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Q: What was it like opening the community during the pandemic?

A: Just like the rest of the world, we started to adjust our plans in the middle of March, but our contractor was able to keep us on schedule, so we were able to continue with our move-in plan. We were very pleased, because most of our folks who were planning June 1 moves had either already sold their homes or their homes were under contract, so they were absolutely, positively planning to move June 1. A pandemic was not going to stop them.

We had 55 independent living apartments open on June 1. We spaced those moves out over time. Residents of our 26 freestanding independent living cottages were able to move in starting June 15.

Another section of the community, more independent living apartments, is scheduled to open Oct. 1. And sometime after that, an assisted living/memory care neighborhood and a skilled nursing neighborhood called Magnolia Place will open, when we receive our license. 

Overall, we have about 80% of the community reserved or occupied for residents to be able to move in, and for the most part, people are able to follow through with those plans.

Q: How is COVID-19 affecting day-to-day living for residents?

A: It’s a balancing act right now, because for many of our residents, a big concern is the ability to socialize, to have visitors and to just live life the way you normally would. This virus has stopped that in a lot of ways. We’ve been learning and adapting and listening to the residents to just see how they want to proceed.

All of our residents go through twice-daily wellness checks — temperature checks and pulse oximeter checks. Also, we have a weekly COVID testing protocol where at least 10% of the campus is tested. And residents at any point in time can get a COVID test and receive those results rather quickly to know whether they are positive. Just like everywhere in the country, we have had some positive cases. All have all been asymptomatic, so just having that peace of mind to know that they can get tested anytime they want to has been very powerful for our residents.

Q: Have you noticed any difference in interest as far as people inquiring about the community, because of the pandemic?

A: We have seen the type of person inquiring shift slightly. In the past, typically, about 60% of our inquiries would come from married couples. Now, we’re seeing more single people starting to inquire. I think that comes from being in quarantine. It’s been very challenging, and that loneliness factor seems stronger. I think people who are in those situations are feeling more likely to want to make a move.

Q: Once they have moved in, are they able to socialize somewhat with other residents?

A: Yes. Fortunately, we were able to set up our communal dining with plenty of social distancing based on the number of residents that we have. We’ve been able to set up our wellness programs and our activities classes, still observing at least six feet of social distancing. And our residents are wearing masks throughout the entire campus. They understand the value of having the mask on when they’re in common areas.

Q: Did any programming or amenities have to be put on hold related to the college because of the pandemic?

A: This summer, we were limited in regard to one of the nicest amenities on Berry’s campus — more than 44 miles of biking and hiking trails — because the campus was closed to the outside world. But now those have reopened partially for The Spires residents, and we’re able to go onto the Berry College campus more freely.

The college’s theater and some of the athletic events are not welcoming fans and spectators right now, but fortunately, the campus has done a really good job of bringing in some virtual events. And in our community, The Spires, itself, we do a lot of virtual events and other entertainment and activities to, we hope, fill that gap until we’re able to get back to all of the campus amenities.

Q: Are Berry College students working on the campus of The Spires?

A: Yes. It’s part of the ethos of Berry College that about 96% of the students work at least 30 hours per week, with the idea that when they graduate, they’re essentially graduating as an entry-level professional. Many of the students work on our concierge staff, where they’re the first greeters of our residents coming into the community. We have students who work in dining and housekeeping. We have marketing interns and finance interns. The students are learning all of the different parts of senior living. That’s the intent of this community, to give the students an incredible learning opportunity, and we hope they can take that and grow into the senior living industry in lots of different ways.

It’s really been fascinating to see the relationships that they’re developing with our residents. The reason residents come here is, they really love the interaction with college students. They feel as if they gain energy from them. There’s tremendous value, all the way around.

A.  Yes, many of those changes are likely to be a permanent part of senior housing in the future. 

Although most of the changes have been accelerated by COVID-19, many of them inevitably were going to be trends of the future. Those changes have affected many areas of senior housing, including:

1. Design issues: Smaller/self-contained neighborhoods, satellite dining/activity areas, enhanced outside areas, limited/restricted points of entry for residents, staff and visitors, isolated visitation areas;
2. Higher cost of operations: Labor costs, personal protective equipment, testing kits, cleaning/disinfecting supplies, insurance;
3. Digital communication: FaceTime, Skype, Zoom meetings, virtual tours/marketing encounters;
4. Marketing: Enhanced websites, virtual tours and marketing encounters;
5. Telehealth: Remote resident monitoring; health-tracking devices; virtual healthcare consultations with residents, family, staff and healthcare professionals.

These are a few of the many trends and changes that now are becoming our “new normal.” These changes are not without challenges in existing communities and will represent opportunities for the new communities of the future. It is becoming clear that these trends will need to be addressed to help older adults and their families feel safe, engaged and secure in senior housing in the future.

Editor’s note: This content appeared in print as the “You’ve Got Questions? We’ve Got Answers” column.

Download Dealmaker’s Handbook 2020

Digital version of Dealmaker’s Handbook 2020

Inside:

• Down but not out: The hard-hit sector is looking beyond COVID-19
• A new frontier: COVID-19 has thoroughly altered the way providers view their mission and methods
• Here’s what I’m telling my members. Comments from NIC, AHCA/NCAL, LeadingAge, Argentum, NADONA, NASL, ASHA, and AAPACN
• Telling the story a little differently: Marketing in a COVID-19 hot spot
• Seeds of change: The pandemic has inspired new ideas about building and running long-term care facilities
• What happened to PDPM? Very little
• Green House: Model for future success?
• The ultimate test: COVID-19 has forced senior living providers to adjust expectations
• Second-quarter reality check

The virus’ unprecedented resident security challenges are now part of the “new normal.”

Despite facilities’ compliance with Centers for Disease Control and Prevention and Centers for Medicare & Medicaid Services screening protocols, infection control worries abound.

In terms of the virus, even visitors are beginning to be viewed as much for what they could take as what they could give.

“Residents are concerned that the likelihood of coming into contact with someone exposed to COVID-19 grows as communities start to open up to more visitation from family and friends,” observes Majd Alwan, Ph.D., senior vice president of technology for LeadingAge and executive director of the LeadingAge Center for Aging Services Technologies.

Deric Blattenberger, director of product management at CenTrak, says the pandemic has complicated facility resident security policies and procedures. Requisite temperature checks and rigid inquisitive vetting only amplify residents’ need for socialization, he adds.

Still, innovation is brisk, Alwan says.

Consider remote monitoring. Examples: hand-washing hygiene monitoring/compliance systems; remote vitals monitors; and tracking systems that follow the movements of positive or suspected residents in isolation and quarantine, minimizing both staff exposure and needless personal protective equipment use.

Not everything is foolproof, however. Alwan cautions about the use of temperature and thermal imaging monitors to detect fevers, a process that molecular testing provides with exponentially more reliable results.

Blattenberger advocates for contact tracing to better react to outbreaks, whereas Alwan sees proliferation of advanced data analytics, point-of-care testing and resident-facing technology support and training.

After years as a nurse call system manufacturer, TekTone acquired majority ownership in Stay Smart Care, a Remote Patient Monitoring, or RPM, solutions company.

TekTone said the move is consistent with its mission to continuously provide communication solutions. Stay Smart Care will operate as a subsidiary of TekTone, allowing the two companies to provide a wider variety of intercommunication solutions and resources to care providers in a variety of markets.

CarePredict to publish research on wearable device outcomes, contact tracing

The company’s research on real-time digital contact tracing and development of a system to control COVID-19 outbreaks in nursing homes and other long-term care facilities is scheduled for publication in JMIR Public Health and Surveillance. Authors will show how digital contact tracing systems show promise as effective tools to control COVID-19 outbreaks in long-term care facilities.

Meanwhile, “AI-Powered Digital Health Platform and Wearable Devices Improve Outcomes for Older Adults in Assisted Living Communities: Pilot Study” will show how such a platform can identify seniors at increased probability for a health decline and provide community staff with actionable information regarding each resident’s activities and behavior. This research will be published in the journal JMIR Aging.

Kisco adds temp monitoring sign-in kiosks in all facilities

Kisco Senior Living, a Carlsbad, CA-based owner and operator of full-service senior living communities, said it will incorporate Accushield’s visitor management system in all 20 of its senior living communities across the country. 

In addition to visitor screening and credentialing, Accushield’s sign-in kiosks soon will include touchless integrated temperature readings and COVID-19 screening questions. Kisco said the system will be used for everyone who visits and works in the facilities.

Increasingly, senior living operators are recognizing rehab’s potential for meeting the needs and desires of residents while also making it an important source of income.

David Tate, chief strategy officer for Reliant Rehab, says rehab is indeed becoming more associated with senior living.

“It is common for senior living operators to promote the availability of onsite therapy services,” he says. “Whether in a small skilled nursing unit, memory care unit or in a dedicated outpatient therapy gym, therapy services are increasingly available to senior living residents. For senior living communities without dedicated therapy space, an approved therapy facility may offer ‘off-premises’ services in a patient’s room. Home health is another provider commonly offering therapy services to residents of senior living communities.”

Although short-term rehab infrastructure may not yet be universal in senior living, Tate says it is more commonplace to see senior living communities with dedicated therapy gyms that occupy prominent locations and can be accessed by residents and potential residents.

“Short-term rehabilitation provides senior living residents an opportunity to receive therapy services in an ideal environment for restoring optimal functional abilities,” Tate says. “While the convenience of onsite outpatient therapy is a definite plus, the more important advantage is receiving functional rehabilitation services in the actual home environment.”

The clinical dynamic

Rockland Berg, architect and principal with the Dallas-based architectural firm three, has witnessed the acuity shift and rehab migration trend over the course of decades. 

“Today, we’re seeing operators getting more creative with licensing regulators, so that they can provide better care in less restrictive environments,” he says. “I think certain states are no longer requiring skilled nursing as part of the continuum, such as Arizona, I believe, and that will continue to change the dynamic.”

Nevertheless, senior living is a different care setting and faces an alternate process of adopting rehab.

High-intensity interval training couldn’t outperform standard exercise training beyond a few for cardiac rehabilitation, Australian researchers have found.

EMR provider Casamba recently announced an exclusive partnership with Accelerated Care Plus, a provider of specialized rehab technologies for senior living and post-acute care providers. Casamba customers now will be able to interface ACP’s rehabilitation technologies with Casamba Skilled, according to the firm.

University of British Columbia researchers in Canada have shown that telehealth works for patients recovering from a stroke. It can be especially helpful for post-acute patients at home, they found.  Among the lessons they gleaned are that the cost and efficacy of tele-rehab is similar to traditional face-to-face programs. Also, patients were most satisfied with tele-rehab when the therapists were well-trained and engaged in social interaction. Clinicians, however, preferred face-to-face rehab but used tele-rehab when necessary.

For patients with chronic kidney disease, the benefits of cardiac rehabilitation are greatest for those whose renal function had most deteriorated when therapy began. That’s according to recent research presented at the European Society of Cardiology 2020 Congress. The findings could help health systems stratify which patients should be referred for cardiac rehabilitation, investigators said. Cardiac rehab can include dietary changes and increased exercise as well as education. 

As the nation turned its attention toward facilities at the beginning of the global pandemic, the American Health Care Association/National Center for Assisted Living warned laundries to up their cleaning and disinfection practices. AHCA/NCAL urged departments to use products with EPA-approved emerging viral pathogens claims as one of the best defenses against COVID-19.

“We always recommend laundry managers work closely with their chemical company to meet current recommendations,” says Randy Radtke, a spokesperson for Ripon, WI-based Alliance Laundry Systems. “Heat, obviously, remains a key factor in assisting with disinfection of loads.”

Quentiel Jamerson, senior product consultant, environmental, Direct Supply, believes COVID-19 generally has hit smaller facilities particularly hard.

“The most common variable has been process,” he adds. “Buildings that did not have a defined process have essentially had to start from scratch.” 

Another critical impediment, he says, is a lack of adequate space.

“Some [facilities] have the luxury of dedicating an entire wing or area of the building to residents who tested positive for COVID-19,” Jamerson says. “Some facilities even have dedicated kitchens, laundry areas, rehab and social spaces, and can be fully functional without accessing other parts of the building. This has not been the reality for most buildings.”

Smaller washers and dryers also may pose a problem because they can’t reach the water temperature required for hygienically clean standards or Centers for Disease Control and Prevention recommendations, said David Potack, president of Unitex.

Radtke believes challenges are only going to mount.

“As we move forward in a post-COVID-19 world, it’s not going to be enough to just launder linens according to prescribed guidelines,” he says. Greater documentation demands will be common, he believes.

AmeriPride Services’ Watkinsville, GA, Springfield, MO, and Minneapolis locations each have earned a Hygienically Clean Healthcare certification.

The certification emphasizes infection prevention, compliance with recognized industry standards, and processing healthcare textiles according to quality assurance standards. To maintain their certification, a laundry must pass quarterly testing to ensure that as laundry conditions change, such as water quality, textile fabric composition and wash chemistry, laundered product quality is consistently maintained. Re-inspection occurs every two to three years. 

AmeriPride now has 13 Hygienically Clean Healthcare certified facilities throughout the United States.

Alliance Laundry Systems displays its advanced washers 

Alliance Laundry Systems recently unveiled a new generation of washers featuring touchscreen controls and full connectivity options for select Primus and IPSO models, the company recently announced on its website. 

The touchscreen control platform offers versatility for vended laundry customers but also helps reduce touchpoints. Touchscreen interfaces on XControl FLEX (Primus) and Evolis (IPSO) models enable customers to tailor cycles with features such as extra washes, rinses and special cycles such as sanitization. The result is customers gain greater control of their level of cleanliness — vital during the pandemic — through onscreen prompts and options, and store owners increase profitability with upsell high value-added options.

In addition, connectivity through laundry management systems i-Trace (Primus) and IPSO Connect gives laundromat owners even greater control to run their business at the lowest possible cost of ownership. In-house laundry managers in a variety of facilities will appreciate the touchscreen as well. Thirty-four language options and real-word descriptions of cycles ensure staff members can effectively operate the machines to obtain quality results.