Perspectives: Will People Return to Senior Care Facilities After the Pandemic? (Part I)

Stephen Lomonico, NHA, president, Thrive Behavioral Sciences.

The Wall Street Journal recently published an article posing that the pandemic is reshaping how Americans care for senior family members, and that more families will opt to keep loved ones at home, rather than relying on senior care facilities. While the pandemic has and will certainly continue to reshape the senior care industry, what might the industry look like in the coming years and after the pandemic?

To find out, we asked senior care industry professionals for their thoughts, insights, and predictions. We’re pleased to share them with you now. (This is Part I of a two-part series; you can check out Part II here.)

Nanne Finis, RN, MS, is chief nurse executive at UKG (Ultimate Kronos Group), which is a global provider of HCM, payroll, HR service delivery, and workforce management solutions. Finis has 40 years of experience in collaborative work spanning clinical, operational, and administrative settings.

Stephen Lomonico, NHA, is president of Thrive Behavioral Services, which provides health services to skilled nursing and assisted living facilities.

Because COVID-19 has spread so quickly through nursing homes, it’s eroded family and resident trust in some facilities. What do you think senior care facilities will need to do to rebuild that trust during and after the pandemic?

Finis: The post-acute world of skilled nursing facilities and nursing homes is a very different world than the rest of the assisted living, memory care, and independent housing industry. I think there is a difference, particularly post-COVID, in how resident care is performed and how organizations are going to be rebuilding that trust, depending on which segment they’re servicing.

I think the sensational news and this challenge has most heavily burdened skilled long-term care facilities where those residents are so vulnerable. The deaths, mortality, and morbidity from COVID has been impacting that segment, and I believe it has impact on the public perception of post-acute care.

I think that this is not dissimilar from acute care, where there’s hesitancy post-COVID or during this pre-vaccine period. Organizations and individual consumers are challenged to think about going into facilities or putting their trust in care in facilities because of the threat to their personal health. There’s the consumer aspect and then an employee aspect. Some are the same people, but we may want to target it from both sides.

I reached out to some of our customers in that post-acute space. I haven’t talked to anyone in skilled nursing, but I read about those environments routinely. When you think about the residents coming into those settings, and the family members, too, they’re not just caring for the resident, but are also very family-oriented. It’s been difficult to safely allow visitors. Coming up with innovative approaches around that piece has been significantly challenging for this family-focused environment.

When it comes to building consumer trust, I think it’s going to take communication and making sure that the safety and health of visitors and residents are first and foremost in everyone’s mind. If a care facility changes its protocol or process, they need to be always going back and communicating the why behind that restriction.

I think our visitors see that in our work. When they come into the buildings, they see those restricted visitor hours, cleaning protocols being executed, and gloving and PPE availability. They walk in and see that type of presence that they would in a hospital, and over time that will continue to build trust. I think it’s going to take a while, and we’re seeing the impact of that in this industry with lower volumes and occupancies than were present pre-COVID. We’re still not up to where we were in occupancy levels, and that’s consistent pretty much across the industry.

One sort of intervention I’m hearing about is that several large facilities in post-acute nonskilled environment have advisory committees that are representative of physicians, nurses, and infection control specialists, with compliance to CDC regulations and practices for infection prevention. Some organizations are using physicians that they have contracted with normally in their own businesses. Others are creating broader advisory councils that are truly looking at day-to-day practices and guiding them on practices for infection prevention, but this will probably emanate as they think about the facility and the design of the facility for the future. A future design might have fewer common spaces, ways to network and socialize that are not as large and open, and better airflow.

Some of these groups are being published in the media and I think those types of initiatives will build trust for not only the residents, but also for their families and consumers of care. This is a way to demonstrate that a facility isn’t just a mom-and-pop shop, and that they truly are meeting national standards and requirements.

Communication and a focus on resident safety is going to need to continue to be emphasized. These facilities need to demonstrate that they’re going to be ahead of the game in providing vaccinations to residents, and in providing PPE so residents and families are safe when they come.

Lomonico: I think the vaccine is a good start. Providing everyone with the vaccine, staff, and residents alike, will go a long way to bringing back confidence in the facilities. It still has to be proven though, and I think that down the road it will build more confidence in skilled nursing centers. In looking at the way it has spread even in communities, the only way that anyone can avoid this virus is to stay completely isolated which is nearly impossible and even with that many people have somehow contracted it. That said, most families cannot take care of their loved ones due to the level of care they need and have to rely on the skilled nursing centers for the care they provide.

Do you think we’ll see a restructuring of the senior care industry, whether that means physically redesigning facilities or adopting new policies and procedures?

Finis: I would say yes. The CDC has put out new procedures related to COVID monitoring, adherence, and prevention aspects. Those have been in practice for several months. I know that federally there’s oversight more on the skilled side of adherence to these policies and procedures for infection prevention, and there’s increasing regulatory oversight since the initial challenges we faced with COVID in some of our nursing homes.

I think that’s just the beginning. The policies and procedures will be changing. They’re on the CDC website and many of our customers can share that with residents and families. Care facilities can tell families and residents that’s they’re adhering to those policies and procedures.
I think yes, there’s going to be a lot of change with physical redesign. Some architecture and design firms specialize in post-acute settings, and there will be a review of surfaces and congregate space and the flow of the residents.

If you need to cohort residents, like to have a COVID floor, for instance, which some hospitals have had, how does that work in a long-term care facility? How do you truly cohort and not isolate? I think this will lead to quite a bit of redesign thinking. Not that we need to have new designs in every facility today, but I think as new buildings emerge, there will be new thinking. Our facilities are making do. There’s probably not a lot of money to redesign from top to bottom, but they are sort of redesigning inside and redesigning the flow of processes.

Lomonico: Restructuring through acquisition has already begun. Facilities cannot afford to operate under the current conditions (low or restricted census and COVID protocol costs). Governmental financial assistance helps, but it appears to be either too little or too late.

Once COVID-19 is better controlled or even eliminated, do you think that people will quickly return to senior care facilities? How might the pandemic have changed how families evaluate facilities when seeking out care for a loved one?

Finis: I think there’s always going to be a level of concern. Our population is aging. I was looking up statistics – we have, give or take, a million licensed beds in this sector, so this is a large component of our healthcare delivery system across the United States. The average age going into the post-acute care environment is 72. It was actually a little older than I thought, and mostly women. I would say that we’re going to see that there’s still a need from a population perspective to live in and be cared for in these facilities. These facilities are truly needed, long-term, and there’s nowhere else for residents to go.

If individuals and families have the choice and they’re fortunate enough to be able to make the choice on where they go, I think they’ll look for an organization that’s clean, that cares about safety and wellness, and that has a culture of compassion. In long-term care, that’s probably a little bit different from assisted living and memory care facilities. In assisted living and memory care, I think individuals and families are looking for those same things, but they’re also looking for opportunities for socialization, for the dietary needs of a resident to be met, and for amenities.

I think overall, families and residents are looking more for safety of their care versus amenities. This will definitely put the healthcare piece of the care in these settings at much higher priority. Does this organization follow CDC protocol, do they understand this, do they have a plan for if COVID were to occur again?

Lomonico: Speed in returning to the facility is mostly determined by the senior’s age and condition. I think there is a thought process now that many people are now working from home and due to that they are able to care for their loved one at home and have supplemented by adding home health care service or personal caregiver if necessary. This solution does not prevent potential exposure or contraction of the virus. It can help with the lessoning of guilt and, depending on the payer source, save money.

Are there any other systemic changes that you predict the senior care industry will see as a result of the pandemic?

Finis: I’ve been hearing about more of a linkage with the healthcare system in some of these levels of care. Whenever we think of healthcare and public health and the population at large, I believe this post-acute industry was always seen as sort of separate in some way. But as the population grows in the 65 and older, and in the 75 and older brackets, more care will be given. These residents will go in and out of acute care facilities. Many of them have multiple medical conditions. The link with the healthcare system at large is definitely going to happen.

I think we’re already seeing more and more of that, not only in referring patients for an inpatient stay, but also the linkage technologically with telehealth with some of the local providers. Other linkages are occurring with medical records, so that there’s some capability for the acute care facility to see and visually get into the records, or vice versa. I think there’s going to be a lot more discussion around that type of sharing.

I think communication use within the industry is promoting the use of technology more and more to support communication with residents. The isolation that residents have been facing has fostered a surge in use of those types of technologies. I think that’s only going to continue.

Lomonico: Certain facility owner/operators have created the Vice President of Infection Control to oversee policies and procedures and help to implement them consistently throughout the companies. This type of trend will lead to more infection control devices and products that can help to sanitize outside influences (e.g., UV lights and other non-invasive solutions) and more affordable sources that can help to sanitize individuals upon arrival to the facility.

You can check out Part II of our series here.

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