Care collaboration offers solution for the ‘Forgotten Middle.’

Collaboration among various stakeholders will likely play a significant role in securing affordable housing and appropriate care for middle-income seniors—a big group expected to increase in size in the wake of the COVID-19 pandemic.

Medicare Advantage plans, adaptive re-use of commercial properties and telehealth are some of the vehicles that could be leveraged to create new approaches to house and care for middle-income seniors.

“Our nation’s middle-market seniors need a sustainable housing solution that addresses their projected health and wealth characteristics,” said NIC Chief Economist Beth Mace. “Given the COVID-19 pandemic, the need is only going to get bigger.”

NIC first identified the growing number of vulnerable middle-income seniors last year in its report, “The Forgotten Middle: Middle Market Seniors Housing Study.” It showed that 54% of seniors cannot afford today’s senior housing product—based on a monthly cost of $4,500—and do not qualify for assistance under the Medicaid program. By 2029, 14 million seniors will fall into that category.

That number will likely grow because of the pandemic and its economic fallout.

Seniors whose savings are depleted by the economic downturn will likely join the middle-income ranks of those who can’t afford the housing and care they need. And more of today’s middle-income could fall into the low-income category of elders who rely on Medicaid, stretching an already overburdened system.

Added to that, consumer confidence will take a hit, said Mace. A rocky stock market and big job losses create uncertainty which can impact decisions to move into seniors housing.

The problem of how to house the rising number of middle-income seniors, many with functional limitations, will be solved in part by an increase in care collaboration.

New approaches were discussed at the NIC Spring Conference during a session titled, “Planning for the Care Needs of the Forgotten Middle.”

Much of the discussion focused on how to integrate healthcare into housing.

“The middle market is where health and housing intersect,” noted Caroline Pearson, senior vice president at NORC, at the University of Chicago. She is co-author of the original ‘Forgotten Middle’ study.

Medicare Advantage insurance plans could help, session participants agreed. These plans, held by a growing number of seniors, are beginning to offer wraparound services such as payments for food, assistance with the activities of daily living and on-site healthcare.

Some senior living providers are forming their own Medicare Advantage plans while others are aligning with healthcare providers.

The big healthcare REIT Welltower, for example, formed a partnership with CareMore Health, a division of Anthem insurance. CareMore enrolls residents in Medicare Advantage plans. They are treated on-site by CareMore healthcare professionals.

“Senior living should be the convener of healthcare,” said session participant Kevin O’Neil, chief medical officer at Affinity Living Group. He added that on-site healthcare can help avoid costly emergency room visits. It’s easier on the resident too.

Working with local health systems is a priority, session participants agreed. But managed care organizations will only partner with senior living providers that can track outcomes, said Diane Burfeindt, vice president of population health at Presbyterian Senior Living. “Data is huge.”

Panelists presented other ideas to lower costs for middle-income seniors. Unused properties, such as vacant schools, could be converted into senior living properties. The low-cost basis of the property would help keep rents in check.

Government programs such as low-income housing tax credits and the rental of ground floor space to retailers are other cost-saving ideas. “It will take a multi-industry mindset,” said James Lydiard, general manager of CareMore’s Touch program for senior living communities.

Technology will help lower costs. Senior living providers are already stepping up their use of telehealth in the wake of the pandemic. Timely, virtual doctor visits will help maintain the health of middle-income seniors at an economical price. “Telehealth is the way to go to reduce the cost curve for the middle market,” said Mace.

The Department of Labor reported that 4.4 million Americans filed for unemployment insurance benefits in the week ending April 18, 2020 as the COVID-19 pandemic continues to cause businesses to lay off or temporarily furlough workers due to lock down across much of the country. This was a decline of 810,000 from the previous week’s upwardly revised level of 5.2 million. The speed and scale of the job losses is unprecedented. In the past five weeks, more than 26 million people have filed claims. By comparison, 9 million jobs were lost over the course of the 2007-2009 recession.

Continuing claims for regular benefits, which are reported with an extra week’s lag, rose 4.0 million to 16 million. This marks an all-time high in the data series. This measure, which accounts for people who are continuing to receive benefits, will keep climbing as jobs continue to disappear. This has also pushed the insured unemployment rate (the share of the labor force that claims unemployment benefits) higher. The insured unemployment rate was 11.0% in the week ending April 11, an increase of 2.8 percentage points from the prior week and up from 1.2% pre-COVID-19. This marks the highest level of the rate in the history of the data series.

Jobless claims are laid-off workers’ applications for unemployment insurance payments. Gig-economy workers, self-employed people and those seeking part-time work are now eligible to apply for benefits in an expanded unemployment assistance program recently created in response to the pandemic. Further, as of last Monday, more than 40 states were paying recipients an additional $600 a week in enhanced unemployment benefits on top of the usual payments.

The largest increases in initial claims for the week ending April 11 were in Colorado, New York, Missouri, Florida and North Carolina.

This week’s increase in unemployment claims marks the fifth consecutive week of surging jobless claims and indicates just how quickly and sharply the economy has collapsed. An 11-percentage point jump in the official BLS jobless rate to as much as 15% to 20% by April is likely and could exceed 20% in May, according to Capital Economics. This would be the highest rate since the 1930s. As recently as February, the unemployment rate was at a 50-year low of 3.5%. In March, the rate had already increased to 4.4%.

In response to the coronavirus crisis, the Federal Reserve has pushed interest rates to zero and enacted nine new lending programs in recent weeks. These include open-ended asset purchases of $1.2 trillion of Treasury securities in just four weeks and the announcement of a series of new lending facilities aimed at households and non-financial businesses, worth up to $2.3 trillion. The FOMC meets next week and may announce further plans to buy more Treasury securities and create new or expand existing loan programs. The Fed’s actions in recent weeks are unprecedented and indicate how troubled the economy is indeed.

A NIC report developed to provide timely insights from owners and C-suite operators on the pulse of seniors housing and skilled nursing sectors.

This report marks the third installment of findings from NIC’s weekly Executive Survey of operators in seniors housing and skilled nursing. The report highlights the findings from responses collected at the beginning of the pandemic to now as operators experience changing market conditions due to the COVID-19 threat to residents, staff and business operations; effects of social distancing mandates from state and local governments and seniors housing and care organizations themselves; and the economic effects of shuttered non-essential businesses on local economies.

Summary of Insights and Findings

Occupancy rates declined and move-in rates decelerated for many organizations in Wave 3, with data showing distinctive downward trends since the survey began on March 24, 2020.

• In Wave 3, a decline in occupancy rates from the prior month occurred across all care segments, with the deepest declines reported for the nursing care segment. In Wave 3, about 40% of organizations reporting on their nursing care beds note an occupancy decline of ten percent or more from the prior month, up from about 20% reporting an occupancy decline of ten percent or more in Wave 2.
• Regarding the change in occupancy from one week ago, the independent living segment saw the most occupancy stability. However, roughly one-third of memory care units, and under one-half to two-thirds of assisted living units and nursing care beds note a decline in occupancy compared to the prior week, suggesting continued weakness in the near future.
• More organizations report the pace of move-ins decelerated in the past 30-days in Wave 3 than in the prior two waves of the survey. Two-thirds to one half of respondents attribute the deceleration in move-ins to a slowdown in leads conversion/sales, or resident or family member concerns. Overall, slightly fewer respondents in Wave 3 cited an organization-imposed ban on moving new residents into their communities, and slightly more cited resident or family member concerns than in Wave 2.
• The nursing care segment saw the largest deceleration of move-ins in the past 30-days. Reasons cited by respondents include fewer hospitals discharging patients to post-acute care settings for rehabilitative therapy as hospitals defer elective surgeries due to the pandemic, and positive or suspected COVID-19 related moves of residents to isolated units. Nearly one-half of organizations with any nursing care beds cited an organization-imposed ban on move-ins, and nearly one-quarter cited a government-imposed ban on admitting new residents.
• A larger share but still minority of respondents in Wave 3 report an acceleration in move-outs in the past 30-days compared to prior waves of the survey. Roughly two-thirds to three-quarters of organizations reporting on their independent living, assisted living and memory care segments saw no change in move-outs—a steady decline from Wave 1 to Wave 3. Just over one-third of organizations with nursing care beds note an acceleration in move-outs in Wave 3.
• Most organizations continue to mitigate staffing shortages by increasing overtime hours, offering flexible work hours, and remote work where possible. Fewer organizations in Wave 3 than the prior two waves of the survey are hiring agency or temporary staff and professionals from other industries. However, more organizations are beginning to offer additional paid sick leave to support property staff. Survey write-in comments indicate other tactics are being employed such as increasing wages, offering shift bonuses and incentive pay, access to on-site groceries and meals, emergency financial support programs, and temporary housing.
• Like previous waves of the survey, one-half of respondents in Wave 3 expect no change in their development pipeline going forward, however one-quarter expect their development pipeline to decrease citing uncertainty as the primary reason. Some of the respondents shared concerns about the economy, restrictions on moving new residents in, access to capital/debt, and cashflow and liquidity issues. NIC MAP® data has shown a deceleration in new construction relative to inventory trending for several quarters.
• A recent NIC blog post entitled “We Feel We Are Alone in a War Zone” incorporates comments from earlier survey respondents that reflect the impact of the COVID-19 crisis on a human level. One of the key concerns reflected in survey comments is a lack of available, accurate, and timely testing. Survey respondents also worry about the effect that the pandemic is having on already strained labor force issues.

Wave 3 Survey Demographics

• Responses were collected April 13-19, 2020 from owners and C-suite executives of 105 seniors housing and skilled nursing operators from across the nation.
• More than half of respondents were exclusively for-profit providers (59%), about one-third (36%) were exclusively nonprofit providers, and 5% operate both for-profit and nonprofit seniors housing and care organizations.
• Owner/operators with 1 to 10 properties comprise 63% of the sample. Operators with 11 to 25 properties make up 24% while operators with 26 properties or more make up 13% of the sample.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 73% of the organizations operate seniors housing properties (IL, AL, MC), 36% operate CCRCs (aka Life Plan Communities), and 34% operate nursing care properties.

Key Survey Results

Change in Occupancy by Care Segment

Respondents were asked: “Considering the entire portfolio of properties, overall, my organization’s occupancy rates by care segment are… (Most Recent Occupancy, Occupancy One Month Ago, Occupancy One Week Ago, Percent 0-100)”

• Approximately one-half to two-thirds of organizations reporting on their independent living, assisted living and memory care units in Wave 3—across their respective portfolios of properties—saw a decrease in occupancy from the prior month. This is up from roughly one-third to one-half in Wave 2. Conversely, roughly one-third to one-half saw no change or an increase in occupancy rates from the time they responded April 13-April 19, 2020 to one month prior, down from roughly one-half to two-thirds in Wave 2.
• Organizations with nursing care beds report the largest declines in occupancy changes from one-month prior among the four segment types across the three waves of the survey. In Wave 3, about 40% of organizations reporting on their nursing care beds note a decline of ten percent or more from the prior month, up from about 20% reporting a decline of ten percent or more in Wave 2.
  
• Regarding the change in occupancy from one week ago, the independent living segment saw the most stability with approximately 70% noting no change. In contrast, approximately 40% of organizations with assisted living units report a downward change of less than 3%. While about a third of memory care units report a decline from a week ago, a growing share (10%) show steeper declines of 3% or more. Two-thirds of nursing care beds saw a decline from one week ago, with one-half reporting a decline of 3% or more.

Pace of Move-Ins and Move-Outs

Respondents were asked: “Considering my organization’s entire portfolio of properties, overall, the pace of move-ins and move-outs by care segment in the past 30-days has…”

• In Wave 3, two-thirds to three-quarters of organizations reporting on their independent living, assisted living and memory care segments report that the pace of move-ins decelerated. Only one-third to one-quarter report no change in the pace of move-ins for these care segments.
• The majority of organizations reporting on their nursing care segments in Wave 3 note a deceleration in move-ins, compared to fewer than one-half in Wave 1.
  

Reasons for Deceleration in Move-Ins

Respondents were asked: “The deceleration in move-ins is due to…”

• In Wave 3, two-thirds to one-half of respondents attributed the deceleration in move-ins to a slowdown in leads conversion/sales, or resident or family member concerns. Overall, slightly fewer respondents in Wave 3 cited an organization-imposed ban on settling new residents into their communities, and slightly more cited resident or family member concerns than in Wave 2.
• Other reasons for deceleration in move-ins written into the survey comments include staffing shortages, fewer hospital referrals and elective surgery rehab residents, inability to engage contractors deemed “non-essential workers” to complete unit renovations, and positive or suspected COVID-19 related moves of residents to isolated units.
• Shown below, the reasons for deceleration in move-ins in the past 30-days for Wave 3 are broken out by organizations without nursing care beds and organizations with any nursing care beds. Considering organizations with any nursing care beds, nearly one-half cite an organization-imposed ban (46%), and nearly one-quarter cite a government-imposed ban (23%).

• About two-thirds to three-quarters of organizations reporting on their independent living, assisted living and memory care units saw no change in move-outs in the past 30-days—a steady decline from Wave 1 to Wave 3 as shown in the chart below.
• Just over one-third of organizations with nursing care beds note an acceleration in move-outs in Wave 3.

Mitigation Strategies for Labor Shortages

Respondents were asked: “My organization is back-filling property staffing shortages by utilizing… (Choose all that apply)”

• Consistent across all three-waves of the survey, most of the organizations report increasing overtime hours to mitigate staffing shortages (89% to 84%). However, fewer organizations in Wave 3 than the prior two waves of the survey are hiring agency or temp staff (36%), and professionals from other industries (22%).
  

Supporting Property Staff

Respondents were asked: “My organization is supporting property staff who may be experiencing challenges by providing… (Choose all that apply)”

• Most respondents across all three waves of the survey report offering flexible work hours and remote work to support property staff. More organizations in Wave 3 than in Wave 1 are offering additional paid sick leave (58% vs. 47%).
• Many respondents in Wave 3 offered written comments about how their organizations are supporting property staff as the pandemic emergency continues for employees and their families, mentioning increases on wages, shift bonuses and incentive pay, access to on-site groceries and meals, emergency financial support programs, and temporary housing.
  

Development Pipeline Considerations

Respondents were asked: “My organization’s projected development pipeline going forward is expected to… (Choose all that apply)”

• There are generally minimal differences in expectations about organizations’ development pipelines across all three-waves of the survey. One-half in Waves 2 and 3 (46% and 49%, respectively) continue to expect no change in their development pipeline going forward, with one-quarter in Wave 3 expecting their development pipeline to decrease (27%), and 15% expecting it to increase.
• Uncertainty remains the primary reason for expected decline. Others cited concerns about the economy, restrictions on moving new residents in, access to capital/debt, and cashflow and liquidity issues.

NIC wishes to thank survey respondents for their valuable input and continuing support for this effort to bring clarity and transparency into market fundamentals in the seniors housing and care space at a time where trends are rapidly changing. Your support helps provide both capital providers and capital seekers with data as to how COVID-19 is impacting the space, helping leaders make informed decisions. 

If you are an owner or C-suite executive of seniors housing and care properties and have not received an email invitation but would like to participate in the current Executive Survey, please click here for the current online questionnaire.

Interest in telehealth shifted into high gear over the last month as senior living providers quickly recognized the benefits of caring for residents with virtual visits as the COVID-19 pandemic unfolds.

Residents do not have to take the risk of leaving their apartments to see healthcare professionals. Visits can instead be conducted online. Timely consultations help prevent later, more costly interventions.

In a big step toward more widespread adoption, Medicare recently announced that it will reimburse for telehealth provided services for the duration of the COVID-19 public health emergency. The change covers providers such as doctors, nurse practitioners and other clinicians. The visits are paid at the same rate as in-person visits.

Telehealth companies are now fielding more requests for services from senior living providers. The use of telehealth is expected only to grow, becoming a standard tool for resident care across the senior living spectrum.

“Remote healthcare has helped us manage through this crisis,” said Richard Nolden, health center administrator at Monarch Landing, a continuing care community in Naperville, Illinois. “Telehealth is not going away.”

The growing value of telehealth was highlighted at the 2020 NIC Spring Conference.

A session titled, “Telehealth: Boon or Threat to Senior Care,” brought together experts who discussed how the technology will impact staffing, cost of care, site of care, and investment returns.

The category of telehealth covers a broad swath of interventions, noted session moderator Kelsey Mellard, CEO at Sitka, a digital healthcare solutions company. These interventions can include everything from remote monitoring of residents via wearable devices to virtual consultations with doctors who can prescribe treatments and medications.

Telehealth can reduce costs and improve care. Peer-reviewed and anecdotal evidence show up to a 40% reduction in hospital admissions with the use of telehealth in post-acute care settings, according to NIC session panelist Michael Kurliand, director of telehealth and process improvement at West Health, a nonprofit focused on lowering healthcare costs for seniors.

The panel was also joined by Robin Glass, president and chief commercial officer at Doctor on Demand, a virtual care provider.

The timing is right

The overall adoption of telehealth services is surging in the aftermath of the COVID-19 outbreak.

• Virtual health-care interactions are on pace to top 1 billion by year’s end, according to a report by Forrester Research.
• Non-COVID related medical visits are expected to reach 200 million this year, up from an original forecast of 36 million visits, said Forrester.
• March telehealth visits rose 50%, according to research by consultancy Frost & Sullivan.
• Virtual care provider Teladoc reported April 18 that it is providing more than 20,000 virtual medical visits per day in the U.S., more than double the volume of the first week of March as the coronavirus outbreak continues to drive telehealth implementation.

Senior living communities are adopting telehealth solutions.

Holiday Retirement announced in March that it is providing 24/7 telehealth access and services to the residents of its 261 communities through MeMD’s national network of healthcare providers.

Monarch Landing’s health center has been using Third Eye Health, an on-call physician service, for about a year now. Third Eye physicians are available virtually during off-hours.

The care provider or nurse on staff connects via iPad to a Third Eye doctor, available within minutes. The software is integrated with electronic health record systems, including PointClickCare and MatrixCare. Both Third Eye and primary care doctors have access to the medical records.

The doctor conducts a live video visit, assisted by the on-site provider. “Telehealth helps us manage resident care,” said Nolden. The service does not replace the primary care physician, he added, but it does help minimize emergency room visits at times when the primary care physician is not readily available.

With a current census of 74 residents, Monarch Landing is also using the iPad platform to virtually connect with specialists, such as psychiatrists and wound care nurses. These practitioners who visit multiple facilities can be a potential source of new infection during the pandemic. “We can provide service but minimize our exposure,” said Nolden.

Prior to the COVID-19 outbreak, Third Eye technology was in use at about 400 nursing homes. “Now we are doubling our business,” said Dan Herbstman, CEO and co-founder of Third Eye. The service is available nationwide. Assisted living facilities with high-acuity residents are using the service too. “Providers are accepting telehealth,” said Herbstman. “The skeptics are coming around.”

How do residents react?

“The residents are fine with it,” said Deborah Hart, CEO at Montgomery Place, a continuing care community in Chicago. “They think it’s cool.”

Montgomery Place uses Third Eye in its skilled nursing center and sometimes with independent and assisted living residents. “It doesn’t cost them anything, so they like that,” said Hart. She moved on to the campus herself in mid-March, a change that has been well received by residents. Several staffers also stay overnight in case of emergencies. “Residents feel comfort knowing that someone is here. I am one of them,” said Hart.

Communities are adopting other telehealth platforms.

Belmont Village Senior Living established new protocols in the wake of the pandemic. Routine off-site doctor visits were discouraged early on.

The company contacted residents’ physicians to ask how best to establish a virtual connection, either by Zoom, Skype, FaceTime, or some other method. The effort coincided with the change in Medicare rules that allowed for the reimbursement of virtual visits.

Belmont distributed iPads to its communities to connect residents with their healthcare providers remotely. Disposable anti-microbial iPad pouches were included to reduce contamination. “We are exercising extreme caution,” said Belmont President Mercedes Kerr.

Like other senior living providers finding success with telehealth services, Belmont is now expanding its offerings.

The company plans to roll out a virtual, after-hours physician service this May. The service will be phased in gradually at Belmont communities. And as with other providers, the service is not meant to replace primary care physicians. “It is a supplement for urgent care,” said Kerr. “We hope to reduce transfers to hospitals.”

Telehealth adoption is expected to accelerate as companies forge partnerships with large healthcare systems, insurers, and information technology companies. These big stakeholders share the goals to reduce costs and improve care.

VitalTech, for example, offers a virtual care platform. It has formed alliances with AT&T Business, the American Hospital Association, physician groups and other providers.

The VitalTech service includes wearable devices that monitor the vital signs of residents. Results are delivered via a smart phone application to the resident’s personal healthcare provider or the provider in the building. The company does not employ physicians but facilitates the connection between residents and healthcare providers.

The application includes medication management as well as a video connection to family and friends. VitalTech is a subscription service but it is being offered free for 90 days to senior living providers during the COVID-19 crisis.

Senior communities are stretched very thin, observed Ernie Ianace, executive vice president at VitalTech. He thinks senior living communities were a little behind the curve in terms of adopting new technology, but the unfortunate event of the COVID-19 outbreak is speeding acceptance of virtual care technology. “So many seniors need care,” said Ianace. “Without technology it will be impossible to serve them.”

In response to the COVID-19 pandemic and associated economic crisis, NIC has launched a number of initiatives designed to inform the seniors housing and care industry, even at today’s rapid pace of change. One of these is our “Executive Insights Survey,” which takes the pulse of hundreds of operators, representing thousands of properties across the country. Survey results and analysis are now published weekly, on this NIC Notes blog. Respondents are senior executives, tasked with leading their organizations through this existentially threatening crisis, both in terms of the health of their residents, and the viability of their businesses. Surveys are distributed weekly to assess occupancy rates, move-in and move-out rates, the development pipeline, staffing, and supports for front-line community employees and staff.

NIC has now released the second week’s “wave” of results from the survey, along with expert analysis from NIC Senior Principal, Lana Peck. While many industry stakeholders, including operators, equity and debt providers, institutional lenders, and a host of service providers, are looking at this weekly pulse check as an indicator of the pandemic’s impact on the industry’s ability to maintain occupancy rates and other key metrics, the survey is also providing insight in more human terms. As reflected in many of the comments in the most recent “NIC Leadership Huddle” webinar (another unique NIC initiative), capital providers and operator executives are fighting a tough battle, often with little support from the government, to keep COVID-19 away from their residents. Survey respondents can leave their comments and concerns, many of which reflect the impact of the crisis on a more human level.

“We feel we are alone in a war zone.”

“We do our best; under the current scenario, the worst isn’t here yet.”

Many comments reflect the reality that in most states and localities, seniors housing and care is not being prioritized for the supplies and support that it needs, despite the fact that these communities are caring for millions of high-risk frail elders. Senior executives and hourly workers alike are working long hours, struggling day and night to meet the often complex needs of their residents while simultaneously protecting them from a disease which is highly contagious, impossible to see, and can be carried for weeks by asymptomatic workers. They know that once COVID-19 gets “in,” it will be deadly, particularly for residents with the pre-existing conditions that are commonplace within these communities.

“Tough times…doing everything we can to keep our residents and staff safe.”

“Post-acute providers are getting no supplies and no financial assistance in COVID response planning. We shelter and care for the most vulnerable to the disease and yet there seems to be no incentive to help us shelter them in place while hospital beds are consumed by the 20% most affected.”

One of the key concerns reflected in survey comments is a lack of available, accurate, and timely testing. This was discussed by the panelists in the most recent “leadership huddle,” who agreed that testing is an essential component of protecting these residents – and is in dangerously short supply, is not always reliable, and sometimes takes too long to be effective.

“Lack of testing is a major concern. We have positive cases but can’t get all residents tested unless they have symptoms. By that point, it’s almost too late to do anything.”

“Given that our employees could be infected, yet be asymptomatic, it is hard to ever feel comfortable that you are doing enough.”

Another key challenge facing these leaders is the scarcity, and now the high cost, of personal protective equipment (PPE). Many report that they are straining to find sufficient PPE, which is complicating efforts to support exhausted staff, many of whom are fearful for the safety of their own families.

“One of the largest concerns we have now is when will COVID-19 peak and getting the necessary PPE to protect staff and other residents.”

“…there are few if any personal protective equipment (PPE – gloves, gowns, etc.) distributions targeted to senior care.”

“Not surprisingly, call outs have increased and availability of PPE has decreased.”

Survey respondents worry about the effect that the pandemic is having on already strained labor force issues. Many front line workers are parents who have children at home. How are they to work long shifts demanded by the additional effort to protect residents – and prepare meals, home school children, and protect their own families?

“Front line staff considering quitting and taking unemployment verse caring with no PPE and kids at home without oversight”

“Staffing becomes critical once a positive COVID resident is identified.”

“Biggest worry is labor shortages; increasing number of staff either testing positive or presumptive position and calling out because of fear. Have an all-out hiring push on, but it takes time and could be difficult because of fear of virus.”

The comments reveal a perspective that is seldom represented in media reports: that it is no easy task to fight this highly contagious killer, particularly in a senior living environment populated with frail elders who often require hands-on assistance, specialized care services, and close monitoring every day and night. Many operators are fighting to save lives, while simultaneously easing the anxieties and concerns of their residents, staff, and families.

“We have been fortunate that our staff have been able to continue their regular hours of work. Closing down our Health Center and not allowing family or friends to visit has been difficult for residents to understand. Independent living residents don’t like the social distancing. As CEO, I send out updates to residents, families, staff to make sure they are informed and know what we are doing to keep everyone safe.”

Some comments include concerns about the media and public attitudes toward the industry. Headlines on infections and deaths, sometimes characterized as occurring in “nursing homes” are on the front pages of every newspaper and are discussed in prime time on live TV. While many journalists and commenters are rightly lionizing the heroic efforts of the healthcare workers in hospitals, too often they tend to take a different tone when discussing the crisis threatening frail elders in seniors housing and care settings. The operators are noticing this, and it is highly likely that their staff is, too. A recent Op-ed in The Hill, written by Bob Kramer and Jacqueline Kung, highlights the importance of this type of press coverage – and the damage it may be doing to the sector’s ability to function.

“There is lots of confusion in the media and news about all seniors housing being the same – IL, AL and MC are not like nursing or skilled care. As an industry, there needs to be better messaging around how each product and service is different in relationship to COVID-19.”

Across this survey, and other NIC initiatives, it is becoming clear that what is most needed, in order to save lives now, is PPE, access to testing, and support from local, state, and Federal government leaders.  As Kramer and Kung point out in their Op-ed, what is not needed is the public perception that the care workers fighting to keep seniors – and the rest of us — healthy on the front lines of this pandemic are any less heroic and worthy of support than their counterparts working in the hospitals across town. Rather than pointing fingers, it would be helpful to recognize that they are humans, too.