As things return to some semblance of normalcy following the pandemic, most of us want to put the episode in the rearview mirror and move on. But for those who were arguably the hardest hit — long-term care communities — returning to the status quo is not likely. And this is a good thing.
These communities instituted changes, large and small, out of necessity. Many of the modifications will not be rescinded any time soon. Long-term care providers found that some of the changes improve care and quality of life even without the specter of COVID-19. They also want to ensure that they will not be caught flat-footed in the case of another outbreak.
Adjustments can be found in four main areas: the accelerated use of advanced technology, the retrofitting of existing residences, the innovative design of new communities, and modified approaches to staffing. If you are seeking long-term care for yourself or a loved one, read on. Following is a view of the changing long-term care landscape in Southeastern Wisconsin and a discussion of changes elsewhere that could influence our local communities in the months and years to come.
The Use of Technology in Long-Term Care Communities
Telehealth
A growth in telehealth services is one of the COVID-19 adaptations that are not soon to disappear. In 2019, only 4 percent of older adults used telehealth. (Telehealth is defined as the use of electronic information and telecommunications technology for long-distance clinical health care.) It is not difficult to understand why this number jumped to 26 percent in 20201. Reducing exposure means reducing contact, including in medical clinics or offices. And the number is likely to rise again in 2021. A late 2020 survey of long-term care industry leaders found that 87 percent expected to increase their technology budgets2.
In some settings such as memory care communities, where dementia patients thrive on routine, staff implemented the transition slowly. It may have begun with phone calls, moving on to video calls when a patient’s anxiety over the change subsided. At this point, health care professionals were able to conduct real-time health evaluations.
Air Purification Systems
Air purification systems have also been added to many communities. Ultraviolet germicidal lighting, although not exactly a new technology, had not been on the radar of many in the recent past. However, because it can eliminate most airborne coronavirus germs, care communities utilized it during the pandemic. The lights are installed within a forced air heating system to sterilize the moving air.
Another emerging technology, bipolar ionization, is also used in HVAC systems. It generates positively and negatively charged particles to help remove viruses.
Modifications to HVAC systems are expensive, so if a community had either technology implemented, it is likely there to stay. Moving forward, attention to air ventilation will be a priority during the construction of new communities.
Here in Southeastern Wisconsin, one community under construction during the pandemic actually converted their original plan for an HVAC system. They instead installed a specialized system that operates independently in individual rooms, using no or limited community duct work.
No Touch
While an HVAC system is not obvious to the naked eye, another system is visible the moment you walk through the door. Many communities now use non-touch body temperature detection through an infrared fever screening system. The system is usually placed near a building’s entrance for quick temperature checks of all visitors and staff.
Also placed at a community’s entrance are automatic doors. While these doors are common, we haven’t seen the widespread use of no-touch technology for navigating a building. However, in some communities, residents can move around the building without pressing buttons or grabbing handles. This is accomplished through motion sensors or voice activation in areas like elevators, corridors, or dining rooms.
If the pandemic had a silver lining, it is that the use of technology has led to cleaner environments in care communities.
Reconfiguring Space in Assisted Living and Memory Care Communities
Thank heavens for Zoom. At the same time, we all realize that nothing can take the place of person-to-person communication long term. An increase in outdoor space is one solution. Many communities have created more visiting areas outdoors where residents and family members or friends can visit while staying safe. And during any future quarantine, nothing can raise spirits like fresh air and a bit of outdoor scenery.
Communities have also rearranged indoor space. Many have dedicated a space or room near the entrance for visits. The area is sanitized after each visit. During an outbreak, this could help keep germs from penetrating deeper into a building. Some have also created smaller dining spaces, in some cases using dividers, to contain potential viruses.
In many places, including Wisconsin, communities have reduced the number of entrances to better monitor the health of visitors and staff. Other communities have taken a different approach. In some cases, communities have added more access points. This prevents visitors and staff from coming into contact with residents outside of a single wing or distinct area.
One other adaptation adopted by some communities is the dedication of a separate, restricted entrance for delivery workers, again to minimize contact.
The Influence of COVID-19 on New Construction in the Long-Term Care Industry
With an increasing number of adults from the baby boomer generation aging, the need for long-term care is also expanding. One result is an increase in new construction of assisted living and memory care communities. Because of the pandemic’s impact on older adults, a reimagining of long-term care spaces is underway.
In a recent issue of Holland magazine, Jeffrey Anderzhon, of Milwaukee-based Eppstein Uhen Architects, described one of the changes coming to the industry. “Medical model care” will be replaced with “small house resident oriented approaches,” said Anderzhon, a senior planner and design architect3. The small house model, the latest buzzword in the long-term care industry, refers to smaller, self-contained residences. The size creates intimacy, a greater sense of community, and an opportunity for staff to know the residents more sincerely. It is also a setting more conducive to containing an outbreak. In fact, small house communities seem to have fared better than more traditional long-term care communities during the pandemic.
And again, outdoor spaces will play an important role. You will likely see an increase in terraces, patios or other outdoor spaces for residents.
Staffing at Assisted Living and Memory Care Communities
COVID-19 impacted staffing at long-term care communities, too. When the pandemic began, larger communities pulled back on employees travelling to work at multiple sites or even working on multiple floors or units. As vaccines and better testing became available, communities began easing these restrictions. Many providers use multi-site staffing as a flexible solution to the labor shortage.
An intensified labor shortage (in many industries) is one of the pandemic’s unfortunate outcomes. In the long-term care industry, nationwide employment during the pandemic declined 7.8 percent4. Some believe this retraction is due to staff members leaving after being exposed to the virus. It could also be due to a need among staff members to care for children or their own older family members. Others believe that a federal bonus in unemployment benefits could be a contributing factor. Some employees may return following the expiration of the bonus and a return to normal routines in places like schools.
Many suggest that the crisis has created an opening for discussion about long-standing staffing shortages within the industry. (A 2018 report found that one in five caregiver positions in Wisconsin were open.5) It is possible that the current situation will bring needed change. Many across the country have taken notice and advocacy is on the rise. For example, the American Health Care Association, a nonprofit that represents long-term care residences, and Leading Age, an association of nonprofit aging service providers, recently proposed the Care for our Seniors Act for consideration by the U.S. Congress. It would require one registered nurse on duty 24 hours per day in long-term care communities (in addition to other staff). The act also includes provisions to attract and retain employees.
Final Thoughts on COVID-19 and Long-Term Care Communities
History demonstrates that health crises often lead to public health improvements. Following the Black Death in fourteenth century Europe, public sanitation was improved. (A labor shortage in agriculture also led to an increase in wages for the working poor.) After the 1918 flu pandemic, the U.S. established an employer-based insurance system that expanded access to healthcare.
Just as these health crises exposed groups of people most vulnerable to a widespread disease, the coronavirus seems to be a catalyst for advancement in long-term care.
In so many ways, prior to COVID-19 we just didn’t know what we didn’t know. As one person who posted on Instagram wisely put it: “Pretty wild how we used to eat cake after someone had blown on it.”
1 https://www.healthyagingpoll.org/reports-more/report/telehealth-use-among-older-adults-and-during-covid-19
2 https://seniorhousingnews.com/2021/04/15/memory-care-innovations-take-hold-in-wake-of-covid-19/
3 https://www.eua.com/media/articles/infection-control-in-elderly-congregate-living-and-care-settings-in-the-us/
4 https://www.mcknightsseniorliving.com/home/news/business-daily-news/nursing-homes-lost-153000-jobs-in-2020-almost-10-percent-of-workforce-report/
5 https://ewala.org/news/news.asp?id=399193&hhSearchTerms=%222018+and+report+and+1+and+5+and+caregiver+and+positions+and+open%22