Assisted-living facilities were hit hardest by COVID-19 fatalities, but adversity has led to a new generation of technology, techniques and best practices.
When it comes to covering assisted-living facilities during the COVID-19 pandemic, it can be difficult to look past the headlines.
Alarmingly, nearly six in 10 of the state’s coronavirus deaths have come from inside nursing homes.
But Carolyn Aldwin, professor of family sciences at Oregon State University and a gerontology specialist, says it should not be surprising. Any place with high concentrations of people will be more susceptible to infections, and any population with weakened immune systems should expect more cases and fatalities.
With all the uncertainty surrounding the coronavirus pandemic, there was one thing she made clear: The large concentration of fatalities was not the nursing homes’ fault.
Not only do the elderly have lowered immune systems, the virus attacks multiple areas of the body where seniors are vulnerable, including the lungs, heart and kidneys. More than 50% of nursing-home residents have some sort of memory impairment, according to the Alzheimer’s Association, which can make social-distancing guidelines difficult to enforce.
The changes the planet is experiencing from rising global temperatures and humans living and working in deforested areas will cause more global pandemics, and elder-care facilities as well as the world at large will need to adapt, says Aldwin.
Elder-care facilities have had to adapt more quickly to COVID-19 than most sectors. As nursing homes battle in the court of public opinion over how they have dealt with coronavirus risk, the pandemic has pushed the industry in a more data-driven, technologically sophisticated direction.
Elizabeth Burns, chief medical officer of Avamere Family of Companies, a group of elder-care organizations based in Wilsonville, says coronavirus has shown the interconnected nature of senior care and overall public health.
“Senior-care communities, or any congregate community for that matter, are actually an indicator of what you have going on outside. The difference is our community is more impacted.”
The company developed new best practices, grouping residents who may have been asymptomatic carriers into cohorts and placing them on “COVID floors.” The company adopted this approach before state and federal guidelines.
The kitchen now uses a “hotel restaurant model,” in which residents have their meals delivered to their room instead of gathering in the dining hall.
“The Centers for Disease Control and Prevention actually stopped by to see what we were doing,” says Burns.
Her company partnered with environmental testing company Enviral Tech to collect surface testing data to identify potential hotbeds for the virus. The findings from the study will be presented at a conference hosted by the Washington Health Care Association. The company plans to share its data with universities seeking to conduct research on coronavirus.
“We are data rich, and so we have to share our information. Data we collect is going to be important for schools and other businesses to reopen safely if we want to open the economy again,” says Burns.
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The company deployed technology-based solutions to deal with COVID-19 challenges and now offers virtual tours of the facility to potential residents instead of in-person visits.
Avamere adopted the software LifeLoop, which is designed to help seniors in assisted-living facilities communicate with friends and loved ones as well as connect with staff. LifeLoop allows residents to communicate and play games such as mah-jongg with other LifeLoop members across the country, creating a large community of seniors in similar living situations. It is a feature that can mitigate social isolation due to quarantine.
Amy Johnson, CEO of LifeLoop, says sales of the software to elder-care facilities have doubled since the outbreak.
Nursing homes were among the first to adopt telehealth and telemedicine before the onset of the pandemic, and like many other industries, their reliance on technology appears to have skyrocketed.
Matt Preston, co-owner of Home Instead Senior Care, an in-home elder-care service, says his office is implementing a more technology-based model of service by delivering telehealth options, and finding digital solutions to keep residents socially active during quarantine.
In addition to using Zoom and FaceTime as a way for seniors to connect with family members, his organization gives residents access to GrandPad, a touch-screen tablet computer designed to be used by seniors.
Preston foresees technology and personal visits working hand-in-hand to deliver in-person care.
Home Instead is testing a yet-to-be-named digital technology that tracks health changes in residents over time. Preston expects artificial intelligence will play a larger part in elder care, although the technology is still in its infancy.
“Our vision is to be able to offer many options to our clients and their families involving artificial intelligence, including biometric monitoring and home monitoring.”
The implications of artificial intelligence in senior care are vast, but one of most promising uses of the technology is its ability to predict potential health outcomes. By putting resident information into a neural network, the software can anticipate health problems before symptoms develop.
A 2010 pilot project conducted by an independent-living facility in Missouri found the average length of stay was approximately two years longer for seniors living with an artificial intelligence-enabled health-monitoring platform developed by health care IT firm Keystone Technologies.
In 2017 researchers at IBM and the University of California committed $16 million to a five-year study that tests how artificial intelligence can be used to detect cognitive impairments sooner.
Labor shortages could impair in-home senior-care services. Karen Fabiano, executive director of Avanti ElderCare Resources, a fiduciary organization in Eugene which connects seniors with in-home care providers, says the supply of in-home caregivers has dropped since the pandemic.
“We’ve had folks in our care teams leave because they needed to take care of their children or limit their own exposure. Agencies have told us they cannot take on new clients, especially in places like the Coast and rural areas.”
Because seniors who use in-home care providers often have multiple caregivers in a given week, and caregivers can come into contact with multiple seniors daily, a single case of the virus has the potential to cause a daisy chain of infections.
Some in-home caregivers Fabiano works with now require residents to wait outside or in a different room while they clean. This deprives the resident of human contact, which can be an important factor in mental health.
Furthermore, when it comes to seniors with cognitive impairment such as dementia, social-distancing rules are difficult to comply with. For in-home care providers, as well as seniors in high-density living arrangements, residents who are unable to follow sanitation requirements present a challenge.
But when it comes to decreasing population density and addressing the needs of patients with dementia, some assisted-living facilities have opted for a housing model designed specifically to combat infections.
The typical model of elder-care facility is called the “hospital model,” named after the general layout of a hospital, with multiple floors, two or more residents per room and a few large communal areas. As nursing homes adjust to a pandemic-prone world, a second model, known as the Green House model, could gain popularity.
Developed by geriatrician William H. Thomas in 2003, the model separates groups of between 10 and 12 residents into individual homes, with smaller common areas shared among a small number of people.
ElderHealth & Living Memory Village in Springfield employs the Green House model of residential facility, with nine home clusters.
The Green House model is better designed to prevent infection and can be adapted quickly to quarantine outbreaks if and when they arise.
Liz von Wellsheim, medical director and CEO of ElderHealth & Living Memory Village in Springfield, adopted the Green House model because it better suits her residents, all of whom have memory loss.
Her organization comprises nine homes, each with around 10 residents, a model that allowed her business to adapt more easily to the outbreak of COVID-19. Each home was quickly quarantined, and an employee was hired to help with testing. There have, to date, been no cases of the virus at the senior-living facility.
But quarantine was not without its difficulties. Families of dying patients are considered essential visitors, and since most residents come to her facility with less than two years to live, family visits are frequent.
She recalls a particularly frightening episode when a visitor from out of state refused to do a digital or window visit, and insisted on seeing their ailing father in his communal-living space.
“The person came off a plane from New York and hadn’t been tested. The chance of infection was huge, but he said, ‘No, let me in, my father is dying,’ and I had to let him into the facility where he could infect everyone. I struggled with that.”
Von Wellsheim waited over the next few weeks to see if the entire house would become infected. While the model is best suited to contain outbreaks, testing is more difficult because there are more common areas to inspect.
But she says her patients, all of whom have Alzheimer’s or dementia, fare surprisingly well when contacting family members through Zoom, FaceTime or similar software. While caregivers usually have to operate digital devices for the residents, von Wellsheim says many of her memory-care patients have figured out how to use Alexa units.
Another idea to innovate the traditional elder-care facility is to forget the idea that only seniors need to live there.
Derenda Schubert, executive director of nonprofit Bridge Meadows, operates a multigenerational-living community in which seniors live in units alongside children and their foster parents.
Multigenerational-living arrangements are ones in which three or more generations share the same living space.
Multigenerational households have more people living under one roof and have reported higher rates of coronavirus infection than typical households. Schubert’s community addresses that challenge by having seniors live in their own detached unit.
“The problem isn’t that there’s three or four generations living under one roof; it’s that there are six or seven people in close proximity. Each of our seniors has their own living area.”
When it comes to social distancing and sanitation practices, she says that the community “keeps each other in check” to make sure everybody is obeying proper protocols.
Bridge Meadows’ North Portland multigenerational-living community
Multigenerational living like the kind at Bridge Meadows does have its limitations. The community is not conducive to seniors with dementia or who require frequent health monitoring. Some residents do eventually need to be moved to hospitals or more traditional eldercare facilities.
But most residents who stay at Bridge Meadows do not need to be moved and instead stay at the community for the remainder of their lives.
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Schubert describes the psychological benefits of multigenerational living as a “superpower.” Living alongside children keeps seniors active and socially engaged, and mitigates problems of social isolation and depression.
The children, in turn, can learn from their elders and get to know people who are more at risk from the virus, and have a better understanding of why safety protocols are necessary.
“Generations are meant to be connected,” says Schubert. “Our brains are wired that way.”
As nursing homes deal with public scrutiny for the lopsided number of coronavirus deaths, facilities that adopt technology and new approaches to communal living will be at a competitive advantage.
At Avamere, the outbreak of coronavirus has lowered enrollments. New applications to move into the company’s elder-care facilities have stemmed from need rather than preference, says Thomas Cloutier, vice president of sales and marketing. But he adds the company’s adoption of technology has been “a saving grace for us.”
Seniors and their families now consider technological advancements and anti-outbreak strategies when deciding long-term care.
“These were things we were looking to adopt in the future, but COVID has accelerated it,” says Cloutier.
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