In conversations these days about Covid-19 and the pandemic, I often hear people say: “I can’t wait for this to all be over.” Clients call me and say they want to move their loved ones into a community once the “all clear” is sounded. Everyone wants life to return to normal. The problem is no one knows when that will happen. Not being a scientist, my speculations don’t carry much weight. But I feel comfortable making the assertion that the pandemic induced crisis in senior living won’t be over until a vaccine is available and widely distributed. Current timelines for a vaccine say 18 months is the earliest a vaccine will be ready. Since the pandemic started in the first quarter of 2020 that indicates a vaccine may be ready sometime in the third quarter of 2022.
Today, we need to make the best choice for our family members and loved ones. I’m honored to help families explore these decisions and to be informed. I wish I had someone like me when it was time for my Mom to enter memory care.
Clearly political leadership won’t wait for a vaccine to lift the state-wide lock-downs, as Texas began easing restrictions May 1st. What does this mean for senior living? There are many considerations in any discussion about re-opening: medical, political, technological, and geographical considerations will all play a part.
Let’s start with what we don’t know about the pandemic.
- When a vaccine will be ready
- Whether having antibodies for Covid-19 gives a person immunity from getting it a second time, and being a carrier a second time
- Whether Covid-19 is seasonal
- Whether current tests are for Covid-19 are reliably accurate
- Whether future drugs like Remdesivir will be developed, or contact tracing will be implemented, or other such mitigating advancements will blunt the pandemic’s impact
- What the future shape of the Covid-19 crisis will look like, both nationally as well as in Texas
Then there’s what we do know about the pandemic, or at least firmly believe.
- The elderly are uniquely vulnerable to Covid-19
- Elderly in congregate living, mostly in nursing homes, have experienced the highest rates of infection and death of any identifiable cohort during the Covid-19 pandemic
- Herd immunity won’t be achieved before a vaccine is developed
- Re-opening will occur on a state-by-state basis
- Re-opening will happen in phases, with some segments of society opening before others
- Congregate senior living will be the last segment of society to loosen its lockdown
I will go out on a limb and assert the following predictions for Texas senior living.
- A full re-opening will not occur for the foreseeable future. Because Texas is beginning re-opening while there are still over 1,000 new cases of coronavirus per day, the threat of infection for senior living communities is simply too high. Regulatory authorities will play a prominent role in re-opening decisions, as will the Governor and local health authorities. Nursing homes, which have the most deaths and most vulnerable populations, are overseen by Centers for Medicare and Medicaid Services, and are the least likely to re-open. Assisted Living and Memory Care are also unlikely to re-open, and are overseen by Texas Department of Health and Human Services. Independent Living communities, which have little regulation because they do not provide any healthcare services, have the best chance of getting back to normal before the end of the pandemic.
- Testing, once it is widespread and reliable, should enable a phased re-opening of senior living. Pressure will build for communities who have had no cases of coronavirus to loosen restrictions. The first phase will be the start of communal activities, meaning the dining room will re-open and an activities schedule will resume. The isolation of seniors in their rooms is too cruel to continue indefinitely. Pundits have noted that even in jail prisoners have the possibility of parole. Testing for residents and staff will probably be a weekly event in most communities. Lockdowns may happen again if the coronavirus is found in the community, but there will be new protocols for re-opening. Testing will hopefully keep clusters from getting out of control. One recent nursing home reported a single case, but found ten more through testing, and was able to create an isolation wing with separate staff. This is hopeful.
- Some geographic areas may open before others. In New York, the State is allowing certain upstate regions to open before the region around the New York City epicenter. In Texas the epidemic is concentrated in the five major cities and in counties with meat packing plants. Some rural counties may be deemed safe to re-open sooner and with fewer restrictions.
- Some sort of family visitation system will eventually be figured out at most senior living communities. This may be an outdoor area or gazebo, with secure fencing maintaining a six foot physical separation, with some sort of sound system to ensure effective communication.
“All clear” in my definition would be a full re-opening, when families are allowed in the building, are able to hug their loved one any time they want, and residents can come and go from the building without restriction. The reason I can’t envision this happening is because allowing non-essential persons into a community increases the infection threat vectors by probably more than five-fold. To illustrate, a typical large Assisted Living community of say 100 residents may have 60 full time staff spread across three shifts of caregivers, management, dining staff, maintenance and housekeeping, and activities personnel. If you add outside visitors such as personal caregivers, hospice, home health, healthcare professionals, miscellaneous vendors, prospective residents and their families, and finally current residents’ family members, you may increase the number of persons coming from outside the building in a given month from the 60 essential staff to somewhere over 400 persons. Maybe more. The prevalence of community spread of coronavirus will have to be very low indeed before non-essential visitors will again be allowed.
So when will we get the “all clear?” My conclusion is that I can’t foresee it until there’s a vaccine. I certainly hope I’m wrong, and a safe method of re-opening is found sooner.
As Always, Texas Senior Living Locators is here to help. Call (512) 402-2795