Although assisted living communities are home to residents who “are completely just as vulnerable” as nursing home residents to COVID-19, “we sort of tend to ignore them in these situations” because the communities are licensed by states instead of the federal government and don’t receive much funding from the Centers for Medicare & Medicaid Services, one expert witness told the Senate Special Committee on Aging on Thursday.
“There is a tendency to focus only on nursing homes, and in many states, assisted living facilities look very much like nursing homes in terms of the level of care needed and provided and the vulnerability of the residents,” said R. Tamara Konetzka, Ph.D., a professor of health services research at the University of Chicago.
The Aging Committee hearing, titled “Caring for Seniors Amid the COVID-19 Crisis,” was the first hearing held by Congress focusing on the impact of COVID-19 on older adults, noted Sen. Bob Casey (D-PA), ranking member.
Konetzka’s comments came in response to remarks by Sen. Martha McSally (R-AZ), one of three committee members who brought the focus of discussion to senior living during a hearing dominated by talk of challenges and solutions for nursing homes and, to a lesser extent, home health agencies.
“There’s been an important focus on nursing homes for the vulnerable who are in these congregate settings, but we also need to think about those in memory care, those in assisted living, those who are older but in independent living,” said McSally, who said her 85-year-old mother lives in an independent living community.
For older adults living in congregate settings, the senator said, “We need to put a moat around them. We need to make sure that we have high levels of situational awareness, that anybody who goes to work there … or at some point visits there, that we know that they’re not inadvertently bringing in the virus with them.” People can have the virus without displaying any symptoms, so “checking temperatures is not enough,” she added.
Securing personal protective equipment and testing has been more difficult for senior living communities than for nursing homes, McSally noted. “It’s not an easy, top-down thing to do with the supply chains,” since senior living communities often are private entities, she said.
“Our testing needs to be focused on staff and, ideally, visitors and others who are going to go in there, and high levels of situational awareness, plus the controls that we’ve learned, to isolate and be able to treat quickly,” McSally said.
Social isolation also is an effect of the virus, the senator said, describing coronavirus as “cruel.”
“Working together, we’ve got to address this issue, to allow people to be safely able to visit at the right time,” McSally said.
Social isolation in independent living and assisted living is a “huge challenge,” Konetzka agreed.
“At the riskiest time, when we have to prohibit visitors, some things can be done in the meantime, like making sure that these facilities have appropriate technology so that residents can at least communicate through FaceTime or other video chats with their families on a regular basis,” she said. “In the longer run, I think it’s essential … that we do worry about the social isolation and start allowing visitors. And that’s one of those things that I think we’ll learn as we go, in terms of how much is too much. But that balance has to be struck. We have to limit that social isolation even as we try to stem the virus.”
‘Virus doesn’t care’ where seniors live
Sen. Elizabeth Warren (D-MA), whose brother Donald recently died after contracting coronavirus at a rehabilitation facility, said that two-thirds of assisted living communities in her home state have reported COVID-19 infections. Nationally, she said, assisted living residents total approximately 800,000.
“The reality is, this virus doesn’t care whether seniors are living in assisted living facilities or living in nursing homes. It can affect them regardless,” she said.
Warren, who also is a member of the Senate Health, Education, Labor, and Pensions Committee, along with Sen. Edward J. Markey (D-MA) and Rep. Carolyn B. Maloney (D-NY), chair of the House Committee on Oversight and Reform, recently asked the CEOs of 11 senior living companies to detail the extent of COVID-19 at their communities and the actions they are taking to prevent or mitigate the disease.
“Assisted living facility residents and their families deserve to know whether or not their facilities are experiencing a coronavirus outbreak, just like nursing home residents are entitled to know that,” she said Thursday. “So I believe we owe it to our seniors to get this done.”
Konetzka noted that data on COVID-19 in assisted living is lacking.
“We don’t collect much data from assisted living, because they are not as dependent on federal funding,” she said. “And under the CMS guidance, as I understand it, we are also not collecting information from assisted living facilities, which … is unfortunate.”
Challenges in memory care are distinct
The pandemic has brought distinct challenges to those with dementia and their caregivers, Sen. Doug Jones (D-AL) said, noting that his mother lives in an assisted living community and that his late father, who died in December, had Alzheimer’s disease.
“Every week, she will mention that as much as she misses my dad, who she was married to for 70 years, she’s also somewhat thankful that he passed before all of this pandemic hit,” he said. “And in part, I think that is because of the problems that she would have faced. She used to go down and visit him every day” but would not have been allowed to do so with no-visitor policies in place.
Heading witness Steven Landers, M.D., MPH, president and CEO of the Visiting Nurse Association Health Group in Holmdel, NJ, said that even something basic like nasopharyngeal swab testing for COVID-19 can be “fairly traumatic and upsetting” for someone with dementia, “because the person just doesn’t understand.”
Home health agencies can “buttress the care” in independent living and assisted living communities, he said. A telehealth reimbursement bill proposed by Sen. Susan Collins (R-ME), chair of the Aging Committee, would enable home health providers to offer telehealth and would strengthen dementia care that agencies provide in assisted living, he said.
For additional coverage of the hearing, see sister publication McKnight’s Long-Term Care News.