Covid-19 is giving health systems a better appreciation for senior living’s position as a part of the health care continuum, and for the fact that operators can provide social determinants of health to keep overall costs down for hospitals and acute care settings.
Providers are also forging bonds with local public health departments they overlooked in the past, which will prove beneficial for communications and transparency, after the pandemic subsides.
But questions remain unanswered regarding if Covid-19 will make it easier to recruit new talent to the industry, and whether enhanced benefits are establishing a new wage floor for labor that will contribute to permanent expense increases.
This is according to executives from Bickford Senior Living, Commonwealth Senior Living, Country Meadows Retirement Communities and Silverado, who shared their long-term forecasts during the 2020 Argentum Senior Living Virtual Conference.
While it’s impossible to predict with certainty how Covid-19 will permanently alter senior living operations, the panelists offered several ideas, with particular focus on infection control, health system partnerships, transparency and communications, and staffing.
Stronger infection control
The virus has already resulted in lasting changes to operations such as enhanced safety protocols and infectious disease controls.
Residents, staff and their families should expect enhanced screening protocols to be a permanent part of entering communities moving forward, Commonwealth Senior Living President and COO Earl Parker said.
In just one example of how pandemic-related infection control practices could persist well into the future, masking could become more commonplace in senior living settings to combat different types of infectious diseases.
This is thanks to the fact that masks are proving to reduce the spread of Covid-19 in communities, and will even prove more beneficial as flu season approaches to prevent or reduce outbreaks, especially when coupled with stricter immunization and vaccination requirements, Silverado Senior Vice President, Community Operations Michelle Egerer said.
The Irvine, California-based memory care specialist mandated the use of personal protective equipment and KN95 masks, which have been approved for emergency use by the Food & Drug Administration (FDA) while the United States wrestles with a shortage of N95 masks. Doing so has helped prevent the spread of the virus between employees who test positive for the virus and are asymptomatic, and residents.
“We know, in a very significant way, that even one mask works,” she said.
Proof of value
Providers contend that the pandemic has crystallized senior living as part of the health care continuum in the eyes of health systems, Country Meadows Senior Vice President and COO Meredith Mills said.
Country Meadows was part of a unique situation in Pennsylvania, where health systems were awarded grants to help run the provider’s infection control strategy. This proved to be an opportunity for health systems to get a better understanding of the senior living space through required site visits of communities. The health systems gained exposure to the details of Country Meadows’ infection control policies and some of the procedures in its pandemic response, such as establishing Covid-19 cohorts.
The Covid-19 wings were especially noteworthy as they allowed providers operating other assisted living or personal care facilities to send Covid-19 positive residents to these cohorts to recover, bypassing hospitals and helping to maintain emergency capacity. Health systems, in turn, are also referring patients that do not need acute care — but do need some clinical oversight and support — to these cohorts.
Country Meadows’ goal has always been to provide resources to the healthcare system as a whole, serving as a bridge between home health care and acute care.
“It puts a spotlight on us as an industry,” Mills said. “Just because we don’t receive Medicare funding, how can we be a resource in the overall system?”
This look underneath the hood has also given health systems a glimpse of how exceptional senior care can reduce readmission rates to hospitals, and that senior living is well-equipped to provide social determinants for better health outcomes for seniors, which can help lower costs across the system as a whole, including benefits for acute and post-acute segments.
“[Covid-19 cast] a spotlight on all of our levels of care that demonstrates that we can take care of these individuals,” Egerer said.
This has some providers confident that better health system relationships will result from the pandemic, and others believe that Covid-19 will accelerate Medicare Advantage networks. But while these developments could indeed be a silver lining of the pandemic, the industry should be wary of the tradeoff that comes with that, Commonwealth Senior Living President and COO Earl Parker said.
He is concerned that accepting more government money will come with more government oversight, and how that is applied. Still, he is bullish on diversifying the way that people can pay for senior living.
“I see it as a big opportunity to expand our the number of residents that we can provide services,” Parker said
Forging new connections
A renewed commitment to better, more transparent communication between providers with residents and staff has the additional benefit of establishing new ties to local public health departments, Bickford Senior Living Executive Vice President of Operations Alan Fairbanks said.
Bickford relies heavily on guidance from local public health departments in its markets whenever it had a positive case in its communities, and the information it shares on outbreaks and positive cases with families is also shared with the agencies, providing a clear look into the provider’s Covid-19 response. These new relationships will prove beneficial and ensure that Bickford has priority access to a vaccine, once a viable one becomes available.
“[It’s a] partnership that was always out there that we didn’t lean on as much as we could have,” Fairbanks said.
Like the industry at large, Commonwealth increased its communication and transparency to residents and staff during the pandemic. It posts weekly updates every Friday for families and associates, detailing positive Covid-19 cases, the extent of outbreaks and response, and circumstances where residents have died from the virus.
“We determined early on that families want to know if the virus is in a building,” Parker said.
Greater communication and transparency has been well received by families, and Commonwealth has reaped unforeseen benefits. A media outlet in one of its markets reached out to the provider looking for information on how Covid-19 has affected the community. Because the information was already public, Commonwealth shared all communications between provider and families.
The outlet later wrote a story detailing the response to the pandemic by Commonwealth and two other providers, but the story honed in on Commonwealth’s response, as the other providers declined to comment.
“It’s the right thing to do. We don’t want to add to their level of concern by trying to keep things in the dark,” Parker said.
Another possible silver lining of the pandemic was that it might be a boon for providers struggling to fill roles and contending with shallow labor pools. And, while the national unemployment rate has skyrocketed, providers continue to struggle to fill openings.
Part of that stems from enhanced unemployment benefits which were cut significantly in July and are set to expire this month, Parker suggested.
News reports conflating nursing homes with senior living, meanwhile, have cast doubts on the safety of the industry for people seeking employment.
Commonwealth attempted to capitalize on the growing labor pools caused by the outbreak, and launched targeted campaigns online and in social media to recruit new talent. The campaigns did generate the expected views and applications, but have not translated to significant new hires, Parker said.
“We’ll continue to push the effort forward,” he said. “There is still going to be opportunity, once the stimulus [ends].”
Commonwealth is one provider that chose not to implement hero pay across the board. Instead, it offered shift pickup bonuses and drew on workers at neighboring communities to fill gaps in scheduling, where applicable. And the provider is looking at ways to support staff as the pandemic persists, and establish career trajectories and training opportunities, which Parker believes will keep wages stable and build an internal workforce pipeline.
“[More employees] are recognizing that they are health care professionals, than a lot of them may have viewed themselves previously,” he said.
Country Meadows also saw an early increase in applications, which did not translate into new hires. Mills believes the industry must improve its messaging in order to recruit and retain new talent. It was an uphill battle prior to Covid-19, exacerbated by an inability to bring prospective hires into communities for interviews and tours, to show what senior care has to offer.
Providers must also overcome the public relations headaches from the pandemic’s early weeks to show that senior living is a safe environment, and that operators are going above the call of duty to ensure the safety of everyone within the walls of a community.
“You’re much safer going to work at one of our sites than you are going to the grocery store,” Mills said.