NIC’s Executive Survey of operators in seniors housing and skilled nursing is designed to deliver transparency into market fundamentals in the seniors housing and care space at a time when market conditions are rapidly changing—providing both capital providers and capital seekers with data as to how COVID-19 is impacting the sector.

This Wave 11 survey sample includes responses collected August 17-30, 2020 from owners and executives of 56 seniors housing and skilled nursing operators from across the nation. Detailed reports for each “wave” of the survey can be found on the NIC COVID-19 Resource Center webpage under Executive Survey Insights.

Wave 11 Summary of Insights and Findings

Over the summer months, much of the southern and western portions of the nation experienced a surge in COVID-19 outbreaks. More recently, this has been followed by a flattening in the number of new cases reported daily. Although some areas of the country are seeing increasing cases of COVID-19, many seniors housing and care organizations are continuing to ease move-in restrictions. The Wave 11 survey revealed generally little change in the pace of move-ins and move-outs in the past 30-days from Wave 10, and greater shares of organizations with higher levels of acuity in their properties—nursing care beds and memory care units—reporting month-over-month and week-over-week improvements in occupancy rates. About half (48%) of organizations with independent living units and 40% with assisted living units report no change in month-over-month occupancy. More organizations with assisted living units note a deceleration in the pace of move-ins and slower increase in occupancy rates than in Wave 10.

• In Wave 11 of the survey, increased resident demand continued to be cited as the primary reason for accelerations in move-ins in the past 30-days (70%), and notably fewer organizations in Wave 11 than in Wave 10 cited a slowdown in leads conversions/sales (48% vs. 70%). Hospital placement (due to more elective surgeries and rehabilitation therapies resuming) has grown considerably since Wave 9 (responses collected June 22 to July 5, 2020). However, notably more organizations in Wave 11 than in all of the prior waves of the survey cited resident or family member concerns (74%), presumably due to new spikes of COVID-19 cases in many areas of the country or possibly due to restrictions on family member visitation rules imposed by some states.
• The shares of organizations reporting acceleration in move-ins in Wave 11 of the survey remained similar to Wave 10 for the independent living, memory care and nursing care segments. However, fewer organizations with assisted living in Wave 11 than in the prior two waves of the survey report an acceleration in the pace of move-ins, and more than one-third (38%) note a deceleration.
• Compared to the Wave 10 survey (and all prior waves, as well), the shares of organizations reporting a deceleration in the pace of move-outs for the independent living care segment increased to the highest level in the Wave 11 survey. Most organizations with independent living, assisted living and/or memory care segments (60% to 64%) note no change in the pace of move-outs in the past 30-days, while about three-quarters with nursing care beds (75%) report no change.
• Most organizations are not currently offering rent concessions to attract new residents (59%). That said, more organizations report offering rent concessions in Wave 11 than in the prior survey (41% vs. 34%). While, one-third of organizations report a backlog of residents waiting to move in, the majority of organizations—about seven in ten—do not.
• Larger shares of organizations with memory care units and/or nursing care beds in their properties report increasing occupancy from one week prior (31%, respectively)—an improvement from Wave 10 but similar to Wave 9. However, four out of five organizations with independent living and/or assisted living care units (83%, respectively) report no change in week-over-week occupancy.
• Organizations with nursing care beds continue to report the largest shares of increasing occupancy on a month-over-month basis. In Wave 11, half (50%) report an upward change in occupancy from the month prior, similar to Wave 10 (53%). Additionally, more organizations with memory care units note increases in occupancy (40% vs. 20%).
• Two-thirds of organizations in Waves 10 and 11 reported that COVID-19 test results for staff, residents or prospective residents are typically available in 3-5 days (67%). However, one in five (20%) received test results in as few as 2-days—an improvement since Wave 10 (13%).
• Due to the pandemic most organizations (83%-85%) have bolstered staffing deficiencies with additional overtime hours. Additionally, a growing percentage of survey respondents report tapping agency or temp staff (48% in Wave 11 vs. 36% in Wave 3) adding to increasing costs since the pandemic began.

Wave 11 Survey Demographics

• Responses were collected August 17-30, 2020 from owners and executives of 56 seniors housing and skilled nursing operators from across the nation. Roughly half of respondents are exclusively for-profit providers (56%), about one-third (33%) are exclusively nonprofit providers, and 11% operate both for-profit and nonprofit seniors housing and care organizations.
• Owner/operators with 1 to 10 properties comprise 59% of the sample. Operators with 11 to 25 properties make up 18% while operators with 26 properties or more make up 23% of the sample.
• Many respondents in the sample report operating combinations of property types. Across their entire portfolios of properties, 72% of the organizations operate seniors housing properties (IL, AL, MC), 24% operate nursing care properties, and 39% operate CCRCs (aka Life Plan Communities).

Key Survey Results

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 11, fewer organizations with assisted living reported an acceleration in the pace of move-ins than in Waves 9 and 10. More than one-third (38%) noted a deceleration.
• However, the shares of organizations reporting acceleration in move-ins in Wave 11 of the survey remained similar to Wave 10 for the independent living, memory care and nursing care segments. In Wave 11, between 33% and 41% of organizations with these care segments indicated that the pace of move-ins accelerated in the past 30-days.

Reasons for Acceleration/Deceleration in Move-Ins

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

• Increased resident demand continued to be cited most frequently as a reason for an acceleration in move-ins in the past 30-days (70%). Hospital placement cited as a reason for acceleration in move-ins has grown since Wave 9 (responses collected June 22-July 5, 2020).

• Regarding reasons for a deceleration in move-ins, resident or family member concerns reached the highest level in the time series. While notably fewer organizations in Wave 11 than in Wave 10 cited a slowdown in leads conversions/sales (48% vs. 70%), considerably more organizations in Wave 11 than in all of the prior waves of the survey cited resident or family member concerns (74%).

Organizations Easing or Increasing Move-In Restrictions

Respondents were asked to describe whether they were easing or increasing move-in restrictions in some or all of the geographies in which they operate.

• Roughly two-thirds (63%) of organizations with multiple properties in their portfolios were easing move in restrictions in some or all of their geographies in Wave 11, compared to roughly half in Wave 10. About one-third (33%) were neither increasing nor easing move-in restrictions. However, fewer than one in ten (8%) indicated they were increasing move-in restrictions in all of their geographies. Among single-site organizations, roughly half were easing move-in restrictions (47%), but none were increasing move-in restrictions.

Organizations Currently Offering Rent Concessions to Attract New Residents and Organizations Experiencing a Backlog of Residents Waiting to Move-In

Respondents were asked: “My organization is currently offering rent concessions to attract new residents,” and “My organization is experiencing a backlog of residents waiting to move-in”

• Most organizations are not currently offering rent concessions to attract new residents (59%). However, more organizations report offering rent concessions in Wave 11 than in the prior survey (41% vs. 34%). The majority of organizations—about seven in ten—do not currently have a backlog of residents waiting to move in.

Move-Outs

• Roughly two-thirds of organizations with independent living, assisted living and/or memory care segments (60% to 64%) in Wave 11 of the survey note no change in the pace of move-outs in the past 30-days, while about three-quarters with nursing care beds (75%) report no change. This has been largely consistent since the survey began in March.
• Compared to the Wave 10 survey (and all prior waves, as well), the shares of organizations reporting a deceleration in the pace of move-outs for the independent living care segment increased to the highest level in the Wave 11 survey.

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)”

• Many organizations continue to report improvements in occupancy rates since the beginning of the survey in March. The nursing care segment had the largest shares of organizations with increasing month-over-month occupancy. In Wave 11, half (50%) report an upward change in occupancy from the month prior, similar to Wave 10 (53%) and the most since NIC began conducting this survey.
• In Wave 11, about half (48%) of organizations with independent living and 40% with assisted living report no change in month-over-month occupancy.
• Fewer organizations with assisted living units in Wave 11 than in Wave 10 report increases in occupancy rates (17% vs. 30%), however, more organizations with memory care units note increases in occupancy (40% vs. 20%).

• The chart below shows the entire time series of assisted living care segment month-over-month occupancy change data for each wave of the survey between March 24 and August 30, 2020. The data is illustrative of effects of the pandemic on seniors housing occupancy rates during the pandemic and the trend is similar to the NIC MAP^® Intra-Quarterly Snapshot data reported beginning in March.
• Indeed, the new Intra-Quarterly database shows that the largest decline in assisted living stabilized occupancy occurred early during the second quarter in the April reporting period, the first full month of the COVID-19 pandemic in the US. In the April reporting period (defined as the February-March-April rolling period), occupancy for assisted living for the Primary Markets fell 1.8 percentage points to 86.0%. The decline in May was less at 0.8 percentage point (to 85.2%), and the decline in June was even less at 0.6 percentage point (to 84.6%). However, in July, the drop in occupancy accelerated to a full 1.7 percentage points to push the overall rate to 82.9%. Total occupancy was even lower at 80.5%, a new record low. This decline, after two months of seemingly better occupancy patterns, likely reflects the recent growth in COVID-19 cases in many parts of the country.
• In Wave 4 of the survey (responses collected April 20-April 26, 2020) four out of five of organizations reported occupancy declines from one month prior (81%). Occupancy rates began to improve in Wave 8 (responses collected May 25-June 7, 2020), with the highest shares of organizations reporting increases in occupancy in Wave 10 than at any other time during the survey (30%).
• In Wave 11, the largest share of organizations with assisted living report no change in month-over-month occupancy (40%) since Wave 1 of the survey when about half indicated no change (54%).

• Regarding the change in occupancy from one week ago—about four out of five organizations with independent living and assisted living care segments (83%, respectively) report no change in week-over-week occupancy. However, larger shares of organizations with memory care units and/or nursing care beds in their properties report increasing occupancy from one week prior (31%, respectively)—an improvement from Wave 10 but similar to Wave 9.

Time Frames for Receiving COVID-19 Test Results

Respondents were asked: “Regarding COVID-19 test results (either for staff, residents or prospective residents) results typically come back within…”

• Two-thirds of organizations continue to report that COVID-19 test results for staff, residents or prospective residents are typically available in 3-5 days, however, more organizations in Wave 11 received test results within 2 days than in Wave 10 (20% vs. 13%).

Labor and Staffing

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

Note: this question was asked in Wave 3, Wave 10 and Wave 11.

• Respondents offering overtime hours has remained steady (between 83% and 85%) with regard to backfilling staffing shortages since the beginning of the pandemic. However, organizations are increasingly using agency or temp staff to fill staffing vacancies. In Wave 11, roughly half of respondents are tapping agency or temp staff to mitigate staffing shortages.

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. The results of our joint efforts to provide timely and informative data to the market in this challenging time have been significant and noteworthy.

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 upcoming Executive Survey: Market Fundamentals, please send a message to insight@nic.org to be added to the email distribution list.

A recent study from North Carolina State University and Georgia Tech found that healthcare workers in the United States are struggling with significant mental-health challenges during the COVID-19 pandemic, including depression, anxiety, and insomnia. While all healthcare workers are at risk, one key feature of caregivers in a seniors housing and care setting is that many of these caregivers have spent months, if not years, developing relationships with the residents they serve and their families. This means the emotional toll experienced by these staff may be that much more overwhelming.

Adding to the stress load is that filling staffing gaps amidst the pandemic has become even more difficult, stretching existing staff thinner. While attracting and retaining personnel has long been an issue for many seniors housing and care operators, the current crisis has exacerbated this challenge. The most recent wave of NIC’s Market Fundamentals survey indicated that 85% of organizations were offering overtime hours to mitigate labor shortages and 42% were tapping agency or temporary staff.

Late last month, NIC’s Leadership Huddle webinar, “From Pro Sports to Senior Care: Innovations in Testing, Tech, and Protection,” offered a glimpse into the future of COVID-19 testing with a discussion of the saliva-based test under development at Yale University and funded by the NBA and the National Basketball Players Association. The Food and Drug Administration (FDA) this week issued an emergency use authorization approval allowing public use of the test.

While very different in terms of scope, demographics, access to resources, and scale, the NBA has faced some of the same challenges that senior living operators face today and their methods to curtail the spread of the virus among players and staff are proving successful. Frequent testing, that’s affordable and delivers more rapid results, has been a key part of the strategy.

Saliva Testing Provides Rapid Results

The FDA early use authorization approval will allow labs to begin using the test more widely. The hope is that labs across the country will soon provide saliva tests at scale. Leadership Huddle speaker Robby Sikka, an anesthesiologist by training and currently VP of Basketball Performance for The Minnesota Timberwolves noted, “This is a cheap, asymptomatic screening test that can be run rapidly.” Without the need for swabs and for more time-consuming lab work, the test would be quick, comfortable, and lower-risk to administer. He claimed the test is “90% sensitive compared to nasal pharyngeal swabs.”

Learn more about the professional sports league’s efforts to contain the virus − including the use of saliva-based testing − and gain insight on the latest developments in testing, wearables, and protocols in this Leadership Huddle Recap on the NIC Notes blog.

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The COVID-19 pandemic is far from over, and still threatens older adults. Operators are implementing new protocols to keep residents safe, but the future is still very unclear, particularly regarding the duration of the pandemic. As a result, operators are shifting their approach from a sprint, dealing with immediate, life-threatening emergencies, to a marathon without a known finish line. In NIC’s tenth “Leadership Huddle” webinar, operators, joined by an executive coach, discussed how they are shifting to this new paradigm, and how this longer-term vision of the pandemic will impact psychology, overall costs, and the bottom line.

NIC Chief Economist, and moderator, Beth Burnham Mace, began the discussion by acknowledging that, “Many of the challenges that were evident in the early days of the pandemic remain, unfortunately.” She mentioned the continued need for adequate PPE and pointed to the need for timely testing: “In recent weeks we have seen that the turnaround time for test results is inadequate. If tests are meant to be helpful and an effective surveillance tool, we need to act further on this.” She also encouraged operators to continue to improve transparency and trust, by providing data to NIC as part of the effort to track and understand the impact of COVID. “As the COVID-19 pandemic has developed, it has become increasingly clear that the availability of data on seniors housing and skilled nursing communities is vitally important,” she said.

From Sprint to Marathon

The panelists started off by reminding attendees of the scale of the sprint so far. Lynne Katzmann, Founder & CEO, Juniper Communities, by way of introduction, shared some numbers illustrating the effort her organization has put in during the pandemic: “1,500 or more days that associates sheltered in place, the 2,000 separate, different, communications to families that I authored, 5,100 status reports, 6,400 personal calls, and more than 2,500 virtual programs that we put together.”

Katzmann outlined how her organization was moving from that initial sprint to a longer-term challenge, saying, “how we look at the world has shifted.” She outlined a three-phase approach to the pandemic: “phase one is crisis management, phase two is what we’re calling the path forward, and phase three is something that will be a new normal.” Now in the second phase, her organization’s goals are, “to restore profitability while keeping our residents and our associates healthy, safe, and engaged.”

“What’s most noticeable about the paradigm shift is how we look at the world, and I think this is true not just at Juniper but for all of us. I think we can simply say that the new certainty is uncertainty.”

A key to Katzmann’s strategy at this stage is to jump-start move-ins through a variety of adjustments, including doubling the sales team, doubling her digital spend, and changing the way the organization communicates and “packages” its offering to consumers. Underlying the new approach is a new vision, “What’s most noticeable about the paradigm shift is how we look at the world, and I think this is true not just at Juniper but for all of us. I think we can simply say that the new certainty is uncertainty.”

Lori Alford, Co-Founder & COO, Avanti Senior Living, agreed that the sprint has become a marathon, adding, “Now we’ve embraced it being a journey. COVID is here, it’s not going away, there’s not a finish line that we can see anytime soon.” Her company has begun to focus on shifting mindsets. She explained, for example, how sales staff have had to adapt to the loss of the opportunity to walk prospects through their properties: “that’s been taken away from us.” Adapting to such challenges, by employing virtual tours, in this case, needs to be viewed as a new normal, which, she said, “is not wrong, it’s just different.”

Mental Health Impacts

Asked about mental health impacts of the pandemic on staff, Dan Brown, Executive Coach, Arden Coaching, pointed out that the impacts can be severe, particularly on frontline care givers. He discussed the high rate of suicides among doctors, which is double that of the overall population. “This isn’t something that’s abstract or theoretical. It’s actually happening.” In response to high stress levels, operators, administrators, even investors, according to Brown, should be attuned to the signs of high stress amongst frontline workers. He said he listens for maladaptive thoughts, or feelings, and whether they are persistent. “One of the feelings that you really want to listen to, when you’re working with people on the front line, is a feeling of guilt, that ‘I can’t do enough.’”

Another thing to look for is an “incongruence,” such as smiling or laughing upon the loss of a patient or resident. “There could be emotional numbness…that, too, is a worrying sign that something may need to be addressed; that they’ve lost touch with their own emotion, their own humanity.” He suggested gently observing and checking in with staff showing these types of signs of stress. He recommends that his clients, most of whom are administrators, have the national suicide hotline number on hand at all times, for immediate intervention in such cases. He also suggested using wearables to monitor their own stress levels, and techniques such as meditation to help control the impact of stress.

Alford has begun to focus on mental wellness in her company. She said, “families are tired, residents are tired, our teams are extraordinarily tired, not just mentally from all of the changes, but the physical draining of being up late to take calls because families are in panic, or keeping the staff calm…they have a mental fatigue and they have a physical fatigue…COVID fatigue is very, very real.” She has found that traditional team motivations, such as, “high-fiving people, passing out candy bars, passing out kudos, sending flowers and adult beverages to their homes” which were effective pre-COVID, are no longer sufficient.

Taking a different approach to deal with the stresses of COVID, Alford’s home office and executive team are engaging in a six-week coaching program, focusing on individual needs and shifting to a more positive approach to dealing with the new normal. “We’re all learning together and it’s OK. Shifting into this more positive mind-set has been incredible; you can see the team standing taller…they bring that home to their families and so if we can get our key folks in the communities to not only lead their team and residents and families, but can send them home and be that great leader at home too, its just a well-rounded approach and makes a difference.” With the positive results of the program, Alford said the organization plans to extend the program to department heads, and eventually to line staff and nurses. She said, “We’re a lost industry. We’re invisible. Because we don’t work in a hospital or a skilled (nursing community), we often times forget our folks on the frontline. They’re facing it every single day, probably a little bit more than even some of the other healthcare workers, and they need just as much support.”

Katzmann shared that the pandemic, particularly early on, was very hard on her own emotional wellbeing. “I learned that I couldn’t work hard enough, and nothing that I did could control some of the outcomes. The sadness and the feelings of guilt…were really difficult, and I think it’s important for each of us to acknowledge that we have feelings and that this has impacted us at every level. That vulnerability in myself enabled me to accept that vulnerability in others.” She pointed to the “great source of support and strength and solutions,” provided by her peers in the industry, which she said has been very supportive. “You know the hashtag at the beginning of all this was, ‘we’re all in this together’…regardless of what side of the industry you play with every day, we are all in this together. At the end of the day we all benefit when we all do well at the end, so we need to support one another through this.”

The Importance of Testing

Shifting gears, Mace asked the panel, and in particular Katzmann, who she described as “one of the leading experts on how to go about (testing) as an operator,” to share “what you’ve learned about testing, where we are today, and where it needs to get to.” Katzmann described reading about how Asian nations, which experienced COVID-19 ahead of the U.S., instituted mass testing early on, and how effective that proved to be. Speaking of the successful South Korean strategy, she said, “Their strategy is simple: test early and universally, regardless of symptoms.” She explained how that approach identifies who is carrying the virus, which then allows for effective contact tracing and isolation. “If you do it early enough, everyone doesn’t have to be isolated.” Katzmann said that Juniper made the decision in late March to test everyone, and that, at the time, “We thought we would do it once.”

“No one was actively symptomatic in our communities and guess what we found? Roughly 50% of our residents and staff were positive.”

Using a private lab, they tested all their residents and associates in hot spot areas. Katzmann relayed how their first test went: “No one was actively symptomatic in our communities and guess what we found? Roughly 50% of our residents and staff were positive.” Of those, according to Katzmann, “94% of our staff and 72% of our residents were not showing any symptoms, no matter how mild. The vast majority of those never showed symptoms. This was April 4^th when we’re getting this information. All of a sudden, we knew that this disease was not being transmitted the way everyone was being told. This disease is transmitted by asymptomatic and presymptomatic individuals.”

With their testing data, Katzmann’s team was able to put together a “battleplan,” which involved creating “bubbles,” and sheltering in place. “We thought we could keep it out and within three weeks COVID would not be an issue,” said Katzmann. Of course, when they realized that wasn’t the case, Juniper, in addition to infection prevention strategies, cleaning, disinfecting, and PPE, realized they would have to test regularly to prevent the spread of disease within their communities. Since then, the company has been testing all associates who have not tested positive in the past, and a number of residents, based on state and level of care. “The thought is that the disease is being transmitted from the outside in, and that if we can catch it early enough, before it spreads within the community, and use proper PPE, we do universal masking, we’re still cohorting, although not at the same level we were earlier, we’ve been able to keep the disease at bay.”

Additional Costs

“we did spend $100,000 a week on testing. So, if you have 1,000 employees and the test is a hundred bucks, you do the math.”

Asked about cost, Katzmann said, “we did spend $100,000 a week on testing. So, if you have 1,000 employees and the test is a hundred bucks, you do the math.” She went on to say, “until there is a vaccine, and not just a vaccine but a vaccine that’s proven, that’s taken by enough people to develop herd immunity, effectively, we must find a way to mitigate the spread of this disease, and I believe rapid, accurate, cost-effective testing is the only way to do that.” She described a number of initiatives designed to streamline the testing process, some of which will also help reduce costs, and suggested new testing technologies will likely drop costs while improving ease-of-use. A new cheek-swab test may soon drop costs to $50-$60 per test. “We’ll be doing it for a long time and eventually it will look like a pregnancy test,” Katzmann summarized, adding, “it’ll be much cheaper and much easier to administer.”

Alford also addressed the impact of COVID costs, likening the new normal of dealing with COVID to the additional preparation, regulatory requirements, and processes in place where hurricanes are a risk. She discussed the likelihood of regulatory requirements which would mandate such things as PPE supplies, testing, cleaning and chemical supplies, all of which would likely impact the cost of doing business.

Questions on the New Normal

NIC Senior Principal, Healthcare, Ryan Brooks posed some attendee questions to the panelists. The first was on hero- or hazard-pay, and how big a role it plays in beating fatigue, and whether it’s cost-prohibitive to offer long-term. In response, Alford said that while her organization used hero pay early on, they have since done away with it. “In order to do that you just have to have a really good culture and programs in place.” Katzmann had a similar position, adding that communication around the issue is critical.

Responding to a question on facility design and architecture, Katzmann discussed the use of ‘neighborhoods’ as a means to cohort and isolate small groups of residents and staff, while providing a degree of socialization. “I think you’re going to see more neighborhood, small house design in the future.”

According to Brooks, many questions centered on the counseling program offered by Avanti Senior Living. “We’ve been fire-hosed with negativity,” responded Alford. “It doesn’t matter what the topic is; it seems every time we turn around the news is just filled with negativity. It’s been really, really hard. So, the focus is really mind-shifting from old habits…how do you shift your mind in a positive way, so that you can reflect inward first, believe in yourself, believe in your company, and then strategize, which then leads to results.” She said, “what we were doing in January doesn’t work anymore,” and suggested that this kind of counseling can benefit entire organizations, saying, “any leader deserves access to that, and it does make a difference, and so we’re looking at actually crafting a program that can be ongoing for our teams.”

Another question addressed the impact of COVID on consumer demand. Katzmann said that Juniper, in the last several weeks, “has seen leads skyrocket to levels that are about 30%-40% above the same period last year,” and suggested the rise is due to immediate need. “How that will translate into the type of demand that we experienced before, a mixture of immediate and longer-term need, will be difficult to know at this point in time.”

Katzmann also mentioned a recent Pro Matura study, which looked at what adult children, particularly eldest daughters, wanted when looking at options for their parents. “They wanted a clean and disinfected environment. They wanted to know that there was regular testing, and they wanted to know that there was access to primary care onsite.” While surprised at the finding, Katzmann sees it as evidence that demand is there. She ended her comments on the subject by asserting that, while it may take time, the industry will be able to restore their bottom line performance, but, Katzmann warned, “We’ll have to be creative, we’ll have to be continuously resilient, we’ll have to adapt, but most importantly…people have to have the cash wherewithal to ride the storm. We are still in the storm and it’s very important to be able to get through it successfully. We can get through it, but people need the support during that process.”

Contact tracing has emerged as a first-line defense at senior living communities in the fight against the pandemic. Knowing who has tested positive for COVID-19 and being able to identify their contacts has helped to keep community outbreaks in check.

While many providers rely on manual systems to conduct contact tracing, new technologies show promise to assist in the process to ensure resident and staff safety.

Take, for example, Kisco Senior Living. The Carlsbad, California-based company installed Accushield touchscreen kiosks at its 20 properties. Everyone entering the buildings—employees, outside providers, and visitors—are screened at the kiosks daily.

Individuals sign in at the kiosk which records the time, date, and, if applicable, who they’re seeing. The individual answers a series of screening questions about their current health condition. The questions can be customized to better identify those who might be at high risk for exposure to the virus. An immediate alert is generated if the individual has tested positive in the last 30 days.

Temperatures are checked manually at the kiosk, though an automated infrared temperature scanner is now being rolled out to expedite the process. Individuals who pass the screening receive a photo badge to wear while on site, an assurance for residents that the individual is authorized to be in the building. Individuals sign out at the kiosk when they leave the building.

Executive directors can log on to a dashboard to monitor data collected at the kiosk. If a home health agency, for example, calls to say an employee of theirs tested positive, Kisco can quickly access the records to determine which residents might have been exposed.

Of course, successful contact tracing relies on the ability to test those at risk. Kisco conducts surveillance testing depending on local mandates and whether the positivity rate in the county is 5% or higher. “We are data driven,” said Ed Ward, vice president of operations at Kisco.

Twenty-five percent of employees and outside providers are tested every two weeks. Residents are tested free of charge if they ask for a test. If a positive test is found, 100% of employees are tested every two weeks until two testing cycles show no positive cases.

“The Accushield system has proved to be exceptionally helpful with contact tracing,” said Ward. “Families and residents have a higher level of security and peace of mind.” He added that the company has initiated a campaign—Kisco Confidence—focused on the wellbeing, safety and security of all residents and associates.

Screening Advances

For years, senior living providers have mostly relied on manual sign-in logs to monitor who is in a building. But using these logs to conduct contact tracing can prove difficult, building operators say. Hand-written logs can be hard to read or may be incomplete. Interviews with staff and residents to recall their contacts may not produce an accurate report.

CarePredict launched an automated contact tracing product March 31 called PinPoint. It is an add on to the company’s monitoring solution that uses wearables and beacon technology to chart resident activity.

The PinPoint product allows facility staff to quickly identify all residents, staff, and visitors exposed to a suspected virus carrier. A report provides a breakdown of contacts, location and duration of contact.

“It’s a tool to break the chain of spread,” said Jerry Wilmink, chief business officer of CarePredict, which has offices in Fort Lauderdale, Florida, and Menlo Park, California.  

Contacts are classified by risk, so the staff can test and isolate those who pose the most significant threat. Another advantage, according to Wilmink, is that the Pinpoint solution reveals which individuals have not been exposed so they don’t have to be isolated. “They can get their life back,” he said.

CarePredict is being used at more than 20 communities, said Wilmink. Inquiries from Arizona, Texas and Florida have increased recently because of the uptick in COVID-19 cases there.

Costs of automated visitor management and contact tracing systems typically include installation and monthly subscription fees.

Many operators use a combination of approaches to trace cases. Montgomery Place, a life plan community in Chicago, has an automated check-in system for employees, visitors and outside service providers. The check-in system was enhanced in the wake of the pandemic with health questions and temperature screens.

COVID-19 cases are tracked manually. But the information is entered into the community data base system to generate email and cell phone alerts for the staff, residents and family members. “We know automated tracing technology is out there,” said Deborah Hart, executive director at Montgomery Place. “But I’m not going ‘Big Brother’ and putting chips on people. I’m not there yet.”  

With different tools available, communities are sorting through the options. “We are debating automated contact tracing,” said Nancy Kao, executive director at The Forum at Rancho San Antonio, Cupertino, California. LCS is the management company. Contact tracing is currently done manually.

The life plan community is undergoing a $100 million repositioning that incorporates a lot of technology. The new memory care building, for example, includes a GPS tracking system for residents.

Kao chairs the Innovation Council at LCS, which manages about 140 senior living properties. The Council evaluates different products and recommends best practices.

“Communities are reaching out for more guidance on technology because of COVID-19,” said Kao. “Every community is in a different place on the adoption of technology.”