CEOs and operating company executives.
“When we went to open up, obviously we wanted to make sure we were pulling from all the best information and protocols and best practices — I think nobody’s an expert in this pandemic,” he said. “… We’ve had to be adaptive, we’ve had to be creative, we’ve had to be vigilant.”
Looking to the future
Part of being “adaptive” has been returning to more strict lockdown protocols as necessary. Covid-19 infection rates are up across the nation, including in some of the states where SRG operates such as California, Texas and Arizona.
Arizona in particular has been a challenging operating environment of late, with infections among SRG staff members on the rise, Grust said. The company has created ongoing messaging to associates, reminding them of the huge responsibility they have for vulnerable residents, and urging them not to put themselves in risky situations as states end stay-at-home orders and businesses reopen.
“That’s an incredibly challenging situation to manage,” Grust said.
Other challenges include the prevalence of third-party home care workers in independent living communities; SRG has mandated that those third-party caregivers furnish proof of negative Covid-19 tests.
In California, if a senior living staff member or resident tests positive for Covid-19, the facility must test every resident and employee every 14 days until there are no longer any positive results. Like other senior living executives, Grust is seeing the effectiveness of PPE and other protocols, insofar as positive Covid-19 cases among staff do not automatically lead to outbreaks among the resident population. But memory care continues to be a vulnerable area, given that residents there do not understand the need for social distancing and isolation.
Covid-19 costs — such as for testing, additional wages and PPE — have driven up expenses for senior living providers across the country, and SRG is no exception. Grust estimates about a 10% increase in expenses, which is within the 5% to 15% range being generally reported. SRG operates some highrises and other large buildings, which creates additional expenses as well as additional operational complexities; for instance, in managing the traffic in elevators.
“I think it’s going to be an interesting next chapter in design in our buildings,” Grust said. “How can you isolate spaces in such a way that you don’t just have people walking through.”
The recent spikes in Covid-19 have underscored for Grust that SRG will be operating on a pandemic footing for the foreseeable future. Staff members have already gone through a “tremendous journey” in the past few months, but that journey is far from over, and it is up to Grust and other leaders to support them in the long term.
But he is heartened by the way that SRG’s team, residents and family members have already pulled together, and by the senior living industry’s overall response. After 33 years in the business, he’s feeling more passionate and committed than ever. Despite the very real toll that Covid-19 has taken on senior living, he believes the industry will be able to demonstrate that communities are safe and desirable places to live, and that providers will innovate and improve based on lessons learned.
“I’m an old jock, so I get pumped up and I like locker room speeches, and I feel like we need to beat the drum that this is an industry that will continue to thrive,” he said.