As the nature and duration of the COVID-19 pandemic remains unclear, the senior living industry finds itself shifting from a sprint to a marathon without a known finish line. 

Lynne Katzmann, Ph.D., founder and CEO of Bloomfield, NJ-based Juniper Communities, told participants in a National Investment Center for Seniors Housing & Care “leadership huddle” on Thursday that her business looked at dealing with the pandemic in three phases: crisis management, the path forward and a “new normal.”

Phase one, Katzmann said during “Coping with the Pandemic: Shifting from a Sprint to a Marathon,” had a simple goal of keeping residents and associates healthy and safe. Juniper did that through testing and proactive infection prevention strategies. Phase 2, the current operating state, focuses on restoring profitability while keeping everyone safe.

“The paradigm shift is how we look at the world,” Katzmann said. “Uncertainty is the new certainty.”

Juniper had to change the way it did business in light of that uncertainty, she said. The company moved to centralized leadership, providing clear goals and priorities from the top down, and upended its staffing patterns. Juniper adopted cohorting of residents and employees, trained employees to be universal workers, and doubled its sales team and digital spend.

“We’re seeing some transitions in the way we handle things and the way we are working to restore profitability,” Katzmann said.

Lori Alford, co-founder and chief operating officer of The Woodlands, TX-based Avanti Senior Living, said her company transitioned from addressing the changing environment caused by the virus as a sprint to a marathon to a journey. She said there is a realization that “COVID-19 is here, and it’s not going away; there’s not a finish line we can see any time soon.”

A shifting mindset

Avanti’s focus over the past six to eight weeks, she said, has been on shifting the mindset from reaching a destination to pivoting, shifting, adjusting and adapting rather than fearing. Sales and marketing, for example, has shifted from a high-touch process to a virtual experience.

“It’s not wrong; it’s just different,” Alford said, adding that eight weeks ago, Avanti put a focus on mental wellness. She said being located in the South, the company is used to preparing for and working through natural disasters, such as hurricanes. The difference, she said, is that those occurrences are short-term crises with an end in sight. 

“No one knows when this will end,” Alford said of the pandemic. “It’s an ongoing journey. It’s wearing. Families are tired, residents are tired, our teams are extraordinarily tired.

“There is mental fatigue, physical fatigue, and definitely COVID-19 fatigue is very real.”

Dan Brown, an executive coach with Arden Caching in Washington, D.C., said healthcare is in a “perfect storm.” It’s an industry driven by metrics and revenue staffed by professionals who feel an altruistic need to provide care to people who are suffering.

“The combination is a setup for burnout and for widespread deterioration of the mental health of the people taking care of people in assisted living and skilled nursing, in particular,” Brown said, adding that suicide rates in the medical field are double that of the general population and likely will increase as a result of COVID-19.

He encouraged administrators, operators and even investors who are coming into contact with frontline workers to look for signs that someone is struggling with mental health in the pandemic, including maladaptive thoughts or feelings of guilt, someone who has lost touch with his or her own emotions or humanity, self-isolating behaviors and strong emotions.

Brown said COVID-19 is testing everyone the way a marathon does at every level, and leaders are looking for guidance on managing change and motivating others.

“We can’t overlook the fact that our healthcare workers within the senior living space are working with someone who is sick and bringing that home to their families and loved ones,” he said. “There is stress in the family environment.”

A self-proclaimed “eternal optimist,” Katzmann said she had difficulty in the early days of the pandemic, when she realized nothing she did could control some of the outcomes of the virus. She turned to the industry and found support among her colleagues. She said she is part of several groups and forums throughout the industry that provide support, strength and solutions.

“No matter what side of the industry you play with every day, we are all in this together,” Katzmann said. “At the end of the day, we all benefit when we all do well.”

A pathway forward

Katzmann said she turned to what was working overseas to learn about how to tackle the virus. Her takeaway from South Korea’s strategy was to test early and universally regardless of symptoms. 

Juniper tested all residents and employees in hotspots in late March using a private lab. The company found that 50% of those who tested positive were asymptomatic. 

“All of a sudden, we knew this disease was not being transmitted in the way everyone was being told. It was being spread by asymptomatic and presymptomatic individuals,” Katzmann said, adding that she used the data to pull together a “battle plan” that included employees sheltering in place with residents, cohorting residents and staff, and adopting prevention strategies, including cleaning, disinfecting and adopting the use of personal protective equipment. 

She said she spent $100,000 per week on testing, adding that the only way to protect communities, profitability, and the health and well-being of residents, families, staff, vendors and the outside community is through rapid, accurate, cost-effective testing.

Juniper is working with a group out of the Massachusetts Institute of Technology to develop a cheek swab test that is cost-effective and provides quick results.

Alford said that as with hurricane preparation — for which facilities are required to have a seven- to 10-day supply of items — she anticipates that future regulatory requirements for senior living communities will dictate securing certain supplies in preparation for another pandemic.

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