Limited resources, perceived external pressure and the ongoing nature of the pandemic have many assisted living administrators managing, but not thriving, according to new research.

The study from Portland State University — one of the first to provide insights into the role of assisted living administrators during the pandemic, according to the authors — details how the pandemic has affected assisted living, suggests implications for future emergencies and provides recommendations based on administrators’ first-hand experiences.

Investigators conducted phone interviews with 40 assisted living administrators in Oregon between February and August 2020 to understand the effects of the COVID-19 pandemic on their roles, residents, families and operations. Although research on nursing home administrators’ responses to crises exists, the authors found that little attention had been paid to assisted living administrators’ experiences.

They reported that the pandemic had a “slow-burning, devastating impact” on assisted living communities. 

According to the authors, more than 800,000 residents live in approximately 29,000 communities. Of the estimated 82,105 COVID-19-related deaths reported in long-term care as of September 2020, almost one-third occurred in assisted living. 

Based on the administrator interviews, researchers identified three primary themes related to managing the COVID-19 pandemic: emotion and burnout management among administrators, staff members, residents and their families; information management, including communications and documents from state and national agencies; and crisis management, including infection control measures and personal protective equipment access.

Researchers found that the responsibility for the safety and health of residents and staff during the pandemic “weighed heavily” on administrators. “Making sure that no one’s gonna die from COVID in our building” was a consistent burden that led to anxiety, loss of sleep, physical illness and burnout among administrators, researchers said. 

“The gravity, especially right now, how many souls I’m responsible for, especially with COVID, and the fact that the virus could rip through our building and kill half of our people and then infect our staff and they bring it home to their families. Those are things that keep me awake at night,” one administrator shared.

Adequate staffing was a persistent concern. For-profit community administrators described staff members “fleeing” their jobs more often than did their not-for-profit counterparts, which the authors said suggested that enhanced federal unemployment benefits and motivational factors contributed to their staffing challenges.

“Administrators described finding themselves in a position to provide what can be dubbed ‘triple duty’ — their usual workload being exacerbated by the increased demands of physical constraints, regulatory agencies and resident families, and by the need to accommodate their personal lives during a global pandemic,” the authors noted. 

The researchers said that their findings point to the need for states to bolster administrator training in disaster and emergency response, as well as in effective communication.

“Their burden is heavy, and some lacked sufficient organizational support during a crisis,” the authors concluded.

A manuscript about the study findings has been accepted by The Gerontologist, the journal of the Gerontological Society of America.