Brian Jurutka
NIC President and CEO Brian Jurutka

Suspected and confirmed positive cases of COVID-19 are higher in senior living and care settings where resident care needs are greater, according to results of a small survey released Friday by the National Investment Center for Seniors Housing & Care. But, generally speaking, COVID-19 testing also is more prevalent in higher-need settings.

Although those findings may seem intuitive, NIC’s “Executive Survey Insights: COVID-19” monthly survey is the first to compare current residents’ status across independent living, assisted living, memory care and nursing care properties, according to the organization. 

According to self-reported data on May 31 from 105 senior housing and care operators, confirmed positive tests were the highest at nursing homes (4.3%), followed by memory care (3.7%), assisted living (1.2%) and independent living (0.2%) settings. Suspected positive cases followed the same trend as confirmed cases, with skilled nursing (2.4%) ranking the highest and independent living (0.1%) the lowest.

Testing for coronavirus, according to survey results, was most prevalent in skilled nursing (34.2%) and assisted living (21.9%), followed by memory care (17.6%) and independent living (9.8%). 

Unlike cumulative data typically available, which shows growing levels of testing and positive COVID-19 cases over time, NIC’s survey offers a snapshot of the testing and reach across all senior housing and care sectors, focusing on resident status on a given day.

“It’s important to understand how testing and reach of COVID-19 rates vary across different types of senior housing and care property types, because the residents and the services they require vary by property type,” NIC President and CEO Brian Jurutka said. “These facilities changed procedures dramatically since the pandemic began as testing and treatment guidelines became available. The more that is known about COVID-19 in senior care facilities over time, the most informed decisions can be about how to keep residents healthy and safe.”

In the early days of the pandemic, he said, there was less personal protective equipment, less testing available and less awareness that the virus could be spread by asymptomatic carriers. Policies and procedures were different than they are now.

“We prevented visitation, suites were set up for potential COVID-19 residents, policies and procedures changed,” Jurutka told McKnight’s Senior Living. “The cumulative numbers give you no sense as to what happened and how things changed in a community.”

Publicly available data, he added, typically refer to “the amorphis group called long-term care facilities” with little or no differentiation among care settings. In addition, data on the effects of COVID-19 on senior living and care largely have been limited to skilled nursing and, in some areas, assisted living communities.

These cumulative data, he said, show a growing number of COVID-19 positive and suspected cases since the beginning of the pandemic. NIC’s point-in-time survey offers insight into the effects of visitation policies, access to PPE, testing and resolution of early COVID-19 cases on trends. 

“These are important constructs, because the population that resides within the different care settings are different,” Jurutka said. Nursing home residents who need higher rates of assistance with activities of daily living will have more contact with staff members, increasing their risk of exposure to the virus, compared with independent living residents who have little contact with caregivers and a lower risk of exposure, he added. 

“As we get further into the pandemic, in addition to looking at the cumulative numbers, it’s important to look at the current penetration of COVID-19 within care settings,” Jurutka said. “The data reinforce that COVID-19 affects residents of different types of senior living facilities differently. A main reason is because these facilities offer different levels of care and serve different populations. Each must be considered separately to form and implement a sector-wide response.”

The cumulative data, he said, paint a slightly different picture than current penetration rates, which are a more relevant metric for those looking at senior housing and skilled nursing today.

“Cumulative data is important for certain studies and certain metrics, but in-place data will be important as we start to reopen and we understand how the changes and procedures — social distancing and PPE and testing — impact what’s in a building today,” Jurutka said. “We are smarter about this than we were three months ago, and we’ll be smarter two months from now. There should be some recognition of the fruits of these efforts and labor. It’s an important additional metric to cumulative data.”

NIC plans to update the information monthly and put out a call to operators to use the survey as an “opportunity to help tell their story,” he said. For this survey, 57% of the respondents said they operate senior housing properties (independent living, assisted living or memory care), 22% operate continuing care retirement communities, and 21% operate nursing homes. Increasing participation would allow the organization to provide key data sets, such as a geographical view, Jurutka said.

In other coronavirus-related news:

  • Montana Gov. Steve Bullock announced an updated directive that permits safe visitation in assisted living communities and nursing homes that are able to follow infection control protocols based on guidance from the CDC and the Centers for Medicare & Medicaid Services. 
  • Maryland Gov. Larry Hogan has announced a phased reopening plan for the state’s assisted living communities. The plan requires universal screenings and face coverings for staff and visitors, mandates widespread testing and allows for limited visitation.
  • The Centers for Disease Control and Prevention has updated and expanded the list of people at risk of severe COVID-19. Older adults and those with underlying medical conditions remain at increased risk for severe illness, but now the CDC has further defined age- and condition-related risks. The CDC removed the specific age threshold from the older adult classification, warning that the risk increases steadily as one ages, and it’s not just those aged more than 65 years who are at increased risk for severe illness. 
  • A new study from the Canadian Institute for Health Information finds the proportion of Canadian COVID-19 deaths in long-term care facilities is about twice the average of rates from other developed countries. Long-term care residents made up 81% of all reported COVID-19 deaths in Canada compared with an average of 42% among all countries studied. The definition of long-term care varies by country but in Canada includes both residential facilities with 24-hour nursing care and facilities with fewer services, such as retirement homes and assisted living communities.
  • The Birmingham Green assisted living and nursing home facility in Manassas, VA, celebrated its 130th individual recovery from the coronavirus. The total number of people at the facility who have recovered includes 56 staff members, 15 residents at its Willow Oaks assisted living facility and 59 residents at its nursing home. 
  • Local retirement community residents protested after Marion County, OR, decided to isolate people with COVID-19 at a Super 8 motel in Woodburn. Marion County Health and Human Services is finalizing a nine-month contract with the hotel to allow people exposed to the virus to self isolate for up to two weeks.  The 81-room hotel would be monitored 24/7 by security. 
  • California and San Diego County officials recently rolled out plans for mass COVID-19 testing in nursing homes, but there is no roadmap for widespread testing in assisted living communities, according to those in the senior living industry. There are almost 600 assisted living facilities in San Diego, ranging from small homes to upscale facilities with 250 residents.
  • North Dakota Sen. Kevin Cramer helped bring compassionate care to long-term care settings still under no-visitation orders due to the coronavirus pandemic. The North Dakota Long Term Care Association’s Reuniting Residents and Families Task Force had been pushing for compassionate care to be allowed in certain situations that do not necessarily mean end-of-life for residents.