Senior living providers are still devoting considerable time and resources to Covid-19 testing, even as they ramp up vaccination efforts for residents and staff.
The senior living industry made great strides early in the pandemic to bring Covid-19 tests into their communities. But nearly a year into the Covid-19 pandemic, providers are still implementing new and forward-thinking ways to test residents and staff for the novel coronavirus.
These efforts include Juniper Communities and a partner company using artificial intelligence to pinpoint high-risk residents and prioritize them for testing; pool testing strategies from Kisco Senior Living that help limit the disease’s spread during outbreaks; and a new initiative from GenCare Lifestyle to help source and process rapid test kits.
Some of these initiatives aren’t cheap, and the costs associated with testing are compounded by lower revenue and compressed margins across the industry as a result of the pandemic. But providers must stay vigilant regarding Covid-19 outbreaks, even as residents and staff get their shots. That is partly to do with the fact that it’s still unclear whether getting vaccinated prevents someone from carrying and spreading Covid-19, according to Juniper CEO Lynne Katzmann.
“One of the reasons we will continue to test is to learn that, and to protect our residents and team members from any spread,” Katzmann told Senior Housing News.
Early on in the pandemic, Bloomfield, New Jersey-based Juniper Communities was among the first senior living providers to advocate for widespread, frequent Covid-19 testing.
Months later, the company began working with Oakland, California-based machine-learning algorithm company Dascena, with an overall goal of finding new ways to innovate and streamline the testing process. Now, that effort is bearing fruit in the form of a newly launched, algorithm-driven Covid-19 testing strategy.
Juniper already tests residents and staff for Covid-19 frequently to detect new outbreaks. In the past, that process involved monitoring every resident and staff member and applying the same infection control measures universally.
Recently, Juniper began using a simple cheek swab test with Dascena’s help to detect Covid-19. In addition to testing residents for Covid-19, Juniper also now collects demographic information such as age, sex and place of residence. That information is then analyzed by Dascena’s algorithm, which was originally developed to detect sepsis before it found applications during the Covid-19 pandemic.
By using Dascena’s technology along with regular testing, Juniper can get a better read on which of its residents have the highest risk for hospitalization, and stratify them into low-, medium- and high-risk categories. That helps the company allocate testing resources and time during a period when both can be in short supply.
“If you fall into the medium- or high-risk area, we can do more testing, we can segregate people, and we can tell them what we’ve learned,” Katzmann said. “And while we can’t tell them what to do, we can make it clear that the data suggests that they would be a good candidate for early vaccination.”
In addition to the testing initiative, Juniper and Dascena also worked together to create a new documentation and reporting portal and workflow, an effort that reduced indirect costs associated with testing. The companies are also working on new ways to implement artificial intelligence and machine learning in the future.
Although Katzmann does think providers will be able to slow down their regular testing efforts once more is known about Covid-19 and how it spreads, some of these initiatives can still serve providers well when dealing with seasonal epidemics down the road.
GenCare, which operates six senior living communities in Washington’s Puget Sound area, recently launched a new rapid testing initiative for detecting Covid-19 or influenza in as little as 15 to 30 minutes.
The program, undertaken with CAIPHI, Inc., uses Quidel antigen tests purported to have an accuracy rate of between 95% and 99%. The tests are administered by CAIPHI EP Testing’s mobile testing teams and screen for both Covid-19 along with Influenza A and B. Neither Gencare nor its residents pay for the program, and CAIPHI is reimbursed for the cost of testing through Medicare and CARES Act funding.
GenCare created dedicated apartments for Covid-19 testing at each of its six communities. The apartments are equipped with a Quidel Sofia 2 testing device and a rapid diagnostic system for infectious disease testing.
The provider will use the rapid tests in a variety of ways. For example, new residents are tested before they move in and required to isolate for 14 days. To ease the quarantine period for new residents, Gencare offers a “Staycation” program marketed as “two weeks of pampering, luxury and personalized community introduction activities.”
GenCare also plans to test visitors when they are allowed back into the communities. Under that process, visitors will wait in the community’s dedicated testing apartment until they receive a negative test result.
For staff, GenCare will offer the rapid tests on a staggered schedule that tests one-third of the company’s employees every two days. And GenCare will test residents for Covid-19 under the program at least once a week.
Like Katzmann, GenCare CEO Leon Grundstein believes that robust testing is necessary until there is more information available on the vaccine. But he also believes that the company’s testing program will be useful even after the pandemic winds down, as the industry will always grapple with smaller seasonal epidemics like influenza.
“It also tests for influenza, so we can manage that issue, which has always been a significant factor,” Grundstein told SHN. “We’d like to incorporate this somehow in our normal procedures.”
Other providers have relied on forward-thinking organizational strategies to stop the spread of Covid-19 in their communities. For example, Carlsbad, California-based provider Kisco Senior Living is using rapid “pooled” Covid-19 testing, a process that is similar to testing strategies adopted by the National Basketball Association (NBA) and the National Hockey League (NHL).
Under that strategy, Kisco regularly collects and tests saliva samples for Covid-19 — once a week for residents who haven’t left the community, and twice for residents who left the community that week along with staff. A negative test for the pool means that no one in the group is infected with Covid-19, while a positive test means at least one person in the group has contracted it.
Because pools are arranged in either 50- or 100-person groups, Kisco can more quickly isolate an outbreak and trace an infection to the source. But doing so is pricey, and Kisco spends $100,000 a month on pool testing alone.
Using pooled testing has allowed Kisco to spot outbreaks early. For example, the company’s process is sensitive enough to detect positive results even before the infected person has shown any symptoms, or even when the virus is in miniscule amounts, according to Ed Ward, vice president of operations for Kisco.
“We’re able to identify them very early, so it’s reduced the amount of big outbreaks in our communities by detecting the presence of Covid,” Ward told SHN.
Kisco plans to reevaluate how it handles testing once all of its communities have completed their Covid-19 vaccine clinics, a process that is still ongoing. What Kisco’s testing strategy looks like in the future depends on how the vaccine affects the spread of the coronavirus, and whether residents and staff get vaccinated in sufficient numbers. But, Ward believes the need to test will linger well after the vaccines are flowing freely.
“We’re going to have to continue to keep some testing, because there are going to be some individuals that aren’t going to get vaccinated for personal reasons, religious reasons, anaphylaxis or severe allergy concerns, and others,” Ward said. “But I think we can look at some modifications [to testing], as long as certain thresholds of vaccine participation are met.”