Q: What was the timeline related to the community?

A: We had started discussions in January. A private equity firm acquired the community. We entered into a consulting agreement in March to help them through some of the transition, and then we took management and operations over on May 1. All the work that goes into the transition occurred in the worst time, which was April. So we had to really pivot in the way we normally transition a community.

Q: What were the big differences between what you normally would do versus how you did it this time?

A: We like to go into the community prior to the official acquisition and meet with the staff, residents and families to talk about our culture. There’s a lot of fear when you’re in that transition period, so that’s important to help mitigate that fear.

We had to do virtual meetings. We all love Zoom, but it’s not the same as standing eye-to-eye with an employee or having a cup of coffee with an employee to say, “It’s going to be OK.” That was one of the toughest things.

Q: Did you need to implement new COVID-related procedures that weren’t in place already?

A: Yes, several. We mandated that oxygen levels and temperatures be monitored twice daily for all residents. We enhanced employee monitoring as well. We have a full COVID infection control manual and binder — all the policies, any tools, any trainings that we have put together over the past several months, and it is updated as policies change. So we shared that.

We also implemented what we’re calling “transitional” suites or wings for any new residents or residents returning from rehab or a hospital stay. They are as far away from other residents as possible, sometimes separated by a plastic curtain. We call them transitional suites because no one wants to move Mom into a COVID wing or an isolation wing.

We also implemented a better relationship with the local health department to continue to secure PPE. In early April, we secured a partnership with a lab, and all of our communities have access to tests. So we got the new community tests.

Q: How has interest been?

A: April was a really tough month. It started picking up again in May, and we’re really seeing leads come in now. Prospects are calling. Families are calling. They’re either going back to work or they can’t continue to care for someone. We do virtual tours and try to connect with them as best we can during the transition of moving someone in during this time. It’s a little bit more hand-holding.

Q: If Charter were to do it all over again, do you think the company would change anything about its approach to assuming management of a new community during a pandemic or a similar circumstance?

A: Yes, we probably would do it again. Everything depends on the cooperation of the current owner of the community. Some transitions are friendlier than others. We probably would attempt to get more PPE in earlier, knowing that we don’t want to walk into a building and all of a sudden have exposure because they didn’t have the supplies. The other thing is, we would have tried to see if we could implement some of our infection-control-related policies and procedures sooner.

Q: How do you think the pandemic might change the way Charter operates overall?

A: It already has changed us. We have several developments in the pipeline. From a design standpoint, two areas we’re focused on are dining and activities. You have to re-look at your dining program and the furniture you purchase, because you’re trying to maintain social distance. In common areas and activity areas, you can’t have the typical seating area where 20 residents can gather. It affects programming, too.

We’ve already enhanced our normal infection control policies, and like preparing for a hurricane, we have to say, “We need X amount of PPE.” We’ve always had to deal with viruses, whether it was the flu or norovirus, but this just put a hyper focus on it.

Q: Charter has 18 communities in nine states. Has it been a challenge because of differing policies and opening and closing dates related to the coronavirus?

A: It’s been extremely challenging. You could have two different health departments that you’re dealing with in one state, because your communities are in different counties, and you’re also dealing with state licensing. And sometimes they have conflicting directions. Whichever the most stringent state is, we’ve been trying to use that guidance as a baseline so we’re prepared.

Senior living is a relatively small sector, even though it seems big, so there has been a lot of information and protocol-sharing among operators. That has been really helpful, because it’s an unknown for everybody. There were no egos. Argentum, the American Seniors Housing Association and even all of the real estate investment trusts have been behind it. Everyone really came together.

A: Yes, but things will be different, and the overall timing is still unknown. 

Residential senior housing has been unfairly tarnished in the lay press, as it has been combined with skilled nursing facilities, which have experienced most of the deaths due to COVID-19. A stigma has developed regarding communal living in general — much of the public does not understand the difference. There will need to be more effective, objective communication of the different senior housing and care arrangements, and the good stories need to be told.

The industry response to COVID-19 will have an effect on all aspects of senior housing —residents, families, staff, operations, marketing and overall financial stability. Occupancies are dropping due to moratoriums on new resident move-ins. Operating with social distancing requirements and stricter safety protocols is increasing the cost of operations. One piece of good news is, unlike many other real estate sectors, senior housing operators are collecting rents.

The bottom line is, it appears to be the consensus of operators, investors, lenders and other professionals that the industry will be going through a challenging period that could last up to two years — and maybe longer. The near-term outlook may be troubling but, properly designed, positioned and communicated, senior housing ultimately will emerge as a safe and secure living arrangement — especially during a pandemic like COVID-19.

According to the Wound Ostomy and Continence Nurses Society, approximately 80% of individuals affected by urinary incontinence can be cured or improved. Yet in their zeal to manage incontinence, many providers unwittingly trade one potential problem for another by relying on medications that pose cognitive risk or poorly made briefs that could contribute to bedsores.

Through relatively simple measures such as thorough initial assessments and other documentation, old-fashioned vigilance, and even alternative therapies, incontinence and its attendant risks can be mitigated. Also at the top of that list: Adopting a person-centered approach to toileting that places the resident’s needs above staff convenience.

Ensuring quality sleep and providing proven alternative therapies can go far in managing incontinence. But to administrators such as Gary Minassian, administrator/owner of  Crestwood Nursing & Rehabilitation Center in Warren, RI, there’s no substitute for an effective bond between caregiver and resident.

Several years ago, Crestwood adopted a new approach to incontinence care that began with thorough assessments upon admission.

Knowing that cognitively impaired yet highly independent and mobile residents with incontinence are among the highest risk for falls, Minassian understood the importance of constant vigilance and observation. That led to the establishment of a program that included certified nursing assistants documenting in a diary their observations of resident behaviors, including eating habits, body language during exercises, changes in gait and mood, and the times when toileting occurs.

The need for frequent toileting and/or urgency to void in the elderly increases the risk of falls by 26% and bone fractures by 34%, according to WOCN. The group also notes that 53% of homebound older persons have overactive bladder/urge incontinence.

BRIEFS — FOCUS ON: INCONTINENCE

• Skin discolorations may mimic pressure wounds

Skin manifestations of COVID-19 may appear similar to pressure injuries, a factor that should be noted during diagnosis and when filing federal reports, cautions the National Pressure Injury Advisory Panel. COVID-19 infections can lead to blood coagulation problems, resulting in skin changes that appear purpuric (discolored) and quickly cause tissue death, the panel explained in a position statement. “[COVID-19 skin injuries] mimic the appearance of deep tissue pressure injury, especially when they occur over tissue exposed to pressure and/or shear stress (for instance, sacrum, buttocks, heels) or under medical devices,” the panel reports. “If the [blood] vessels are significantly or fully occluded, then adequate reperfusion is not achievable even in the presence of reasonable repositioning and turning of the patient and the use of appropriate support surfaces.” 

• MBET’s Miracle Dressing available

MBET Health has launched its new Miracle Dressing Wound Care System, billing it as a proactive solution for an impending surge of pressure injuries related to COVID-19 mitigation. Miracle Dressing is a patented, Class 1 medical device used along with an agglutinant with marine extracts to prevent pressure sore development and promote healing of Stage 1 and Stage 2 wounds. It can be left on up to 21 days and comes in strips for the sacral area or for heels, elbows and buttocks. “MDS is the easiest way to not only prevent pressure injuries in all facilities across the healthcare spectrum, but to enable staff efficiencies and pain reduction with the first and only 21-day stay-in-place dressing,” said Eric Lewis, M.D., a dermatologist, surgeon and founder of MBET. “We are thrilled to offer a product which has already been shown —  in private practice and various healthcare facilities — to help prevent pressure injuries, while promoting skin rejuvenation.”

Presbyterian Homes & Services  and Senior Housing Partners recently participated in a  virtual groundbreaking and naming event in St. Paul, MN. Highland Bridge is the new name of the full 122-acre development situated along the Mississippi River in the Highland Park neighborhood. The location is on the site of the former Ford Motor Co. automobile plant, which operated from 1925 to 2011. 

• Clearwater at Sonoma Hills opens

Clearwater Living announced the opening of Clearwater at Sonoma Hills, a brand-new luxury assisted living and memory support community in Rohnert Park, CA. The senior living community is situated in the Cotati neighborhood, near Sonoma State University, with easy access to many restaurants and diverse entertainment venues.

• School conversion underway

Pennrose has begun converting a school building in Auburn, MA. When completed in 2021, the site will be a 55-unit senior community, including some affordable housing. The undertaking includes the historic building renovation, the demolition of later built wings and construction of a new addition. 

• Oaks at Algonquin construction begins

McShane Construction Co. is underway on the construction of a new senior living development known as The Oaks at Algonquin. The firm was selected by Spectrum Retirement Communities to provide comprehensive construction services for the 166-unit residence. Designed by Vessel Architecture, the H-shaped building will accommodate independent living, assisted living and memory care units. Each independent living unit will feature a full kitchen, and assisted living units will incorporate a kitchenette with a refrigerator and microwave.

• Ryan Companies opens campus

Ryan Companies announced the opening of Silvergate Rancho Bernardo, a 90% preleased, 11-acre resort-style campus in San Diego.