Lois Bowers headshot

A year ago at this time, I was in San Diego in advance of the National Investment Center for Seniors Housing & Care Spring Conference, enjoying the sun and one of my favorite cities for a few days before the meeting began.

I had flown into California on Saturday and the next day learned that the first case of COVID-19 had been reported in long-term care. It was time to pull out the computer and update the blog I was going to post on Monday.

In March 2020, it was still an unusual sight to see bottles of hand sanitizer sitting atop the check-in desks at the Marriott Marquis San Diego Marina. A few days later, when the NIC meeting started, attendees approached each other unsure whether to shake hands or bump elbows. At lunch, nobody touched the basket of rolls in the center of the table.

Worldwide, fewer than 90,000 people had been reported sickened by the virus, and fewer than 3,000 deaths were known. All of us still were unsure what the coronavirus would mean for the industry, for the country or for us personally.

A year later, however, effects are clear, even if we still don’t know all of the answers.

Less than 1% of the U.S. population lives in long-term care settings such as assisted living communities and nursing homes, and yet as of Feb. 25, 35% of COVID deaths are tied to long-term care residents, according to the Long-Term Care COVID Tracker. More than 1.3 million cases and almost 173,000 deaths of long-term care residents have been reported, affecting almost 33,000 facilities, according to the tool. (A different study previously estimated that 30% of long-term care deaths have occurred in assisted living, although the total numbers of cases and deaths can be difficult to calculate because the industry primarily is regulated at the state level.) Thousands of staff members have been affected as well.

Overall, as of Sunday, there have been 28.6 million cases of COVID in the United States, and more than 513,000 deaths, according to Johns Hopkins University.

A year ago, we hadn’t experienced 12 months of lockdowns, social distancing and mask-wearing. We didn’t have stories of fights for funding, personal protective equipment and testing. We didn’t know that senior living would reach an all-time low occupancy in the fourth quarter, with more than half of operators questioning whether they would be able to stay in business for another year.

But the industry was preparing for whatever might arrive. The American Seniors Housing Association, LeadingAge and AMDA–The Society for Post-Acute and Long-Term Care Medicine already had issued materials, as had the Centers for Disease Control and Prevention.

Kevin O'Neil, M.D.
Kevin O’Neil, M.D.

At the time, for the aforementioned blog, I spoke with Kevin O’Neil, M.D., chief medical officer for Affinity Living Group (now ALG Senior, the name I’ll use for the rest of this blog), for a glimpse into how one operator was preparing to confront the coronavirus. Among steps taken or planned by the company at that point: practicing infection control; forming a committee with representatives from all areas of the company; getting buy-in from organizational leaders; consulting resources from reliable sources such as the CDC; communicating with staff members, residents and their families; screening new admissions and residents returning from the hospital or another care setting; and keeping in touch with public health officials.

With much of the pandemic in the rear view mirror now, Dr. O’Neil on a recent phone call said that all of that preparation proved crucial when COVID inevitably hit ALG, as it did practically every senior living operator. Plans evolved with the pandemic. The mental health needs of residents and staff members, and the provision of telehealth and telebehavioral health for residents, for instance, have been areas of focus that perhaps weren’t initially anticipated.

One big lesson for the industry, Dr. O’Neil told me, is that “all of us in the business of geriatric care, senior living, need to work together.” And that has been the case, he added, heaping praise on industry organizations, medical professionals and public health officials. “None of us are hoarding this information, thankfully. We’re sharing with others,” he said.

Vaccination a focus now

As I wrapped up my blog for March 2, 2020, I noted that the National Institutes of Health had announced the preceding week that a COVID-19 vaccine was in the works, “although it probably won’t be available for a year or so.” Fortunately, successful development happened more quickly than predicted, with the first vaccinations in the United States against SARS-CoV-2 taking place in December.

At ALG Senior, approximately 85% of residents now have received at least one dose of the vaccine, and more than 70% have received both doses. Many of those who have not received the vaccine either were away from a community (and therefore will receive the vaccine elsewhere) or have a medical contraindication, according to the company.

As other providers have found, however, the vaccination rate is lower among employees — 62% of eligible ALG employees have received at least one dose of the vaccine — in part due to myths and misperceptions about the vaccine, including those related to the speed with which it became available. ALG, Dr. O’Neil said, needed to counter myths and the inaccurate information that corners were cut to develop the vaccines in use in the United States right now.

“The technology that contributed to the development of these vaccines has been in place for years,” he said, noting that mRNA technology is used to fight cancer.

But among its Black and Hispanic workers, Dr. O’Neil said, ALG also needed to overcome mistrust of the vaccine sown by unethical medical studies conducted in the nation’s past. “Obviously, the ethics of this [COVID-19 vaccine process] have been exemplary, but we had to overcome a lot of that vaccine hesitancy,” he said.

Toward that end, Dr. O’Neil said he participates in a weekly video posted on a private Facebook page for employees, and the company also holds town hall-style meetings. ALG’s marketing team also distributes educational materials.

As a result of those efforts, he said, new vaccinations at clinics are increasing. Hesitant employees also have observed that vaccinated colleagues and residents received doses without issue and have heard media reports that the vaccine supply has been limited in the greater community, creating a sense of urgency.

At ALG’s first clinic, approximately 30% of staff members received the vaccine. “The second clinic, we went well over 50%,” Dr. O’Neil said, adding that the company’s chief information officer believes the vaccination rate among employees could reach 70% soon.

“The other thing I think is critically important is us being good examples,” he said. “We had pictures taken of our CEO, Charlie Trefzger, getting his vaccination. I got mine. Our whole executive team.”

Leaders also were candid about the possibility of side effects, Dr. O’Neil said. “And we stopped using the term side effects,” he said, adding that he prefers the words “anticipated immune responses” because those effects are “a sign your immune system is working.”

ALG has had a mandatory flu vaccination policy since 2019 and has implemented a mandatory COVID vaccination policy for newly hired employees and new residents. Dr. O’Neil predicts that existing employees and residents also will see a vaccination mandate at some point in the future, when the company believes they are more comfortable with the prospect.

“I can’t give you a particular date, but it’s not going to be a year from now,” he said.

And with the number of senior living residents and staff members across the country who are vaccinated increasing every day, Dr. O’Neil said he is hopeful that things in the industry may start to return to some kind of normalcy in the fall. Already, some senior living communities are loosening some restrictions.

But it’s not time to relax quite yet. Regardless of when the environment feels more like pre-pandemic times, Dr. O’Neil warns that “complacency is probably the biggest danger to an organization.”

“You need to be ready continuously,” he said. “We knew that there would be a pandemic someday. There are going to be other pandemics.”