Report examines senior living facilities in the wake of COVID-19

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

socially distanced residents in front of their retirement home

Photo: Gilbert Mercier via Flickr

The devastating toll of the coronavirus pandemic in nursing homes has had a domino effect on the entire senior living industry, according to a new report. Misconceptions about housing for older adults, along with negative perceptions about assisted living, independent living and active adult communities, have prompted many owners and operators to take a hard look at what this industry must do to reassure residents and families about safety and wellness.

The report, produced by the International Council of Active Aging (ICAA), notes that COVID-19 has provided a rare opportunity to reassess and potentially reboot strategies for defining senior housing and services. It addresses critical questions for this $5.6 trillion care segment: “What will life in a senior living community look like next year, or in three years, or five? Which communities will flourish, which will remain challenged, and which will cease operations? Will people want to live in senior living communities – and why?”

It’s important to differentiate nursing homes from other types of senior living facilities, according to Colin Milner, ICAA chief executive.

“There’s an awful lot of them (senior living facilities) that have not had any issues, and once again, everybody is has been painted with the same brushes,” Milner said in a phone interview. “One of the goals of this report is “helping families, residents, those in the media, as well as the government really understand clearly the different segmentations within the industry and who they serve.”

However, it can be difficult, if not impossible, to determine exact case and mortality figures for these segments of the senior living market. It’s up to the states and individual counties to track and monitor this data, according to the Kaiser Family Foundation. Assisted-living facilities, which serve approximately 800,000 older, frail residents who are also at high risk of getting the virus and serious complications “have been mostly overlooked,” it said. In comparison, about 1.5 million frail older adults and people with serious disabilities live in nursing homes, according to U.S. News and World Report, and account for around 40% of deaths from COVID-19 in the U.S., according to CMS data.

Longevity is big business

According to 2017 data from the ICAA, the total longevity economy, defined as the value of all the products and services (including health care) chosen by adults 50 years and older, was estimated at USD $5.6 trillion in the United States, a figure increasing to $7.6 trillion as those dollars circulate through the economy This includes:

  • 46,049 retirement communities accounting for $66 billion,
  • 22,380 assisted living facilities generating some $51 billion,
  • 4,814 continuing-care retirement communities (CCRCs), accounting for $28 billion,
  • Approximately 26,000 senior and adult day centers, providing roughly $34 billion in non-medical care.

The pandemic has made many older adults reluctant to commit to any communal type housing arrangement, even for those in independent living. Milner says the entire industry has seen a downturn in revenues as families move loved ones out of senior housing, cancel or delay contracts, and concern increases over the impact of forced social isolation.

“There’s a balancing act for moving into community now,” he said. “They would have to be convinced it’s a safer environment.” While clarity about the virus and its effects are improving, there’s still a lot of confusion about what is or isn’t safe for older adults and how to weigh the risks and benefits of isolation.

To figure out what the “next normal” of senior living will look like, ICAA gathered more than 150 leaders and experts in the longevity field to create a COVID-19 Senior Living Task Force. The task force focused on two key areas to position the industry for the future: optimizing the health and wellness of residents and staff, and developing a new mindset about the benefits of senior living communities. The task force outlined six key strategies:

  1. Design, re-design and/or renovate exteriors and interiors of buildings,
  2. Develop purpose-driven, caring, passionate staff,
  3. Provide technology to increase connections, aid efficiency and optimize health,
  4. Develop the culture of positive aging, framed by all the dimensions of wellness,
  5. Establish trust by being prepared to respond to emergencies and unexpected events,
  6. Update perceptions to reinforce the new value proposition of each type of senior living.

“This an opportunity overall for the industry to do a reset and where they focus, and that is not just housing people, but providing people with an environment that adds to their well-being and wellness,” Milner said.

One of the major recommendations to come out of these new COVID-generated strategic approaches is a greater focus on the built environment. Milner predicted we’ll see more buildings that are built to be “well buildings,” including features like improved air filtration in rooms and airflow within the community, better lighting and surfaces that are easier to clean and disinfect.

There also would be increased focus on helping residents remain well, whether they are confined to their spaces, or can go outdoors for exercise and socially distant interactions. The word “preparedness” will be front and center, Milner said. Communities need to be prepared, not just have a plan to be prepared.

“We need to make sure that we have multiple solutions in place and not just a plan,” said Milner. “A plan is one thing, but if I’m moving into community, what would you prefer — that I come into a community that says well we have a plan in place, or a community that says ‘we’re prepared for anything’?”

For journalists interested in covering this issue, Milner suggests that even reluctant stakeholders may be willing to talk with the right approach. Acknowledge that they’ve likely had COVID-19 issues and ask what they’re doing to help people maintain their lifestyles, help families become more engaged, and how the staff is managing the process beyond the clinical aspects.

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