How Omicron Puts Senior Living Providers Under Pressure to Start 2022

The omicron variant of coronavirus drove Covid cases to an all-time high in the early days of 2022, putting senior living providers under intense pressure to start the year.

In particular, providers are facing staffing challenges as infections among the workforce compound an existing and extreme labor crunch.

Furthermore, evolving guidance from federal and state health authorities is creating logistical headaches, burdens, and confusion.

And then there is the question of whether omicron will suppress occupancy rates — not only if surging infections deter new move-ins, but if staffing shortages prevent communities from welcoming new residents.

The significant good news amid omicron is that senior living residents appear to largely be protected by Covid-19 vaccination and boosters.

Another staffing setback

Unlike the delta variant, the omicron variant appears less severe than the original strain of Covid-19, but the population of residents within the senior housing sector remains more vulnerable than the general population.

“Our primary responsibility is to them,” ALG Senior Chief Medical Officer Dr. Kevin O’Neil told SHN. Hickory, North Carolina-based ALG operates a portfolio of about 150 communities.

Positively, ALG had not experienced any cases of severe disease among residents as of Jan 11.

Senior housing operators are leaning on the efficacy of vaccines to protect staff and residents.

Approximately 90% of ALG’s staff have been vaccinated, according to O’Neil. ALG’s vaccination mandate, which includes medical and religious exemptions, became effective in November.

West Allis, Wisconsin-based Heritage Senior Living required vaccination as a condition of employment as early as February 2021, though the company does not currently require staff to be boosted, VP of Clinical and Quality Operations Amanda Runnoe told SHN. Heritage’s portfolio consists of 14 communities.

O’Neil, who lauded vaccinations as the most important step that can be taken against the virus in December, added that he thinks a second booster is coming.

“Just like the flu shot, we know our immunity wanes from year to year and viral strains change from year to year,” he said.

Despite generally high levels of vaccination across staff and residents, omicron appears to be affecting senior living workforces more than residents.

Bonita Springs, Florida-based Discovery Senior Living VP of Operations Jeff Floyd told SHN via email that of all of the positive Covid tests, approximately one-third are among residents, while the remainder of cases are among employees. Discovery operates a portfolio of more than 100 communities.

Approximately 5%-10% of Covid cases are among residents at Heritage Senior Living communities, according to Runnoe. The remaining 90%+ are among staff.

“I know that the rate of infection is higher among staff than previous variants have been,” Runnoe told SHN. “We’re seeing infection in all levels of vaccination status – from people that are fully vaccinated and boosted, to people that are not vaccinated at all. All vaccination levels of vaccination status are affected.”

Providers are turning to agency staff while also relying on nimble scheduling and relying more on Covid-negative workers. And Runnoe believes that the apex is yet to come.

“I think in the next one to two weeks, we’ll peak, and then the number of cases will settle and people can return to work,” she said.

But, she thinks staffing challenges will continue beyond the current omicron wildfire of the Covid-19 pandemic.

Beyond quarantine or the sick time employees need to take as a result of Covid, burnout looms over the workforce at large, in particular among those working in seniors housing.

It’s a point also made by JoAnne Carlin, Senior Living Senior Vice President of Clinical Risk at global insurance broker and risk advisor Marsh.

“Everyone has a different limit. We have been through a lot of trauma in the past two years, and it’s taken a toll,” said Carlin.

It’s important to keep your staff focused on the genuine purpose of them being there – the residents, she said.

Initially, staffing morale centered around safety and fear of the virus, according to Runnoe. That isn’t the case this time around.

“We’ve been working through this for two years now, so people are familiar with the process,” she said. “There’s definitely burnout from the amount of staff who are picking up shifts and working double shifts.”

A regulatory patchwork

Covid-19 is one pandemic, but it’s now a different disease – omicron, Carlin said, also drawing similarities with the flu.

“That’s why the CDC has to keep changing things … because omicron is different than delta which was different from the Alpha (variant),” said Carlin.

While omicron appears safer than previous variants like delta, it can still cause deadly disease. And hospitalizations from Covid reached an all-time high this week, according to a report from the Wall Street Journal.

Still, due to the apparent efficacy of vaccination and the mildness of Omicron, the CDC changed its back-to-work quarantine guidelines from 10 days to five days for those who test positive for the virus or report symptoms, regardless of vaccination status.

That means that a worker who tests positive may only miss five days of work, which theoretically should help ease the type of staffing crunches that senior living providers are facing. However, there are drawbacks to the shorter period.

“That’s helpful,” Carlin said. “[But] now you have more people who are exposed.”

That is, workers returning to the workplace after five days, before completely clearing the virus, leads to more exposure. That, in turn, leads to more cases, which leads to more days missed due to quarantine, or illness.

However, the CDC guidance now includes contingency and crisis staff restrictions for healthcare workers stating that in times of crisis, an asymptomatic person could return to work immediately.

“What we have done is help communities understand that [contingency and crisis operations] are an option,” said Carlin.

The CDC guidelines are a starting point, but state and local governments also have a say regarding workplace quarantine restrictions.

“All of the communities have to first and foremost follow their state and local guidelines. These complicating factors are as bad, if not worse because states keep adding more and more requirements,” Carlin said.

For Carlin, preparing Covid-related staffing shortages is comparable to a natural disaster – you need an incident command center and you need boots on the groun.

“Think of this as a huge disaster and emergency management plan,” she said. “When you have a natural disaster, it’s going to be short-term, you create an incident command.”

For larger organizations across multiple state/provincial jurisdictions, it’s important to have a committee to keep up with regulations and protocols, said Carlin. But she notes, regardless of company size, each community ought to have one person tasked with keeping abreast of the relevant departments of health.

“This person should be communicating with local agencies daily and be monitoring relevant supplies such as PPE and disinfectant,” Carlin said. 

Together, the committee – incident command – and the responsible individual need to ensure that the community has what it needs to function. Carlin noted that they always need to be prepared with a plan B.

Occupancy in question

Even through the 2021 surge in infection rates caused by the delta variant of Covid-19, senior living providers steadily built occupancy.

Senior housing occupancy rose to 81% in Q4 2021, marking the second consecutive quarter of growth amid steady demand, according to recently released data from NIC MAP Vision.

As for whether omicron slows or reverses the trend, the variant’s impact on staffing — not fear of infection — is the main factor, in Runnoe’s view.

“Now, it’s not so much ‘Oh, my goodness, you’re moving into senior living, you can get Covid. Now, it’s ‘Oh, my goodness, is there staff there?’” she said.

It’s too early to get a strong read on whether omicron actually is dampening occupancy, but there are signs that census might be holding up. One large senior living provider told SHN that inquiries remained robust throughout the holiday season, despite the increasing concern over omicron.

Likewise, real estate investment trust Welltower (NYSE: WELL) on Tuesday issued a business update that — while citing elevated labor and supply expenses as a result of omicron — did not raise red flags on occupancy.

“Positively, [Welltower] noted move-in activity and lead generation remain above pre-Covid levels with strong annual renewal rate increases in January 2022,” BMO Capital Markets Analysts Juan Sanabria and John Kim noted.

For Carlin, sustained senior living demand during these latest phases of the Covid-19 pandemic is a testament to providers’ success in creating safe environments and offering valuable care and services that can’t be duplicated in a person’s single-family home.

“Senior living is still the best place for folks to go who need that kind of environment, and especially assisted living and memory care,” she said. “Those venues I think are beyond replication; these environments are so supportive to an individual resident’s needs.”

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