article is sponsored by Willis Towers Watson. In this Voices interview, Senior
Housing News sits down with Director of Clinical Risk Services-Senior Living
Center of Excellence Rhonda DeMeno to learn how senior living operators are
planning their reopening strategies, managing risk stratification during this
process and planning their budgets for 2021.–
In December, you began
a new position at Willis Towers Watson as director of clinical risk services.
What experiences in your career do you draw from most frequently in this
am a registered nurse with over 30 years of experience in the senior living
space. I have vast experience in regulatory compliance and quality performance.
I have held positions with several senior living providers as a vice president
of consulting services, corporate compliance officer and other clinical
operations positions where I was responsible for regulatory outcomes and
corporate quality performance initiatives.
my past roles, I applied quality performance expectations to clinical
operations policies, procedures and assisted with the development, deployment
and integration of electronic documentation and resident assessment systems. My
experience as a vice president of consulting services for a large senior living
provider taught me auditing and gap analysis, so I learned how to identify risk
and customize mitigation plans for providers, improving care outcomes.
enjoy rolling up my sleeves to assist providers with customized solutions that
are meaningful and realistic to their organization. These are not
one-size-fits-all solutions — they require a true partnership. My skills have
taught me to be a good communicator built on trust and advocacy for our
am passionate about the senior living industry and working with clients on
quality performance projects as well as assisting in developing policies and
systems to drive performance. I believe that is one of my bench strengths. I
also realize that quality performance will enhance the lives of seniors
residing in senior living communities and will also provide staff members with
a great working environment.
That’s great. What are
your goals in the role for the remainder of the year, and in 2021?
have several goals. One goal is to continue to grow in my new position. For
years, I was on the clinical, operational side of the business, playing defense
to regulatory challenges and daily operational challenges that surface being an
current position with Willis Towers Watson brings new challenges, exposure to a
wide range of clients equipped with different ways of operating. Building
relationships with our clients so they are comfortable reaching out for
assistance or guidance will be an ongoing goal for 2020 through 2021.
ongoing goal for 2020-2021 is to assist providers in understanding clinical
programs that drive a culture of safety. That can be in any area where risk
exists, including falls management, elopement, infection control, and
When COVID-19 hit, like many other clinicians, I
went into an overdrive mode — helping our clients with guidance on best
practice standards. One of the areas that quickly surfaced was that of the need
to understand infection prevention and control. My nursing experience in
long-term care has taught me extensive infection control and prevention
practices; however, knowing the magnitude of the pandemic, I felt it was
necessary to further my credentials with an infection prevention
I am currently studying for the infection
control certification through the CBIC (Certification Board of Infection
Control), which will reaffirm my knowledge in infection prevention and signal
to the Willis Towers Watson client’s professional credibility in the field of
feel that infection control and prevention measures will become increasingly
important in the years to come. My goal is to have the CBIC certification by
eight months into the pandemic in the U.S. What are you hearing in senior
living on the topic of reopening, both in terms of entire communities, and
pieces of communities, such as dining halls or other shared, public spaces?
Providers must adhere to their state or local authority directives.
There continues to be a heightened awareness for infection prevention, and
provider directives are related to the local situation and reportable cases.
Many providers are applying CDC guidance for visitation strategies and
community conditions to allow for visitation indoor or outdoor, and have
adopted a range of CDC guidelines. A few examples of these guidelines
- Fourteen days with no
new community onset of resident or staff COVID-19
- Sufficient staff to
support the management of visitors
- Designating key staff
to support infection prevention and control education
- Adequate PPE supply and
- Strict adherence to
cleaning and disinfecting
- Scheduling visitors by
- Monitoring for
adherence to proper use of masks and social distancing
- Requiring that visitors
be 18 years or older
- Limiting the length of
visits, visitation days, hours and number of visits per week
with those and many other CDC recommendations, many providers even had to delay
the reopening of their salon services and offer different levels of visitation,
such as outdoor versus indoor. There are changes in dining services, cleaning
efforts, and social distancing.
Providers are adhering to local or jurisdiction guidance or referring to
CDC guidelines for reopening.
How does the budgeting
for 2021 differ than previous years?
senior living budget process usually begins with forecasting resident
occupancy, admissions, and discharges and revenue per unit. Providers also
often build their annual budgets on the baseline, i.e., the current year’s
metrics combined with a review of the past year’s revenue metrics and costs per
resident day as a means of forecasting.
the fog of the pandemic complicates all of that. It is forcing senior living
leaders to make unfamiliar forecasts. COVID-19 has impacted several areas that
must be accounted for in the 2021 budget and financial planning, including:
- Labor costs and employee benefits
- Testing and immunization
- Disinfecting and cleaning
- Environmental modifications
My advice to senior living providers is to complete a budget diary based
on COVID-19 lessons learned and expenses incurred by the department or
discipline. For example, the administration should log surveillance expenses.
Part of those expenses is related to equipment, training of staff, time spent
on completion of the surveillance checks, correspondence time, reporting time
and time spent on documentation.
In 2020, providers did not have the opportunity to plan for COVID-19 or
for the financial impact that this pandemic has created. Budgeting for 2021
will need to address all sorts of items and offer a forecast for managing
emergencies like a pandemic.
Where should operators
take their cues on reopening?
Senior living operators are challenged with keeping
track of CDC guidance, state orders and county and city directives as well as
specific directives for licensing. They should refer to local county/city
jurisdiction directives and include national and state directives in their
plans for reopening. It is a good idea for senior living providers to have a
written reopening plan, have no active COVID-19 cases and confirm with local
authorities and health departments before reopening.
How are senior living
providers using risk stratification to combat COVID-19 in the final few months
have been very impressed with senior living providers and their focus on
infection prevention and solutions to keep residents and staff safe. Regarding
risk stratification, providers are taking time to understand their patient
populations and vulnerabilities. They realize that a holistic approach to risk
stratification means understanding each resident’s overall health conditions
and comorbidities and building an individualized risk stratification plan for
stratification considers the resident age, comorbidity status, physical
functioning capabilities and psychosocial needs. Based on resident
characteristics, providers have designed specific resident service plans to
mitigate COVID-19 exposures. For example, a resident who does not have many
comorbidities may attend small group gatherings or communal dining.
if a resident is immunocompromised, they may have a different level of dining
service or activity schedule planned, one on one activities planned or be
assigned to a consistent care team to avoid unnecessary exposures. Providers
are becoming very innovative in their attempts to provide a safe environment,
determined by resident needs and a customized approach based on the level of risk
the resident may have due to exposures and immunocompromised health status.
What areas do you
recommend operators focus on for best managing risk in their communities?
are many areas for focus in 2021. Regarding clinical services, I believe that
infection control must be an area of focus for 2021. Senior living providers
may need to consider adding an infection preventionist to the operations team.
I also believe that new regulations will be evolving due to the pandemic. Those
regulations may be focused on infection control, environmental and engineering
controls, staff competency and reporting.
areas of risk are the day-to-day clinical risks of resident falls, elopement
and medical management. For example, resident falls continue to be the leading
cause of injury for the elderly, with falls constituting a significant source
of liability exposure.
pandemic has been the area of focus for all providers due to its virulence and
attack rate on individuals age 65 and older with comorbidities. Senior living
providers continue to be challenged with the day-to-day responsibilities of
managing resident clinical conditions and risk associated with the aging population.
Still, they must focus on clinical programs like falls management, skin
management, elopement prevention and overall medical management. Providers must
monitor these programs and continually educate team members, residents and
family members about their safety culture and programs that mitigate
unfavorable outcomes in these areas.
other elephant in the room is staffing and recruitment efforts. Many providers
have gone above and beyond to retain staff during the pandemic. Senior living
providers need to continue the measures that have been put in place to keep
team members safe and engaged in their work during the pandemic and create a
workplace that provides safety and security to attract dedicated team members.
Staffing has been an ongoing challenge for
senior living providers and will continue to be so. It will be up to the
provider to customize employee benefits, creative scheduling options and
opportunities for advancement. Building partnerships with academic institutions
is a good method to recruit employees and attract entry-level candidates
What do you recommend
operators watch for in terms of reopening risks and approaches in 2021?
must stay focused on outbreak management, which they can do through community
surveillance programs. Providers need to stay informed of local jurisdiction
directives, outbreak and positivity cases reported. Also, providers will
continue to need to adjust testing protocols according to the CDC, state and
local guidelines and continue to coordinate resident care and treatment when
COVID-19 positive cases surface.
With the upcoming flu season and the possibility
of a COVID-19 vaccine, providers will need to be armed with a robust
immunization program for residents, staff and family members and stay on course
with infection prevention measures throughout their communities.
Editor’s note: This interview has been edited for length and
To learn more about how Willis
Towers Watson can help your community manage reopening risk, and budget for the
next year, visit
WillisTowersWatson.com. Willis Towers
Watson hopes you found the general information provided in this publication
informative and helpful. The information contained herein is not intended to
constitute legal or other professional advice and should not be relied upon in
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