As senior living providers are hitting critical mass in their Covid-19 vaccination efforts, they are taking a big step toward normalcy by resuming more regular visitations.
As Covid-19 swept across the United States last spring, senior living communities shut their doors to almost all visitors — including residents’ family members. In the ensuing months, isolation has taken a steep toll on residents, and some senior living providers reported that fear of being cut off from loved ones was an even bigger deterrent to move-ins than fear over being infected with Covid-19.
While providers have hit on creative ways to connect residents and family members, more normal visitation at last seems within reach.
Two weeks ago, Kentucky Gov. Andy Beshear announced that visitations could resume at non-Medicare-certified long-term care facilities including assisted living facilities, personal care homes, intermediate care facilities for individuals with intellectual disabilities and independent living facilities — as long as those facilities have gone through vaccine clinics.
Kentucky is not alone. Tennessee Department of Health Commissioner Dr. Lisa Piercey said that the Volunteer State will end restrictions on long-term care facilities on February 28, and Michigan Gov. Gretchen Whitmer indicated that she could announce a loosening of restrictions as early as this week.
The efficacy of Covid-19 vaccines has governors across the country reassessing restrictions on daily life that have been in place for over a year, in some areas. Long-term care settings that were home to some of the pandemic’s earliest epicenters are now seeing positive case loads and deaths plummet, spurring calls from senior housing groups to relax visitation restrictions on communities.
The American Seniors Housing Association (ASHA) sent a letter to the National Governors Association encouraging governors to ease visitation restrictions in the coming weeks.
“Given the very high resident vaccination uptake rates and the fact that the vaccination program will be complete in most senior living communities by the end of March, it is imperative that the states take steps to allow residents to visit with families and loved ones,” ASHA President David Schless wrote.
Doing so will not bring senior living back to a pre-pandemic “normal,” however. Conflicting guidance from the Centers for Disease Control and Prevention (CDC), state and local public health departments will force providers to resume visitations with safety measures in place. Additionally, visitors to communities in states where visitations have resumed must schedule their visits, and they must either be vaccinated or attest that they have not been exposed to the virus recently. Some providers are conducting rapid antigen testing of visitors to verify they do not have Covid-19.
Resuming visitation is seen by most on the front lines of the fight against Covid-19 as a giant leap, and another sign that the pandemic will soon subside, Wickshire Senior Living Vice President of Clinical Operations Maggie Dewey told Senior Housing News.
The relaxing of visitation restrictions conceivably will also put pressure on providers to mandate staff vaccinations in order to protect residents and themselves from asymptomatic coronavirus carriers.
Vaccines are working
Revisiting community restrictions would not be possible if not for the proven efficacy of the Pfizer and Moderna Covid-19 vaccine clinics.
Since the first vaccine clinics launched last December, nursing home deaths have plummeted by more than 60%, the New York Times reports. This is a sign that the vaccines are working in real world settings, and faster than anticipated. Senior living owners and operators also are reporting drastically reduced Covid-19 caseloads, correlated to the rollout of the vaccine. For example, Sabra Health Care REIT (Nasdaq: SBRA) reported a 70% decline in the number of communities with positive Covid-19 cases from January through the end of February during its Q4 2020 earnings call.
The Food & Drug Administration’s (FDA) emergency use authorization of the one-dose vaccine developed by Johnson & Johnson — which shows to be very effective against severe cases of Covid-19 — gives states another option to offer their residents.
But demand for vaccines continues to outstrip supply, even as Pfizer and Moderna promise a massive influx of vaccines to reach the Biden administration’s goal of 100 million vaccinations in its first 100 days. And states across the country are struggling to keep up with their vaccine timetables.
Still, the effectiveness of the vaccine is the primary reason Beshear announced that visitations could resume in the Bluegrass State, Kentucky Senior Living Association Executive Director Bob White told SHN. Since vaccine clinics began, 95% of residents among the organization’s member providers have received Covid-19 vaccines, and providers were revisiting their own restrictions ahead of the governor’s announcement.
Another factor in Beshear’s decision to resume visitations was listening to the recommendations of his long-term care task force within the Cabinet for Health and Family Services — on which three providers sit.
“With those advocates on that task force, they’ve been able to create this type of guidance for visitation,” he said.
The Ohio Assisted Living Association is also advocating for Gov. Mike DeWine to relax restrictions in the Buckeye State, Executive Director Jean Thompson told SHN. Over 90% of residents among OALA’s member providers have been vaccinated so far, and she expects 100% participation by the end of March.
Covid-19 positivity rates among Ohioans over age 80 have decreased from their December peak — 18% of the age cohort accounted for the state’s total Covid-19 hospitalizations.
Thompson believes that relaxing restrictions on senior living facilities will help residents combat the isolation they have experienced since lockdowns first started last spring.
“We can open up more visitation since the positivity rate in counties all over Ohio is going down,” she said.
Safety protocols remain in place
While vaccinations trend upward, providers are keeping safety protocols in place while resuming visitations. Brentwood, Tennessee-based Wickshire, which operates 16 communities in eight states, is following CDC recommendations and guidance in the states where they operate as the provider reopens its communities.
Visitations are held in designated common areas of Wickshire communities. Masks are still required of residents and visitors. Individual residents may only have a maximum of two visitors at a time, and visitors must fill out an attestation form and have their temperatures taken before entering a community.
Additionally, Wickshire requires visitors to wear surgical-grade masks or higher, and the operator provides hand sanitizer. Visits are scheduled through community concierges throughout the week.
Charter Senior Living is also scheduling visits, and requires visitors to bring proof of a negative Covid-19 test or be pre-screened, in some states up to 24 hours in advance, Vice President of Health and Wellness Stephanie Pfingsten told SHN. The Naperville, Illinois-based operator’s portfolio includes 24 communities in 11 states.
Communities must also be free of Covid-19 for at least 14 days before visitations resume, and Charter is limiting the total number of visitors to any one community to four at a time; residents may have up to two visitors at a time. Visitations are scheduled throughout the day, with a maximum of 60 minutes per visit, to ensure these restrictions are followed.
This is in addition to compassionate care visits and essential caregiving visits that have occurred throughout the pandemic, for residents in need of higher levels of care under the Americans with Disabilities Act (ADL). But these procedures vary depending on the state.
“We don’t have a one-size-fits-all visitation policy,” Pfingsten said.
Caledonia Senior Living and Memory Care of North Riverside, a senior living community in North Riverside, Illinois, resumed visitations in mid-February, CEO Gus Noble told SHN. The community made the decision after 100% of its resident population received both doses of the Pfizer vaccine.
Visitations are restricted for the time being to Caledonia’s Heritage Hall, and Noble expects visitations to gradually return to normal as more staff and the general population are vaccinated, which will go a long way toward establishing a post-pandemic foundation for socialization.
“The next thing we must do is to reconnect families,” he said.
Staff vaccinations lagging
As more states decide to relax restrictions on long-term care facilities, providers will be under pressure to mandate staff vaccinations. A recent survey of 84 senior housing and skilled nursing providers from the National Investment Center for Seniors Housing & Care (NIC) revealed that 80% of resident populations received at least the first dose of coronavirus vaccines, compared to just 50% of staff.
A growing number of providers are now mandating that staff receive vaccines as a condition of employment, including Irvine, California-based Silverado Senior Living, Bloomfield, New Jersey-based Juniper Communities and Louisville, Kentucky-based Atria Senior Living.
Caledonia’s staff vaccination rate currently sits at 85%. Still, Noble mandated that all staff and residents get fully vaccinated by March 31. He made the decision after talking with his young son’s doctor, a Black woman, who noted that Covid-19 has adversely affected persons of color and lower-income workers — demographics which coincidentally intersect with the community’s staff population.
Noble invited this doctor to discuss the benefits of getting vaccinated, and also invited another Black senior living executive to share his experiences as a Black man in senior living, and why it was important for him to get the vaccine.
Finally, Noble wrote each of his team members personal notes, and amassed studies and university reports dispelling misinformation about vaccines, in an effort to give his workers everything they needed to make an informed decision.
Ultimately, he decided to be proactive in making vaccinations mandatory. He believes vaccinations could become mandatory at “the stroke of a pen” in Washington, D.C. or the Illinois capital of Springfield.
Charter’s vaccination disparities trend closer to the NIC survey. Through late-February, over 90% of residents have received at least one vaccination, while staff vaccinations are just under 50%, Pfingsten said.
Wickshire is seeing a similar disparity between residents and staff, Dewey told SHN.
But neither provider is ready to mandate staff vaccinations, and each is continuing to do educational outreach to give employees everything they need to make the most informed choice for themselves.
Dewey noted that associate vaccination rates are trending upward, as more employees see residents and co-workers go through both doses with little to no side effects.
“[Mandates] are certainly not off the table, though,” she said.
Charter is stepping up its educational efforts to improve staff vaccination rates, and Pfingsten sees similar trends among frontline workers as more residents show no ill side effects.
“The drastic decrease in cases [has made a] tremendous difference,” she said. “They’re seeing the impact of what the vaccine has done.”
Smaller providers, however, may not be able to mandate vaccinations. White observes that a large operator such as Atria can levy a mandate among its staff because it has economies of scale on its side. Smaller providers, on the other hand, must contend with other industries to recruit new talent. If a worker decides to quit rather than get vaccinated, finding a replacement may prove challenging.
But White is hopeful that workers observing the benefits of the vaccines first-hand will sway them to receive their doses, as the vaccination effort escalates, and as they see the benefits of less restrictive visitation policies.
“We’ve seen a marked improvement in the number of staff that have opted to get the vaccine, but opted out of the first clinic,” he said. “We’re probably up to around 60%.”
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