The COVID-19 vaccine started to roll out across the United States in mid-December with assisted living and nursing home staff members and residents, as well as other healthcare workers, first in line for inoculations. For the long-term care industry, however, the recovery will be a hard-fought effort.

The industry was under substantial pressure even before the pandemic. But now it’s at the brink, financially and operationally. By late November, The Atlantic magazine’s COVID Tracking Project found that infections at facilities, including assisted living communities and care homes as well as nursing facilities, had reached a new weekly high of 46,000, the worst week in six months. Cases among the sector’s residents and staff members made up just 5.7% of all the U.S. COVID cases but accounted for 39.3% of the deaths.

The 2021 outlook is grim. Getting through it will hinge, to a large extent, on financial rescue programs at the federal and state levels. In addition, it will be important how well operators manage developing and/or deepening trends. Here’s what to look out for.

Clinical risk management has never been more important

A San Francisco Jewish senior housing complex made it through the first three months of the coronavirus pandemic without experiencing a single case. How? It had stocked up on personal protective equipment and masks for employees and residents. It stringently screened everyone walking through the door. Everyone was educated on best mitigation practices and symptoms and infection prevention protocols. One executive said an early start mattered … and their doorknobs had never been so clean.

The right procedures and controls do make the difference in disease transmission. It’s a lesson that must drive improvements to the industry’s clinical risk management programs in 2021 and beyond. COVID-19 is not likely to be our last pandemic.

Now, the industry faces an as-yet undetermined liability over COVID deaths even as insurers are responding to the uncertainty. Before COVID, premiums were escalating dramatically and coverage availability was tightening. It’s much worse as we move into 2021, though, particularly for professional liability, general liability, management liability and workers’ compensation. It makes the case to reduce your exposures and strengthen ties with your broker. 

Repairing the damaged mental health of residents

The coronavirus pandemic also spawned a mental health pandemic; the Centers for Disease Control found that more than 40% of Americans had anxiety and depression, symptoms of trauma, more thoughts of suicide and were abusing drugs and alcohol.

But if the mental health crisis was bad for the general population, it has been exponentially worse for residents in long-term care. Being isolated in their rooms with no group dining, activities or in-person family visits was stressful for residents. This reality was aggravated by factors such as too much negative television, no exercise, limited direct sunlight or fresh air.

Compounding it all (especially for those with cognitive issues) was the confusing element of caregivers whose identities were obscured by protective garb. Reversing the decline will be a critical challenge well into 2021, the urgency heightened by the risk to residents’ physical health when their mental health is not addressed.

It’s more important than ever to encourage staff members to be alert to cues of issues. They are closest to residents, especially in group settings, and can spot when they are less engaged. It’s more difficult to monitor in independent living settings, but training helps. Communities must be ready to tap into the right resources for the setting, whether primary care practitioners or psychiatric home health nurses. And ultimately, balancing mental health and safety will be key in the post-COVID world, finding ways to stimulate residents so they can re-engage again.

Staff pressures also need addressing in 2021

The much vaunted “healthcare heroes” aren’t only found in hospitals. They were right there in trenches of our senior living and care communities, dealing with the same stressors of long hours; equipment shortages; fear for their families, their residents and selves; and grief over losses.

The toll the pandemic has taken on staff members’ emotional health needs to be addressed now. If nothing else, post throughout employee spaces information about community resources (suicide prevention hotline, food banks, etc.). Also consider sponsoring an Employee Assistance Program. Such programs offer confidential mental health counseling in a variety of formats (telehealth and, when it’s safer, one-on-one, for example). It’s key, however, that staff member are informed about the EAP and how to access its resources.  

The pandemic also has brought home long-standing understaffing issues that have aggravated the emotional well-being and performance of employees but also undermine the structural soundness of the industry. Understaffing makes providing basic care a challenge. It adds to the difficulties of monitoring residents – for COVID-19 now, but for any contagion. It also makes it more difficult for caregivers to follow protocols consistently.

The unprecedented events of 2020 make the case for addressing the deficiencies in the system; 2021 is the logical time to start if we are going to avoid a repeat.

Pete Reilly is the practice leader and chief sales officer for Hub International’s North American Healthcare Practice. Gigi Acevedo-Parker is national practice leader, critical risk management, for Hub.