A decisive majority of independent living residents are glad to be in a senior living community during Covid-19, although they see room for improvement in some key operational areas.
Meanwhile, staff are generally glad to be working in independent living during this time and believe that their communities have responded well to the pandemic. And providers should be concentrating their efforts on forging strong and consistent connections with prospects, while also considering less traditional models such as senior living co-ops.
These are among the findings from the Covid-19 Sentiment Report conducted by Plante Moran Living Forward and Retirement Dynamics. The report compiled findings from a survey of 3,582 independent living residents, 717 prospects and 703 staff members. Responses were collected between late June and late July across 13 provider organizations. All the operators involved were nonprofits, although some were managing buildings owned by for-profit entities.
As the United States began entering lockdown last spring, Retirement Dynamics President Bobby Sumner and leaders at Plante Moran Living Forward foresaw that the pandemic would have serious ramifications for senior living, and they wanted to glean data as quickly as possible as the industry entered an unprecedented period.
“You don’t know what you don’t know unless you ask,” Sumner told Senior Housing News.
The fact that so many people responded to the survey sends a clear message, according to Dana Wollschlager, partner and senior living development practice leader at Plante Moran Living Forward. In particular, she is impressed by the large number of senior living residents who responded, both through digital and mail-in surveys.
“It said to us that they want to be heard,” she told SHN.
A strong showing
As a less needs-based product, independent living appeared to be a particularly vulnerable part of the senior housing continuum in the early days of the pandemic. However, IL largely has proven resilient, and these latest survey results confirm that providers have many reasons to be proud of their response to Covid-19 and optimistic about the future.
For example, 86% of residents said that they are glad they moved to a senior living community, and 93% of respondents said that they believe that their community took all necessary safety precautions. Residents also saw staff rising to the Covid-19 challenge. Prior to the pandemic, 89% of resident respondents rated their community’s staff as “above average” or “excellent,” and that percentage dipped only slightly — to 87% — during the pandemic.
Clark Retirement, which offers housing and services across several levels of care in the Grand Rapids, Michigan market, was among the organizations surveyed, and President/CEO Brian Pangle is not surprised at the high level of resident satisfaction. He estimates that 85% to 90% of Clark’s residents in independent living — be it in detached cottages or in congregate living — have maintained a positive outlook over the last several months.
“They feel safe, and that they live in an environment where we’ve kept them safe,” Pangle told SHN.
Similarly, prospective residents have not abandoned their interest in independent living due to the pandemic, even if Covid-19 has raised new concerns. Nearly three-quarters of prospects said that their timeline for a move is unchanged. The less encouraging statistic is a decrease in the likelihood to move among the prospect group; that statistic declined from 64% prior to the pandemic to less than 57%. However, write-in feedback from this group suggests that they could be swayed by better communication and messaging from communities.
And, in terms of staff responses, 92% said they feel the community where they work responded well to Covid-19, and 86% would recommend that friends work at the community.
These numbers should give senior living providers confidence in their recruitment efforts, Wollschlager said. They can point to this data to show that workers felt safe, felt heard as frontline heroes, and were glad to maintain their jobs in this industry while mass layoffs were occurring in hospitality and retail.
“I think this is a great chance for providers to continue to tell that as part of their value proposition,” she said.
Areas for operational improvement
While the big-picture takeaway from the survey might be that providers have risen to the Covid-19 crisis and consumer demand has not cratered, the responses also reveal where operations can improve.
Dining is one pain point. Prior to the pandemic, 71% of resident respondents rated their dining experience and options as “above average” or “excellent,” but that fell to 59% during Covid-19. The virus forced culinary programs to make difficult changes, as group dining venues were shuttered and replaced with in-room options. Dining teams had to pivot almost overnight, and menu choices and food quality may have suffered.
Pangle acknowledges the inherent challenges that the pandemic has posed for dining at Clark. In retrospect, one step he might have taken would be to have food trucks to come on campus more frequently, earlier in the pandemic. But, even that step would only go so far in supplementing the community’s own culinary offerings. Today, Clark has switched away from disposables back to using china, warming trays and other supplies that should be improving quality.
“But it’s a real challenge, and we’ve worked to address it as best as we possibly can,” he said. “I can’t wait to reopen all our venues as completely as we can.”
Communication is another area that providers may want to focus on.
“Some residents indicated they were not provided with the rationale for fluctuating, increasingly strict community regulations and implored their communities to involve residents in decisions concerning their safety,” the survey report stated.
Clark certainly encountered fluctuating regulations; Michigan’s governor has issued about 200 executive orders during the pandemic, Pangle said, while the Centers for Disease Control & Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and state departments of health and other bodies also have been putting out regulations and guidance at a fast clip. Sometimes, these rules or best practices conflicted with each other.
The provider took the approach of communicating rigorously about new regulatory mandates or guidance, noting possible points of conflict among them, and taking the position of generally adopting the most stringent protocols to ensure safety. But, rather than getting too bound up in the byzantine regulatory frameworks, Pangle also emphasized in his communications that residents should focus on exercising their best judgment and common sense.
“I would suggest that we’re dealing with mature, smart, competent people,” he said. “People are wearing their masks, staying physically distanced, doing the right and smart things.”
Technology has proven invaluable during Covid-19, but is another area where resident and staff feedback indicates room for improvement. For example, 72% of staff said they want a tech platform to streamline communication with families, and 54% of staff said their community’s tech infrastructure should be improved. There’s also a wide gap between prospects and residents, with 89% of prospects saying they are “able to leverage technology to maintain connectivity with friends and family during the pandemic,” versus only 47% of residents saying the same.
Pangle is glad that Clark Retirement invested in its tech infrastructure over the last four to five years, which set the organization up to implement new tools during Covid-19. These tools have ranged from Zoom and Microsoft Teams, to infection control technology that screens workers and visitors for symptoms, to a texting application called Trumpia that allows for mass communication with the workforce over mobile devices.
“Six months ago, it would have been one of those things that we said, we should think about this, now it’s part of our toolset,” Pangle said.
Any providers that have not made investments in their technology infrastructure should consider Covid-19 a long overdue wakeup call, Wollschlager said.
“If they think that a prospect who is leveraging technology as effectively as you or I is going to go backward to move into their community, they’re sadly mistaken,” she said.
Evolving the value proposition
Senior living occupancy has steadily dwindled since Covid-19 struck, and while many providers are increasing their move-in volume, they are also trying to determine the best way to rebuild census in light of ongoing consumer concerns.
“Prospect write-ins noted a significant amount of fear related to congregate living and how the community would suppress their freedom in choosing how to respond to risk,” the survey report stated.
Furthermore, 61% of residents said they feel safer in their senior living community compared to their previous home, but 69% of prospects said they think they would have felt less safe in a community versus their own home.
This statistic might be somewhat hard to interpret, given that residents can compare their experience in a senior living community with their previous lifestyle, while prospects can only imagine what being in a senior living community would have been like over the past months, Wollschlager noted.
Perhaps more troubling, 61% of prospects reported feeling a sense of isolation while sheltering in place, while 68% of IL residents reported feeling isolated. On the one hand, this finding stands to reason, given the independent living communities restricted visitation to safeguard health, whereas people living in their own homes have been able to set their own parameters around socialization.
But, a key part of the senior living value proposition is that it fosters a sense of community and gives older adults opportunities for socializing that they would not have elsewhere. If the pandemic erodes this value prop, that is potentially a serious concern in terms of sustaining demand for the product even after the pandemic ends.
In light of this situation, senior living co-ops might gain more popularity. Out of all the survey respondents, 27.5% reside in a cooperative residence. And, among the prospect group, the youngest respondents were most interested in co-ops. This finding suggests that the rising generation of aging boomers find appeal in the “buy-in” format of a co-op, the report authors wrote.
It’s an idea that makes a lot of sense to Shona Schmall, director of marketing and sales/cooperative development with Minneapolis-based Ebenezer Management, part of Fairview Health Services. Ebenezer is the largest manager of senior co-ops in the state of Minnesota, with a portfolio of more than 50 properties.
Co-ops are member owned communities, and are run through a resident-elected board of directors. The concept is to bring together people who are like-minded, with shared interests, in groups and committees.
“What I love about it is that members make their own decisions,” Schmall told SHN. “Every co-op is different, based on the needs and desires of that community.”
During the pandemic, the co-ops formed safety committees, taking guidance that Ebenezer provided to create processes and procedures to provide safety. Some co-ops formed buddy systems so that members checked in on each other, created resident-led social programs and activities such as outdoor sing-a-longs, and embraced technology, according to Schmall.
“We’ve got recommended contract service providers that have come in and provide some technical assistance to help with technology, and members are cohesive and network with other co-ops,” she said. “I’ve been amazed how they embraced just using Zoom … They’re the type of people that will embrace change and figuring things out.”
In other words, the co-op model had already created strong social bonds among members that carried over when the pandemic struck, while the co-op structure supported a member-driven response to Covid-19. An increasing number of older adults will be drawn to this model in the future, as a way to alleviate the isolation of living in single-family homes, while maintaining more autonomy and control than traditional independent living affords, Schmall believes.
But, not every senior living organization has the interest or wherewithal to develop or manage co-ops. There are steps that any provider should be considering to promote resident engagement and reduce isolation, many of which are laid out in the report on the survey findings. These steps range from adapting activities so that they can take place outdoors or hallways, to making a psychologist available to provide information and on coping techniques.
Many providers have already taken some of these steps, and while the pandemic demands greater creativity and out-of-the-box thinking, Sumner believes that one of the key takeaways of the survey is that providers can make a big positive impact with relatively small and straightforward operational adjustments. This is a welcome finding, given some of the fears that arose when the pandemic first swept across the industry.
“My biggest takeaway from all this is that nothing in the senior living industry is so broken it’s not fixable,” he said.