Although the original COVID-19 drama appears to have waned, infectious disease and medication management experts were guarded heading into this fall’s flu season.

“Something new this year is that two new vaccines were recently approved by the FDA to protect against pneumonia due to respiratory syncytial virus in adults age 60 and over,” said Erica Johnson, chair of the Infectious Disease Board of the American Board of Internal Medicine. 

“While there has been a fair amount of media attention surrounding the new vaccine [for seniors], it may prove to be a bit more challenging to incorporate into the core group of routine vaccines we are accustomed to,” warns Erin Marriott, RPh, director of clinical and regulatory support at Guardian Pharmacy Services.

Erin Donatelli, PharmD, vice president of clinical and consulting services for Remedi SeniorCare, stresses that treatment options and outbreak procedures for COVID-19 and the flu should follow a tight timeline after symptoms or a positive test.

Pharmacists and others expressed confidence in the preparation and efficacy of new COVID boosters and vaccines. Still, work remains to be done.

“As a country, we are still dealing with misinformation, mandates and some poor communications from government leaders,” says Chad Worz, PharmD, chief executive of the American Society of Consultant Pharmacists. “It will take a huge effort by doctors, nurses and pharmacists to rebuild confidence in vaccines.”

Meanwhile, experts are mixed about a repeat of drug shortages. Andrew Agan, a spokesperson for Guardian Pharmacy Services, said that drug shortages remain a major issue. “From atropine to lidocaine, there’s a large list of drugs currently in shortage,” he says.

As for parting advice, experts have plenty.

“Get ahead of potential outbreaks,” Worz says. Residents should be vaccinated and evaluated in anticipation of needed antiviral treatments that could involve possible interactions with other medications, he adds.

And finally, “work collaboratively with your pharmacy partner on securing access to any of the needed vaccines,” Marriott says. 

Millions of adults in the United States are not taking their medications as prescribed because of the costs, according to a new report from the Centers for Disease Control and Prevention.

Most adults aged 18 to 64 took at least one prescription medication in 2021, noted a recent CNN report. But more than 8% of them — about 9.2 million people — said that they tried to save money by skipping doses, taking less than prescribed or delaying a prescription fill, according to the CDC data.

Although average drug costs did not increase in 2021, the number of prescriptions did, and that increased spending, CNN reported.

Many adults aged more than 65 years who have chronic conditions, however, may be taking too many medications and could benefit from a medication review with their primary care physician. Patients also may assume that their health providers check for drug interactions or assess whether a medication no longer is needed, even if that is not actually happening, according to a recent report from WebMD.

If given the option, up to 80% of older adults aged 50 to 80 would be open to stopping one or more of their prescribed medications, according to a 2023 poll by researchers at the University of Michigan. 

» Older Americans have access to more vaccines than ever, but increasing numbers cause concern for some individuals

From pneumonia and shingles to COVID boosters to the new respiratory syncytial virus vaccines and a broader range of flu shots for seniors, older Americans are facing an ever-growing array of vaccines to be mindful about every autumn, as one USA Today article posits.

And although most older adults understand and agree with the importance of prevention, the sheer numbers of shots are giving some of them pause.  “They are tired of getting shots, and their hesitation often comes from confusion about what they need and when,” one expert told the national newspaper. “Educating them about their risks and administering several shots at the same time can help,” she said.

“We have the opportunity as we never have before to prevent much more disease,” said an infectious disease specialist at Vanderbilt University School of Medicine.

Artificial intelligence is everywhere.

AI promises to create untold efficiencies and, in turn, solutions to so many thorny issues of workforce, care and operations. 

Still, caution with this emerging tool is advised, experts say.

“AI is not new,” says Majd Alwan, PhD, chief strategy and growth officer for ThriveWell Tech. “Alan Turing, a computer scientist who is considered the ‘godfather’ of AI, devised what is known as the Turing Test in 1950, which asks, ‘Can a computer convince a human they’re communicating with another human?’”

Recent examples of innovation at work:

• Certainty-based location visibility, which Deric Blattenberger, general manager of senior care for CenTrak, describes as “enterprise visibility with location certainty,” supported by real-time location systems through wearable pendants.

• CarePredict has developed a continuous activity and behavior observation platform that uses AI to learn correlations between particular changes in activity and behaviors and labeled health events, says Satish Movva, the company’s CEO and founder.

Alwan asserts that the “deep learning” promises of AI in senior living and other long-term care settings seem endless — everything from falls detection and medication management to early detection of pressure ulcers.

“AI can play a significant role in early identification of risk,” notes TK King, vice president of healthcare strategy for Accushield. “Its ability to scan data, search for keywords and evaluate trends means it can pinpoint staffing needs and resident risks.”

Still, healthcare experts agree, many issues surrounding risk need to be tested.

Movva urges early adopters to be mindful of privacy and security concerns. And Blattenberger warns of a risky upcoming phase that introduces virtual caregivers and “approximate” outcomes.

Alwan describes current efforts as a significantly acceleration and competitive “race” and warns adopters to protect data from corruption or premature release.

He’s also adamant about ensuring that humans remain in charge of testing and evaluation.

Researchers have demonstrated the ability to use artificial intelligence as a tool for detecting diabetes early in older adults.

The new artificial intelligence model finds that X-ray images collected during routine medical care can provide warning signs for diabetes, even in people who don’t meet the guidelines for elevated risk, as reported recently by Emory University.

In some cases, the chest X-ray warned of high diabetes risk as early as three years before the patient eventually received a diagnosis. The model’s output also provides a numerical risk score that potentially could help clinicians customize the treatment approach for patients.

The multi-institutional team reported that the model could help physicians detect the disease earlier and prevent complications. The findings were published in Nature Communications.

» Robots, virtual reality increasingly enhance senior living experiences

Robots are in force at many senior living communities across the country, providing everything from meals to locating help.

Some American Senior Communities properties in Indiana have added a robot named “Robbie” to help provide limited services.

Robbie delivers and serves food, allowing members of the dining staff to give more attention to residents. The robot features trays, safety sensors and music, and it has been assigned the task of transporting food between the kitchen and dining rooms alongside culinary staff members.

“Our goal in using robots is to allow our dining staff to spend more time in the dining room with residents, ensuring that their needs are met,” said Karen Powell, vice president of nutrition and culinary services at American Senior Communities.

At The Falls at Cordingly Dam, a Benchmark Senior Living assisterd living and memory care community in Newton, MA, it is virtual reality experiences from Rendever that are enhancing daily life. The platform includes videos and 360-degree images that let viewers explore places from their past or sites they have never seen. 

This embrace of some types of technology, however, comes with express hesitancy about other forms of technology, including the use of artificial intelligence in primary care and various types of therapy.

Real estate investment trusts with portfolios heavy in senior living and care assets are being called the “unsung heroes” among investors by the author of one online post.

As the baby boom generation continues to age, “the proportion of older adults in the US population is projected to increase, leading to a higher number of seniors in need of healthcare services, assisted living and retirement communities, and other age-related solutions,” wrote Kate Stalter, a Series 65-licensed asset manager, in a late September “MarketBeat” article. That, combined with their income potential, means such REITs could be lucrative investments for the long haul, she said.

The article described Irvine, CA-based Sabra Health Care REIT; Hunt Valley, MD-based Omega Healthcare Investors; and Westlake Village, CA-based LTC Properties as high-yield investments, with yields of 8.74%, 8.14% and 7.42%, respectively.

“REITs have built-in tax benefits, as they are required to distribute at least 90% of their taxable income to shareholders,” Stalter added. “That means REIT investors receive a consistent stream of dividends derived from rental income or property sales.”

» Aging boomers pressure key systems

The US population is rapidly aging, presenting profound implications for economic development, national security, Social Security, Medicare and Medicaid, a recent Census report found.

According to the US Census Bureau, the median age in the United States hit a record 38.9 in 2022. That number is going up rapidly. In 2000, the median age was 35; in 1980, it was 30.

» Think tank argues case for AI for seniors

In a new Brookings Institution study, researchers said that addressing the older adult population’s financial challenges requires exploring innovative strategies and tapping technology to fundamentally transform healthcare delivery. One crucial application of artificial intelligence, the study noted, is its ability help manage the overall well-being of older adults. For example, AI can assist with routine financial tasks such as automatic bill payments, expense management and personalized recommendations, which might greatly benefit older adults.

Staffing shortages that have decimated long-term caregiving also have hit laundry departments especially hard.

“There used to be dedicated staff for each unique job around a community,” observed Quentiel Jamerson, senior product consultant for Direct Supply. “Nursing cared for the residents, maintenance staff fixed building issues and housekeeping kept everything clean. Today, a [certified nursing assistant] may now have additional chores around housekeeping and preparing meals.”

Managers must be more “strategic,” and thoughtful of “a universal care worker mentality that has now unofficially become somewhat of a norm,” Jamerson added.

In a December survey of linen, uniform and facility service companies, TRSA concluded a universal truth: Paying higher wages is necessary to maintain service, said Ken Koepper, the organization’s director of member and industry relations.

A focus on processes they can control “is the single most effective way for operators to create efficiencies,” Jamerson added. “Having every step of the process defined, scheduled and assigned minimizes confusion and saves time,” he added, noting that operators with strong process controls had fewer pandemic service interruptions.

One key is better training, said David Groth, industrial laundry specialist for
Spartan Chemical. He also emphasized the value of standardizing processes such as loading and underloading.

Monitoring production productivity is another, Koepper added.

“Setting simple staff rules for process operations helps to increase efficiency, while educating on how to best prevent cross-contamination when processing both clean and dirty textiles,” said Paulo Rocha, sales manager for Miele. “When employees feel safe and use equipment that is simple to operate, operators realize their best chances of keeping [full-time equivalents].”

One way to avoid common mistakes is to incorporate more intuitive controls, said Randy Radtke, content and media relations manager at Alliance Laundry Systems. “It’s one of the best ways to deliver quality results and meet daily throughput requirements by leveraging intuitive controls.” 

A Textile Rental Service Association white paper for long-term care readers cites increasing political scrutiny of the Medicare and Medicaid systems as one reason to outsource laundry. TRSA said that programmatic cuts, added workplace safety challenges, and wage and regulation uncertainty all add pressure on laundry operations. In recent years, long-term care injury and illness rates did not fall faster than the rate for all industries. The sector has a total incident rate at twice the level of all businesses, and days away from work, reassignment or transfer in the 2.5x range. Accordingly, TRSA warned that long-term care managers will have to devote substantial resources to injury prevention if they keep laundry in-house. 

» York Capital-backed Healthcare Linen Services Group acquires Linen King

Healthcare Linen Services Group, a portfolio company of York Capital Management’s private equity group and a provider of healthcare laundry services in the Midwest and Central United States, announced that it has acquired Linen King, the largest independent provider of healthcare laundry services in the South Central part of the US. HLSG said that the acquisition expands the company’s operations into “attractive” markets and adds new major customers.

Following this transaction, HLSG will operate 21 linen processing plants across six premier regional brands  — Logan’s Linens, Logan’s Uniform Rental, Superior Health Linens, Textile Care Services, Reino, and now Linen King — that process approximately 350 million pounds of healthcare linen on an annual basis for almost 1,000 customers in 19 states.

» Alliance Laundry Systems closes on purchase of Laundry Equipment Services

Alliance Laundry Systems, a leader in commercial laundry equipment, has expanded on an already strong direct distribution base with the acquisition of Laundry Equipment Services. Alliance closed on the purchase at the end of 2022.

The acquisition is Alliance’s latest move in a strategy to bring what it called “extraordinary service and factory support to expanding markets where there is an opportunity to partner with exceptional people.” This is Alliance’s fifth distributor asset acquisition in the past two years.

For much of 2022, lockdowns and other restrictions tamped down the usual resident security concerns in the nation’s long-term care settings.

Still, workforce shortages meant fewer vigilant eyes and ears to ensure resident safety, meaning that thinned staffs had to be even more vigilant than usual. Among the risks: upticks in instances of workplace violence and ransomware attacks, as well as ongoing fall risks from a notable increase in the use of antipsychotics.

Although the situation in senior living differs from that in skilled nursing, looking to the nursing home experience can be informative for senior living providers. In a mid-summer report, STAT News asserted that gains in long-term care resident safety have stalled over the past decade, noting that a federal study released earlier this year found “rates of patient harm remain disturbingly high.”

In late August, the Centers for Medicare & Medicaid Services warned nursing homes to prepare for the end of the public health emergency. Although the agency reminded that the end date was a moving target, it promised a “more resilient healthcare system that can better adapt to disasters and emergencies.” Meanwhile, CMS has more than hinted at plans to put emergency planning front and center in its ongoing reform agenda. For those interested in how it could affect resident security, changes cannot come soon enough, especially in the wake of lockdowns and worker shortage turmoil.

“We have sophisticated, automated inventory systems to keep track of our equipment and supplies. Why don’t we have similar systems to keep track of our precious residents and staff members?” said Stan Szpytek, president of the national consulting firm, Fire and Life Safety Inc. 

Szpytek said he is seeing a significant increase in the number and severity of E-tag violations and weaknesses in life safety and emergency readiness. He is warning providers to begin preparing, and a good place to start is with the lessons from the pandemic.

“COVID-19 taught us that the management of emergent or emergency situations can produce a long list of consequences that may not be immediately apparent until they are actually experienced,” he said. “The reality of a public health emergency like COVID-19 should have taught healthcare providers that emergencies and disasters come in all shapes and sizes.” 

Attorneys representing residents and employees of Avamere Holdings have filed a class action suit accusing the long-term care provider of failing to protect its residents and staff from a massive cyberattack. The lawsuit stems from a data breach believed to have affected more than 380,000 people across the company’s 96 healthcare sites.

An unauthorized individual gained access to a third-party-hosted network between Jan. 19 and March 17, 2022, according to the HIPAA Journal.

An August court filing faults “Avamere’s failure to protect its computer systems from unauthorized access by cybercriminals,” despite numerous industry warnings and earlier breaches. It also alleges Avamere waited more than two months to notify people of the breach, which included theft of names, birth dates, addresses, Social Security numbers, lab results and information about conditions and medications, according to the company.

A representative for the Oregon-based provider said it simply was being careful when it notified potentially affected individuals. 

“Out of an abundance of caution, Avamere Health Services recently notified certain individuals whose information was included in a security incident involving unauthorized access to a third-party hosted network utilized by Avamere,” said Kevin Hill, general counsel for Avamere. “We remain committed to protecting the privacy and security of personal information.”

» Culture change efforts survive if established before COVID: survey

A survey of long-term care administrators has concluded that facilities that had well-established “culture change” efforts in place before 2020 more successfully weathered the effects from the pandemic.

The survey found that about 60% of facilities operating under the principles of culture change before the pandemic have maintained or expanded their efforts to focus on resident quality of life and person-centered care. The survey, conducted by the nonprofit entity Altarum, recently was featured in a special report, “The Sustainability of Person-Centered Care During a Pandemic.”

It included 62 facilities in 30 states, including facilities affiliated with the Green House Project, the Pioneer Network, the Eden Alternative and the Live Oak Project. 

Demand for clinical care efficiencies and effectiveness will propel significant product innovation over the next five to 10 years, driven largely by the unavoidable collision of staffing challenges and the tidal wave of aging baby boomers.

That’s according to long-term care tech experts including Daniel Zhu, vice president of product management of data, analytics and AI/ML at MatrixCare.

“This is going to push for the adoption and regulation of machine-assisted clinical decision-making, robotic surveillance and monitoring, as well as intelligence-informed optimization of processes,” he said. “Imagine a voice-activated assistant (such as Alexa and Siri) at the bedside of every patient, helping to automatically chart and record patient vitals, quickly and accurately answer questions regarding patient medications, clinical history, and more.”

Travis Palmquist, senior vice president and general manager of senior care at PointClickCare, envisions a more prominent role for technologists soon.

“When we look at the next generation of products and applications, there’s an opportunity for technologists to take a more active role in keeping people healthier, stronger and safer (for longer),” he said. “All of these tech trailblazers play an important role in providing preventative care and wellness solutions to an aging population.”

Palmquist calls attention to his company’s collaboration with DBSync, a leading SaaS integration platform that recently expanded its data integration suite into the healthcare market by launching Microsoft Dynamics 365 Cloud Workflow for Senior Living within the PointClickCare marketplace. Providers, he said, “now have a 360-degree perspective of their residents across their cloud and on-site applications, which simplifies the admission process and resident move-in.”

Of course, no gaze into the crystal ball is complete without artificial intelligence.

“From utilizing computer vision technology … to measure, monitor, and assess wounds using a simple mobile phone camera [and] to voice-to-text dictation functionalities to help with various charting needs, AI has already influenced the future and success of the market,” Zhu said.