Earlier this year as the first vaccines flowed into senior living communities, it seemed as though the lockdowns and restrictions of 2020 were soon to be a distant memory.
Now, a new and significantly more infectious strain of coronavirus dubbed the delta variant threatens to derail some of that progress, and the industry is monitoring the situation closely and already making some adjustments, such as reinstituting mask mandates.
Among the biggest risks to senior living operators is that growing case counts among unvaccinated people could lead to a resumption of some local or statewide mandates or restrictions, slowing occupancy recovery; or even lead to new outbreaks among their workforce and residents.
The potential for delta outbreaks among staff members is a particularly pressing concern, given current labor challenges that include worker shortages. And average staff vaccination rates have been stuck around the 65% mark since about mid-March 2021, according to survey results from the National Investment Center for Seniors Housing & Care (NIC). It’s possible that the delta variant could propel more mandates that staff get vaccinated — a trend that already is picking up across the hospital and health system space.
Vaccination rates for senior living residents are much higher than for staff, but even for fully vaccinated residents, there is a risk that some of them could come down with “breakthrough cases” due to the way older adults’ immune systems work. While breakthrough Covid-19 cases are thought to be rare, fully vaccinated senior living residents are testing positive for the disease.
That is not to say Covid-19 vaccines don’t work — they do, and there is plenty of evidence that the Pfizer and AstraZeneca vaccines provide significant protection against symptomatic infections, hospitalization and death. Some public health officials have adopted the phrase “pandemic of the unvaccinated” based on the fact that unvaccinated people are much more likely to get infected, go to the hospital or die of the disease than the vaccinated.
Still, senior living providers are in a tricky spot. Another lockdown or more restrictions in response to a surge in cases locally could stymie efforts to recover occupancy lost during the pandemic, especially if they put a damper on tours or move-ins. And while vaccinated residents are much more protected from the disease than the unvaccinated, operators would still rather not see any of them test positive if they can help it.
That uncertainty is why senior living providers including Avanti Senior Living, Solera Senior Living, Pacific Retirement Services (PRS) and Arrow Senior Living are doubling down on ways to keep their residents safe while also preparing for possible disruptions in the future. And thanks to those efforts, many of them remain cautiously optimistic about the path forward, including in areas where Covid-19 cases are surging, such as in Florida and Missouri.
The bottom line is that, given the wide circulation of the delta variant, the senior living industry should not slow down its efforts against Covid-19 or declare victory, according to Dr. Kevin O’Neil, who works as chief medical officer at ALG Senior.
“The likelihood of being hospitalized and dying, even among the older adults in our senior living communities, will be markedly reduced if they’re fully vaccinated,” O’Neil told Senior Housing News. “But we need to not be complacent.”
Cause for concern
The delta variant is wreaking havoc among unvaccinated people across the country. Although not at the level of last year’s peak, hospitalizations are rising in 45 states, with Arkansas, Florida, Louisiana, Mississippi, Missouri and Nevada seeing the sharpest upticks.
While the risk of catching Covid-19 is lower for vaccinated people than those who are unvaccinated, the delta variant has led to rare breakthrough cases — though the majority of these are thought to be mild or asymptomatic.
The risk of catching a severe case of Covid-19 is greater for older adults, even those who have been vaccinated. As people age, their immune system function declines, making them more susceptible to infections or diseases, such as breakthrough cases of Covid-19, O’Neil said.
But while they can get Covid, older adults who have gotten their shots are still better protected from infection, and are much less likely to experience serious symptoms than those that haven’t, should they contract it.
“The vaccine response may not be as robust as it is when we’re younger, but it does confer significant protection,” O’Neil said.
Some senior living communities have seen outbreaks of Covid-19 among their vaccinated residents in recent weeks. For example, a group of mostly vaccinated senior living residents at a life plan community in Pompano Beach, Florida, came down with Covid-19 after attending a Fourth of July concert. A similar story played out in May, when 21 vaccinated residents tested positive for Covid-19 at a continuing care retirement community (CCRC) in Spokane, Washington.
While the vaccines are effective, the industry should not cease its efforts to stop the spread of Covid-19, either. The longer a variant spreads among the general population and the more bodies it infects, the more chances it has to replicate and mutate. And there is always the chance that the next variant is more resistant to vaccines than the last.
“That’s a real source of concern, because then we’re going to have to try to develop new vaccines,” O’Neil said.
The spread of the delta variant is also concerning to Dr. Sandra Petersen, consultant to Pegasus Senior Living’s health and wellness team. Petersen, who has been leading the provider’s Covid-19 efforts, fears the effects that a runaway virus in the general population might have on the senior living industry.
“I worry about our vulnerable residents, whose immunity may wane over time — not a good situation to be sure,” Petersen told SHN. “Mix that with staff who don’t want to get vaccinated, and we are in a scary place.”
Not only would a significant viral resurgence lead to “really bad outcomes” in states with lower vaccination rates, but “the risk is significant” that it also may derail the industry’s ongoing recovery, she added. But the ultimate outcome is hard to predict.
“I think we are rapidly dividing into a nation of vaccinated, unvaccinated and those who have some form of natural immunity,” Petersen said. “It’s hard to say where that will leave us.”
As case counts creep back up across the country, many operators are anxiously waiting to see whether that might lead local officials to reimpose restrictions in some places.
“The severe limitations on gathering and normal life in 2020 aren’t something we want to relive,” PRS CEO Eric Sholty told SHN. “The possibility of new restrictions as the delta variant spreads is something we’re concerned about.”
Still, Sholty believes the company likely won’t see restrictions in every state where the organization operates.
“PRS may see renewed restrictions in West Coast states, while states like Texas, Arizona, and Florida will stay open,” he said. “We’re used to operating that way and are prepared to respond as needed.”
Lori Alford, co-founder and COO of The Woodlands, Texas-based Avanti Senior Living, said she is “cautiously optimistic” about the road ahead with regard to the delta variant. The fact that the industry survived some of its darkest days last year by comparison is a big reason why.
“I’m more hopeful than a year-and-a-half ago,” Alford told SHN. “One, we know what to expect; two, we’re prepared; and three, we’ve built a team on adaptability.”
Dealing with delta
In addition to the possibility that residents or staff will come down with Covid-19 as the delta variant circulates, there is also the risk that a new surge of cases will lead to new local mask mandates or restrictions. And some locales have already done just that. In St. Louis, city officials have again mandated mask-wearing in public spaces and on public transportation, effective July 26. Officials in Los Angeles also reinstated the city’s mask mandate as cases rise.
Arrow Senior Living COO Amanda Tweten knows firsthand the challenges of running a senior living community during the pandemic. Four of the operator’s 26 communities are in the Springfield, Missouri market, which is struggling with new variant-fueled Covid outbreaks.
But thanks to some precautionary measures, Arrow has been able to avoid any new Covid-19 infections at those communities for the last nine weeks. While the operator has not mandated that employees need to get the vaccine, the company’s leaders do test unvaccinated staff twice a week, and require them to wear face masks at all times in the community.
Arrow also takes the temperature of everyone who walks into the community, and screens them for possible exposure.
The provider has set a goal of reaching 70% vaccination rates at all of its properties. While not every Arrow community has reached that level of “community immunity,” striving for that goal has helped the provider keep residents safe without enacting many of the lockdowns seen in early 2020.
For instance, a positive case at an Arrow community might lead to a pause in group activities and a new round of testing for residents and staff. But that is a far cry from sequestering residents to their rooms for an entire day.
“Because we are vigilantly, diligently, twice-a-week testing, I think we’re catching possible exposures earlier,” Tweten said. “And then are able to face it and make … small tweaks to how our residents are living in our community.”
Denver-based Solera Senior Living is another senior living provider grappling with what to do about the delta coronavirus strain. One of the company’s eight communities is in Florida, where the delta variant is surging.
Solera’s chief wellness officer, Crystal Roberts, has two big concerns: that a delta-fueled surge could lead to new cases which spread to staff or residents’ loved ones, who may not all be vaccinated; and that an uptick in cases leads to new restrictions.
“I was hoping we wouldn’t get back to this point again,” Roberts told SHN.
Like Arrow, Solera has implemented safety measures that include screening everyone who comes into the community for Covid. The company also made it a requirement for workers to get vaccinated earlier this year, and recently reinstated a mask mandate inside its communities for all visitors and staff.
“As you can imagine … some people were very upset,” Roberts said. “But I would rather be safe and apologize than to have something happen and not get ahead of it.”
PRS also implemented its own vaccine mandate for staff at its continuing care retirement communities (CCRC) about six months ago — and that has made a big difference in the operators’ confidence in dealing with the new resurgence. And Sholty feels strongly that the entire senior living industry should follow suit.
“I know it’s scary — you’re probably already dealing with a recruiting crisis or you may feel like your employees will react negatively to a mandate on principle,” he told SHN. “But PRS’s experience rolling out a vaccine requirement for employees is that your worst fears won’t come to pass. Most employees will get the vaccine rather than resign. It’s not easy, but it’s necessary.”
Some others in the industry are joining the call and urging other senior housing and care providers to enact their own vaccine mandates. For instance, LeadingAge and more than 40 other health associations are encouraging their members to make vaccines a condition of employment for health care workers.
“Throughout the pandemic, long-term care providers have demonstrated their dedication, commitment and bravery in the face of deadly challenges never faced before,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “By mandating these highly effective vaccines, they will be doing everything possible to deliver safe, quality care to the older adults and others they serve.”
As of July 11, 81.7% of residents and 67% of staff at LeadingAge member communities were fully vaccinated.
At the end of the day, the current period will likely prompt many providers to make hard choices about balancing the need to keep residents safe with the need to keep them from feeling isolated. While that might mean walking back some of the newly loosened rules, doing so now might be able to prevent a bigger disruption down the road.
“Our job is to make sure we’re making the right choices for the safety of our staff, residents and families,” Roberts said. “What we don’t want to do is not do anything, and end up back in a situation where we have all these restrictions.”
Whether mandates are in place or not, providers need to communicate loudly and with clarity on the need for staff to be vaccinated, O’Neil said.
“It’s really critically important to get the message out that if you’re going to be working in the senior living field, you have a moral obligation to get vaccinated,” he said.
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