Tripledemic Has Senior Living Providers Gearing Up for Next Virus Fight

Senior living operators are taking necessary steps to prepare for what could be a “tripledemic,” in which operators must tackle potential spikes in Covid-19, influenza and respiratory syncytial virus (RSV).

“We’ve come into a place where it feels like we’re operating almost normally with some precautions that have stayed with us,” MBK Vice President of Health and Wellness Diana Engle told Senior Housing News. “Resident and staff safety is always going to be top-of-mind for us and it’s our responsibility to be prepared for whatever comes next.” 

Irvine, California-based MBK Senior Living operates 35 communities across six states. 

With the country stepping down from its pandemic-level readiness and masks coming down, older adults in senior living communities are more vulnerable to various respiratory illnesses after nearly three straight years of strict prevention measures.

And this year could change the narrative from 2021, when infection control protocols remained more stringent and senior living operators were able to avoid the typical, seasonal occupancy dip related to flu outbreaks.

This is a point that Wendy Simpson, CEO of LTC Properties (NYSE: LTC), alluded to on the real estate investment trust’s recent Q3 2022 earnings call.

“If we get Covid, RSV and the flu, all at once, what that’s going to do to our industry and admissions bans?” she said. “We’re hoping that those won’t be instituted again, because those were very harmful for both assisted living and skilled nursing. But if occupancy does not continue to increase or it decreases because of a surge in the fall … that could delay the margin recovery.”

While a rise in illnesses could pose a challenge for operators, some say their communities and employees are more experienced than ever in proper infection control procedures that could prove useful heading into the winter months. While forecasting cautious optimism, some said they still have elevated concern regarding the possibility of an onset of multiple virus cases, regardless of strain or type.

Senior Lifestyle Vice President of Clinical Services Angel Morrison said the operator was concerned that a rise in influenza, Covid-19 and RSV cases could lead to “an overwhelmed health care system.” Chicago-based Senior Lifestyle operates more than 130 communities.

“We’re taking the threat of the ‘tripledemic’ very seriously,” Morrison said. “We remain vigilant and armed with the mindset, tools, and resources we need to have a positive impact and be a support to those who need us.”

Changing regs, rising cases

As of September, the U.S. Centers for Disease Control and Prevention (CDC) allowed assisted living operators an option to follow either the Covid-19 health care setting recommendations or the more flexible congregate care settings recs. Aging services nonprofit association LeadingAge said the changes would allow providers to make changes sooner, mitigate the impact of virus cases within the health care system and protect individuals seeking care in a health care setting.

But last week, the CDC warned of a tough winter as influenza, RSV and Covid-19 cases could swirl across the country. Nearly one in five PCR tests for RSV were positive for the week ending October 29, nearly doubling over the course of last month.

Senior living operators need not be overly alarmed but need to prepare, ALG Senior Chief Medical Officer Kevin O’Neil told SHN .

“The best thing is to do all we can to prepare and educate about the importance of prevention in terms of vaccines and the importance of continuing with aggressive hygiene measures,” O’Neil said.

For Integral Senior Living CEO Collette Gray, it’s important to stay connected to what’s happening day-to-day at communities rather than attempting to predict the future.

“We’re preparing ourselves for whatever may come,” Gray said on the threat of a tripledemic. “We will watch the situation closely and we began messaging campaigns about flu season and vaccinations months ago.”

Integral Senior Living is based in Carlsbad, California and operates 115 communities across 26 states.

MBK’s Engle added that the positive momentum built between residents and staff within communities since the start of the pandemic has helped foster resident engagement and participation in vaccination clinics, while continuing important aspects of everyday community life like social programming and events.

“I don’t think I am more worried than I usually am going into winter,” Engle said.

Vaccinations remain top priority

Senior living operators have taken different paths towards vaccinations, including Covid-19 and influenza shots, in the past three years. Some have implemented mandatory immunizations of staff, while others have not.

But no matter how you cut it, Gray attributed Integral Senior Living’s “deep freeze” on new Covid-19 severe cases to its required vaccination program.

“It’s allowed us to really see great progress in 2022,” Gray said.

Heading into the winter, there’s typically a push to increase influenza and pneumonia vaccinations to vulnerable older adults. Senior Lifestyleimplemented a companywide vaccination campaign to promote vaccine education to residents, staff and families, according to Morrison.

The Senior Lifestyle campaign includes community-based vaccination clinics that focus on high-dose flu shots, up-to-date Covid booster vaccines and pneumonia vaccines.

While Covid-19 boosters and influenza shots are widely available, RSV does not have a vaccine yet available for public use as various pharmaceutical companies are vying for the next big breakthrough in immunization therapy.

In the race to bring the first RSV vaccine to market, pharmaceutical giant GlaxoSmithKline (NYSE: GSK) recently had its potential immunotherapy pushed to the top of the vaccine race after years of industrial failure to find a viable RSV shot, according to Pharmaceutical Technology, a pharmaceutical industry-focused publication.

But all this emphasis on vaccine coordination and awareness could lead to some individuals being uninterested in seeking additional Covid-19 booster doses or influenza shots, O’Neil said.

“My concern is that we have probably got some vaccine fatigue where people may have one booster but not the most recent,” O’Neil said.

ALG is part of a small group participating in a project with the American Medical Directors Association (AMDA) and CDC to identify measures that can be put in place to improve immunizations among staff and residents, with the initial focus on resident engagement, O’Neil said.

“We want to heighten and overcome any kind of hesitancy about immunizations and the importance that they have in preventing disease,” O’Neil added.

Hickory, North Carolina-based ALG operates 150 communities across eight states.

Staffing issue looms largest

Senior living operators have spent years battling high employee turnover and retention issues due to myriad factors. But workforce pressures have become especially acute during spikes in Covid-19 infections, such as during the delta and omicron waves.. Senior living care staff are at higher risk of infection due to the nature of their jobs, and operators must plan accordingly to handle fluctuations in employee availability due to sick leave.

Operators widely offer Covid-19 boosters and influenza shots free of charge, and many have implemented on-call plans in the event multiple staff members are sick.

“Staffing shortages are probably everyone’s biggest concern,” Engle said, noting that operators, including MBK, must mitigate risks while they also market career opportunities to the next generation of senior living worker. The company recently added a recruiter who is able to reach new prospective candidates.

If RSV continues to “hit hard,” Engle said MBK and the wider industry must uplift working families to ensure adequate paid sick leave while being a resource for additional support.

At Senior Lifestyle communities, Morrison said there was a “marked improvement” in staffing levels in 2022.

Gray added that as an industry, senior living operators need to “look at more for our associates,” such as flexible scheduling and incentive programs.

“It’s not just about infection control, it’s how we look at the labor market as well and take care of our staff,” Gray added.

Infection control, transparency are connected and crucial

Part of the infection control protocol created by MBK during pandemic has been a concentrated response in combating misinformation and fear surrounding potential spikes in cases. That means sharing the latest health and safety information with residents and families, while also keeping staff updated on changes in protocols.

“We know what to do and how to minimize the spread of illnesses within our communities,” Engle said. “Folks can have questions, and if the fear takes root, it can be hard to pull that back.”

Providers learned a lot from combating misinformation in the early days of the pandemic, and that showed Engle that resident hesitancy and fear related to Covid-19, influenza, RSV and norovirus are similar to a bell curve which builds, peaks and recedes over time with the proper practices in place to inform residents and their families.

Gray also attributed 2022’s strong occupancy rebound to the cutting through consumer misconceptions, highlighting the availability of the Covid-19 vaccine and operators’ ability to showcase just how safe senior living communities could be with proper infection control.

“Our teams have strong muscle memory when it comes to managing infection control and it’s become part of our day-to-day,” Gray said.

Over the last three years, staff at Integral Senior Living communities were refining and adapting education, communication and prevention strategies in order to protect residents to the fullest extent, Gray said. She said one of the “key” infection control strategies “has been transparency and communication.”

“That’s really helped us and it’s been a key part of our strategy,” Gray added. “It allowed us to look internally and it just helps up our game when it comes to protecting our residents.”

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