Jobless Rate Slides Back to 8.4% in August

The Labor Department reported that nonfarm payrolls rose by 1.4 million in August and that the unemployment rate fell to 8.4% from 10.2%.

The Labor Department reported that nonfarm payrolls rose by 1.4 million in August and that the unemployment rate fell to 8.4% from 10.2%. This suggests that the employment recovery from the unprecedented COVID-related drop in March and April continues to reverse course. Eleven million jobs have now been recovered during the May to August period. Nonetheless, the level of payrolls remains about 12 million below where it was in February. Sept 8

The 1.4 million job gain in August was smaller than in the prior three months, but was significant, nonetheless. The change in total nonfarm payroll employment for June was revised down by 10,000 from a gain of 4.791 million to 4.781 million and the change for July was revised down by 29,000 from 1.763 million to 1.734 million. Combined, 39,000 jobs were subtracted to the original estimates. Monthly revisions result from additional reports received from businesses and government agencies since the last published estimates and from the recalculation of seasonal factors. Market expectations had been for a gain of 1.350 million. 

August hiring was helped by the employment of 238,000 temporary field workers for the 2020 Census. Census hiring could rise further in September before slipping later in the year as those positions are no longer needed. However, other sectors also saw impressive gains, with retail adding 249,000 jobs, leisure and hospitality, 174,000 jobs and professional and business services up 200,000 positions. In July, leisure and hospitality sectors had added 621,000 jobs as COVID-related jobs come back.  

Health care added 75,000 jobs in August, with gains in offices of physician, dentists, hospitals, and home health care services. Job losses continued in nursing and residential care facilities.  

The 1.8 percentage point drop in the August unemployment rate to 8.4% was good news and driven by a 3.8 million person increase in the household measure of employment and occurred despite an increase in the labor forces of nearly 1 million. The increase in the labor force in turn may be the result of the expiration of jobless benefits at the start of the month which pushed some workers back into the labor force. At 8.4%, however, the unemployment rate is still quite elevated by historic standards and significantly higher than the 50-year low of 3.5% in February.

The number of permanent job losses rose 534,000 in August to 3.2 million from 2.9 million, a figure that suggests difficult time for a number of Americans. Moreover, more than 29 million workers remain on government assistance and the number of unemployed remain 5 million above where it was pre-pandemic. 

Among major worker groups, the unemployment rate fell in August for adult men to 8.0%, adult women to 8.4% and teenagers to 16.1%.  

The underemployment rate or the U-6 jobless rate fell to 14.2% in August from 16.4% in July. This figure includes those who have quit looking for a job because they are discouraged about their prospects and people working part-time but desiring a full work week. In the previous 2008/2009 recession, this rate peaked at 17.2%.

Average hourly earnings for all employees on private nonfarm payrolls rose by $0.11 in August to $29.47, a gain of 4.7% from a year earlier.  

The labor force participation rate, which is a measure of the share of working age people who are employed or looking for work increased 0.3 percentage point in August to 61.7%.  

While the August improvement is welcome news, the labor market continues to be strained and the recent spike in the virus across many states could hamper further gains. Indeed, some states are backtracking plans to reopen as coronavirus infections are rising again.

Executive Survey Insights | Wave 11: August 17 to August 30, 2020

NIC’s Executive Survey of operators in seniors housing and skilled nursing delivers transparency into market fundamentals in seniors housing and care.

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.

Staff Mental Fatigue and Burnout: The Hidden Toll of COVID-19

Caring for the mental health of senior care staff during the pandemic is essential so they can continue providing compassionate care for residents.

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.

A Pandemic of Grief

In the initial months following the COVID-19 outbreak, much of the media focus was on hospital emergency room and ICU staff – those who would most traditionally be considered as the frontline healthcare workers. There has also been coverage of long-term care and senior care resident well-being and the impact of social isolation and loneliness on resident mental and physical health. What seems to get less attention is the impact of the pandemic on seniors housing and care staff. These staff have been facing high levels of stress resulting from many months of continued crisis as they seek to protect and care for residents while observing the latest infection control protocols. They have also been coping with forced isolation and, in some instances, death of residents for whom they have become the only ‘family.’ Finally, they carry the burden of concern for their own families’ health and safety.

Increasingly, however, these frontline workers are sharing their own deeply personal experiences of mental anguish, symptoms of post-traumatic stress disorder, and burnout. Many have highlighted these experiences to draw attention to the plight they and their colleagues are experiencing to reinforce that these workers absolutely should be considered frontline healthcare workers, and to underscore their need for supportive mental health services.

Tools for Identifying At-Risk Workers

The University of North Carolina School of Medicine, UNC Health, and Google have launched a mobile app that is designed to provide healthcare workers with mental health resources. The Heroes Health app is designed to identify mental health stress among healthcare workers and apprise leaders about the times of day or particular units that might need additional support, without identifying specific employees.

Healthcare workers complete weekly questionnaires on symptoms related to various mental health conditions. These questionnaires then feed summary reports of the user’s symptoms and trends over time. The summary reports include an assessment of their sleep quality, anxiety, and potential PTSD symptoms.  

Additionally, apps like Headspace and The Breethe meditation app are supporting healthcare workers by offering free access to their platforms in an effort to help mitigate the stress and anxiety felt by those who are caring for sick patients and residents. Such access includes breathing exercises to reduce stress and meditation for anxiety.

Proactive Coping Strategies

Given the high-stress nature of frontline healthcare roles, forward thinking operators are striving to combat the mental fatigue that working during a pandemic poses to their staff. It is crucial to find ways to support staff mental health and provide them with tools for managing the very real personal toll this crisis is taking on them. As an example, frontline caregivers may find themselves restarting old habits like smoking amid the stress. Without effective mitigation strategies, there is going to be a great deal of burnout, and the risk of these staff leaving the field going forward.

Overcommunication

Overcommunication is one of the strategy pillars Aegis Living has employed throughout the pandemic to keep staff current on the latest information. In the early days of the pandemic, these were daily communications that served to provide the most up-to-date information. These frequent touch points with staff provide leadership the opportunity to connect with their staff, to validate their experiences, and to be a source of support and encouragement for them. As Aegis Living President Kris Engskov has stated, these interactions were in part “to be a cheerleader” for staff. These points were further emphasized during the most recent NIC Leadership Huddle: Coping with the Pandemic held on August 17 when Lori Alford, Co-Founder and COO of Avanti Senior Living and Lynne Katzmann, Founder and CEO of Juniper Communities discussed “COVID-fatigue” and its impact on staff.

Managing Staff Emotions

As residents have become ill or passed away, staff and caregivers are understandably grieving. However, the work of caregiving and supporting residents and their families does not go away during the grieving process. Staff need support from one another, and to be able to talk and listen to each other, sharing feelings of anxiety, grief, panic, or guilt. While staff are all sharing in collective grief, leadership should reinforce with staff that this is in no way indicative of their failing.

The unfortunate reality of the pandemic is that residents may get sick despite all that staff do to protect and care for them. Given all these stress factors facing staff, managers should be on the lookout for warning signs, such as distractions while on the job, incomplete work, irritability with families or clients, and emerging lateness or absence from work which did not exist previously. Operators should also be encouraging staff to seek professional help as needed, especially as tele-mental health services have become increasingly available. Remind staff that there is no stigma in doing so. Empathy and understanding are key when addressing these issues and encouraging staff to seek help.

As Executive Coach Dan Brown of Arden Coaching pointed out during NIC’s recent Leadership Huddle, operators and administrators should be attuned to the signs of high stress amongst frontline workers. Brown 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.’”

Advising Staff

One of the most important aspects to keep in mind when considering the mental health and well-being of senior housing and care staff, is that staff cannot consistently offer great care to residents unless they are taking care of themselves. This may mean remembering to schedule their own relaxation time, whether that is a warm bath, an in-home movie, a favorite food, or a glass of wine.

Staff are going to be worried about bringing the virus into their own homes, so operators need to be providing regular testing for staff as well as reminding them to follow safety protocols at work, and to shower and change their clothes before engaging with family members at home.

One thing is clear – there will be no resolution to the pandemic anytime soon. The mental toll that it is having on frontline caregivers is real and could be extremely detrimental if this brave and needed workforce succumb to depression, PTSD, and other mental health challenges. As the battle with COVID-19 shifts from a sprint to a marathon, one of the key tasks of executive leadership teams and management at all levels is to be attuned to and address the mental health of their staff. Caring for the mental health of staff—especially during a pandemic that has caused high levels of mental stress and fatigue, and profound depths of grief—is essential to avoid burnout and enable staff to continue providing great, compassionate care for residents.  

 

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COVID-19 Testing Method Discussed in NIC Leadership Huddle Gains FDA Approval

The FDA issued an emergency use authorization approval allowing public use of the COVID-19 saliva-based test discussed during the NIC webinar.

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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NIC Leadership Huddle | Coping with the Pandemic: Shifting from a Sprint to a Marathon

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.

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.

huddle10-speakers

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 4th 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.”