“Senior living needs some disruption, beyond just lifestyle changes for older adults, we need disruption and innovation that will lead to exponential progress in caregiving.”

By: Cindy Phillips | Managing Partner, K4Advisors

April 27, 2020

Caregivers are the heroes in senior communities across the country, and COVID-19 has only made that more visible. Especially in assisted living, personal care, and nursing homes, they are an integral part of everyday life and a lifeline for many residents. 

The current challenge is really two-fold. One, there are not enough of them and that problem has been prominent in our planning with predictions from entities like Argentum and Leading Age for almost a decade – and it’s forecasted to only get worse. And two, their pay scales fail to or barely reach a living wage, and the alternative jobs at the same scale are often easier or more flexible. 

Even worse, during COVID-19, shamefully some are blaming these caregivers for igniting the spread of this pandemic in nursing facilities. They point to a common practice of aides or nurses working in multiple communities, which might be true, but those claims fail to also recognize the realities this workforce is experiencing. They are simply trying to make a living and this practice has been essential to ensuring facility staffing levels are met.

Going forward, it is not clear whether this negative publicity or stress will make the caregiver shortage even worse, but it is evident that the solution is multi-faceted. It cannot be solved by simply more recruiting or more training. 

Senior living needs some disruption, beyond just lifestyle changes for older adults, we need disruption and innovation that will lead to exponential progress in caregiving. The COVID era has showcased the value of technology in driving that progress. Here are a few examples:

Voice Enablement – Many stories are being played out on television or the Internet showing older adults using voice assistants such as Alexa and Siri to listen to music, play games or engage with families or friends. Sadly, some even to find companionship in their last hours of life. But they are also being used by residents in senior care communities to get COVID information, community updates, or to reach a remote caregiver at the front desk. These interactive communication assistants are being welcomed by seniors, they empower them to get what they need, when they need it, and in the end enable staff to redirect their time from answering repetitive questions to more critical caregiving duties.

Smart Home Technology – Just like at home, over 100 senior living communities across the U.S. have embraced this technology. With the support of K4Connect’s Home Automation package of smart lights, a thermostat, and a motion sensor have been installed in resident rooms, apartments or cottages. These devices not only provide convenience and safety (especially when tied into the Voice feature above), but also the ability to passively monitor the movement (or absence of it) of an independent living resident who may live alone. This daily “resident check-in” feature is always valuable, but during COVID-19, it has been an incredibly helpful safety net to identify unusual patterns while we are social-distancing. Without a system like this, many community caregivers would have to be making many more daily calls or visits to all residents versus helping those who really needed it. 

Wearables/Vital Sign Collectors – The Internet of things (IoT) has brought us so many useful devices and wearables, even to those in the 65+ market. Beyond simple fitness trackers, many seniors are using devices to collect and report their weight, blood sugar readings, and heart rhythms. The COVID-19 outbreak has shown the value of having a wireless personal device to take daily body temperatures and pulse oximeter reading for those with COPD. They now can collect and report this data to a remote nurse or a medical provider. All of this is ultimately saving hours of caregiver time in accomplishing the same, if not more, through remote data collection, monitoring and oversight. 

Telehealth – Telehealth has been on our radar as an industry for quite some time and is possibly one of the silver linings of COVID-19. We are finally getting some regulatory relief to use video conferencing to connect older adults to their medical providers. Especially during stay-at-home restrictions, technology is providing a safer, easier screening tool. It is also reducing transportation challenges – which can be unavailable or unpleasant for frail patients and saves caregiver time eliminating a need to accompany them to an appointment.

As a recent Zeigler Senior Living Z-News email confirmed, telehealth can help operators “optimize their workforce” and “direct residents to the most appropriate caregiver for their condition.” Using telehealth goes a long way in ensuring providers and caregivers, both in short supply, are utilized in the most efficient way and it can be a more pleasant experience for the patient.

Maybe talk of digital caregivers or robots seems futuristic, but the scenarios above are not just ideas, they are available and in place today, helping many communities keep their residents safe and they are helping caregiver staff focus their talents and energy on those that need it most. If they can provide relief when the demands on staffing are high, then we are making some progress!

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Contact me with questions at Cindy.Phillips@K4Advisors.com, or learn about tools to support older adults and caregiver staff at  www.K4Connect.com.

“It clearly feels like we’ll be forced to find, or hopefully define, our ‘new normal‘.”

By: Cindy Phillips | Managing Partner, K4Advisors

April 16, 2020

As we begin the difficult discussions on how to reopen America, and subsequently senior care communities across the country, we know there is still so much more work to be done, and so many more lives to be saved. We are nowhere near finished, and I wonder if we ever will be?

Finished, I mean. This pandemic is not like any other situation I’ve experienced. It combined the worst of them all, demanding greater levels of physical, emotional and intellectual energy than ever before, and will likely bring lasting changes to the way we live and engage with one another. I am sure we will never be “back to normal” again. Although some may struggle to hear that, it clearly feels like we’ll be forced to find, or hopefully define, our “new normal.”

That said, if one of our lessons learned from this is ways to keep people healthier and safer, especially our most vulnerable older adults, then I want the new normal. If other lessons are that we need easier ways to quickly communicate and keep people informed, ways to digitally connect them with their friends and family, ways to provide virtual access to medical professionals, ways that everyone, no matter your age or socioeconomic class, can have these options, then I want the new normal.

Look, I am not trying to trivialize or minimize the all-out war we are waging against this virus, but I do believe in senior living we’ve recognized (maybe cemented) the need and importance of being prepared to fight something like this in two ways. 

First, the medical one, bringing to bear all the resources, knowledge and expertise we have in stopping the spread of the virus, and in finding a treatment for those who get it. At the community level, all senior living operators have been doing their very best to adhere to critical policies and procedures, even though they are changing day to day. They have demonstrated an amazing ability to improvise with limited resources, still able to serve, protect and prevent the spread of COVID-19 on their campuses. While there are some notable hot spots, the effort overall has been incredible given the vulnerability of this population.

The second way we must fight something like COVID-19 is through communication. On a global, national and state level, we’ve watched endless hours of news coverage explaining the pandemic’s origins, realities, discoveries, and mitigation efforts. We want to hear our leaders outline the strategies for getting us to a better place and a plan for next steps. 

This is no different at the community level, with many executives and frontline leaders sharing important guidance, but also messages of hope and calm. Thankfully, everyone is recognizing the critical importance of this and it is a sobering reminder that having platforms for not only mass notifications, but also for more detailed updates on a routine basis must be a part of our everyday life going forward. 

I can remember back to the beginning of this epidemic, hearing about the first cases at Life Care Center at Kirkland, and thinking with my old Executive Director hat on, honestly saying to myself, “This is going to be a huge communication challenge.”  I knew how much residents, staff and families would need frequent doses of information, education, and reassurance, wanting to know the exact steps being taken to keep everyone safe. It was also clear to me that having the right tools and technology in place to facilitate the timely and accurate delivery of this communication was going to be essential. 

Now on the sidelines and seeing this from the view of a technology provider, I have watched and read about communities doing this well. Some were lucky, having already embraced the digital world, they had in place critical notification pathways such as a resident app or portal, a friends and family app, a COVID hotline or digital signage, enabling them to easily create a single message and instantly publish it to their key stakeholders. Some communities, now our clients, have added some of these features during COVID, recognizing there will be no better time to get them in place.

Other communities had video chat or conferencing features in place, YouTube channels, and capabilities to stream live content to their community TV channels. While these may not have been fully integrated or may not have worked perfectly at the start, with the help of solution providers like K4Connect, they were able to provide continual updates and communication to the many who were counting on it. Eventually, these tools also provided new ways to connect residents and loved ones, and now have ushered in a new form of virtual programming that may remain long after quarantining and social distancing ends.

But for every one of these communities, there are probably two or three more that are struggling to keep their communities informed and updated. Some may have used their website or Facebook page to publish broad messaging or video clips, but often these do not reach all the necessary audiences or may not be easily updated by in-house staff. Without the proper tools, they are either under communicating or wasting critical staff time getting the message out the old-fashioned way (photocopies, emails, letters, elevator posters.) Or even worse, as documented in a recent McKnight’s survey, fielding hundreds of phone calls from residents, family members, or even staff, many wanting to know the same information.

Whichever scenario best describes your community, the good news is we can all get better.  At K4, we think of transformation and innovation as a journey, not a destination. Our maturity model outlines the critical steps to leveraging the benefits of technology, how to become a Smart Senior Living Community. So no matter where you begin, you have a roadmap to build and execute a long- term strategy to address engagement and communication.

Gerri Knilans recently said in her April 14^th blog, “Societal needs dictate the technology we develop, and at the same time, emerging technology can also shape our society.” Maybe it happened in the reverse order, but we have better, more affordable ways to engage and communicate with all these important audiences. I hope that while these were once seen as “nice to have tools,” that an unfortunate chapter in our lives called COVID, will make them a “must have.” 

This will not be the last emergency, weather event, or even the last pipe to burst in a building. Make use of the lessons from this terrible event to re-examine your digital transformation strategy, and know that the advisors and support team at K4Connect will be here as a partner (not a vendor), to help you integrate these tools as part of your “new normal”.

Contact Cindy about these tools at Cindy.Phillips@K4Advisors.com, or learn about our integration platform, FusionOS, and our resident engagement and communication app, K4Community, at www.k4connect.com.

“We may not have all the answers yet, but we do know the big categories of a ‘back to normal’ project plan.”

By: Cindy Phillips | Managing Partner, K4Advisors

April 9, 2020

We are about a month into the COVID-19 pandemic, and we are already seeing unparalleled levels of fatigue, fear, and predictions for loss of life that are hard to wrap your head around, nevertheless your heart. 

It is no more evident than on the front lines of any senior care provider, the caregivers are facing untold levels of exhaustion, painful separation from family, and sheer burnout at both a physical and an emotional level.  The leaders of those organizations are facing equivalent pressure to think clearly, make decisions quickly and focus their attention on the right priorities.

“If there’s one thing people agree on….it’s we can’t do this forever,” said Laurie McGinley and William Wan a few days ago in a Washington Post article.  

It feels as if the days are running together, now referred to as COVID time. Our pace has felt like a sprint, but we know it’s a marathon, unfortunately, one without a clear finish line.  The amount of information we need to process daily continues to grow, and the range of emotions we are asked to manage is simply overwhelming.  Yet we are told this is far from over, with hints at this time of extending the stay-at-home orders from the end of April to June 1^st across many states. 

I’ve never run a marathon, but I assume it is easiest in the first third, harder in the middle (peaking at “the wall”), and hopefully at least mentally easier in the final third. The tough part for all of us right now is knowing whether we’ve hit the wall yet. 

I think it depends on where you live.  Maybe in New York, that is exactly where they are, looking for some support or strength to keep going. In North Carolina, where I live, I don’t think we’ve gotten there yet.  For the sake of this article, I will assume for most of us, it will get worse before it gets better (see data analysis by state.)

So how can you prepare yourself, your team, and of course your residents for the rest of this marathon called COVID-19?

My doctoral research focused on how some people handled adversity and obstacles successfully, while others didn’t.  I collected the actual strategies they used to get through it, often leading them to come out even better on the other side. Two of those strategies seem most relevant here.  One, broadly define your goals. This approach provides flexibility in reaching the goal and avoids a sense of failure simply from starting with a rigid definition of success.  

As a Senior Living executive, my suggestion is to start defining what “back to normal” will mean for your community. 

That will look different in every community, but one important point is that it won’t be a switch to a new normal, it will involve many smaller steps and the deliberate peeling back of layered restrictions.  It will be a complex process, and with much of it driven by CDC guidelines (maybe CMS) for independent living and nursing facilities.

“People want to understand when current lockdowns and restrictions will lift, and normal life starts to return. When will we begin to defeat #COVID19. There is an end to this. We need to define it,” Dr. Scott Gottlieb, former head of the FDA, recently shared via Twitter on March 21, 2020.

However, residents (and staff) are likely to struggle with this definition. The reality that it will not happen overnight. So, it is important to start this messaging now and began to explain the various steps that will free them from the onerous quarantine and safety protocols.

We may not have all the answers yet, but we do know the big categories of a back to normal project plan:

• Definition of Outbreak Peak,
• Screening & Testing Protocols
• New Cleaning Procedures
• Community Access to Various Levels of Care
• On-Going Visitation Policies
• Admissions and Move-In Policies
• Re-Opening of Dining & Restaurants, Activities, etc. 

Seeding this discussion now will help these stakeholders begin the buy-in process.

The second of the two strategies is to approach things incrementally, allowing for small victories along the way and agility for when things change. Back to our marathon analogy, it is not a coincidence that the Rock-n-Roll series has a celebration at each mile. It is a reminder to be celebrating each day that you are keeping residents and staff safe, working to deliver or serve thousands of meals, and reaching dozens of residents with virtual activities and especially through the religious holiday events. 

In addition, the back to normal project plan will be another opportunity to show key milestones, track progress and enable people to see the finish line come into view. It is proven that people are more patient and understanding when they see the process and the steps to the goal.

On a Leading Age-North Carolina call this week we were once again reminded that we will get through this with communication, communication, communication. The two strategies outlined above are all about how we do that. At K4Connect, we live at the intersection of technology, communication, and engagement. I am hopeful this approach will help you in crafting your message and a tool like K4Community will make sharing it the easier part.

“We know how to do this, we call it strategic planning, we just usually have more time.”

By: Cindy Phillips, Managing Partner, K4Advisors

April 7, 2020

I was talking with a colleague last week who runs a large CCRC and who has been in both acute and post-acute settings most of his career. I asked him, “Have you ever seen anything like this before?” He paused, and his response was “No.”   

It’s clear at this point in our COVID response that we are all in unchartered territory. Even the industry veterans, from LPN to CEO, are being tested like never before. It’s what I am struggling with right now as a recent operator myself, what advice would I give? Our leaders, in every setting, are being forced to make very tough decisions every day and often without much experience to guide them or time to fully assess the options. 

As our conversation continued, my colleague later added that the only parallel he could think of was his military experience. This fits the current narrative – the “War on COVID-19.”  

This war, a medical director recently said, is almost unwinnable. “Nursing homes have no way to avoid outbreaks – they can reduce the risk and increase the likelihood of delay, but it still is a roulette. Unless we get an effective vaccine or treatment, eventually almost every facility will have their crisis. More than 20% of their residents will die and another 20% or more will be much less functional for having been so sick,” said Dr. Joanne Lynn in her March 28 blog.

Can Reconnaissance Help?

This whole conversation got me thinking about what we could take from military practices to help in our response. The word reconnaissance emerged. 

Merriam Webster defines it as “a survey to gain information; an exploratory survey of enemy territory.” At the national level, that means looking at other countries and how this virus evolved.  For senior living, we have only to look at other communities who are getting hit ahead of us. Looking ahead to see the decisions we will have to make and give ourselves time, if only a few days, to prepare our response.

We’ve done it already with decisions on employee screening, visitation rules, end-of-life exceptions, staff return-to-work policies, communal dining changes, and policies on new admissions or move-ins, to name a few. 

So, what’s next? How do we prepare? 

My suggestion is to focus just one step ahead, spending time today working on the decisions for tomorrow. We know how to do this, we call it strategic planning, we just usually have more time. Here are a few examples of some of the hardest decisions likely on the horizon for many of you. 

Tough Decisions to Come

What if a family wants to take their loved one out of Assisted Living or Nursing?
“Moving an older adult from a long-term care center is risky and could have long-lasting impacts. The federal Centers for Disease Control and Prevention (CDC) does not recommend such moves,” said geriatrician David Gifford, chief medical officer of the American Health Care Association and the National Center for Assisted Living, in a recent AARP article.

It is happening already. About 28% of respondents in a survey from Skilled Nursing News said family members had removed a resident from a facility explicitly due to COVID-19 concerns. 

We’ve got to be prepared, so what education do we need to share with families?  How will we do that and what will your policy be if they insist? Beyond the normal paperwork or guidelines for a resident spending time outside your facility, do you need something else?

What happens when you get your first case of COVID-19?
Many are already dealing with this, but beyond the CDC guidelines on isolation there is so much more on plans for communication. How will we tell residents in our community, their families and then the media? Who will care for these residents? How will you deal with the anxiety that will emerge from your caregiver team? 

What conversations need to happen quickly if it’s a bad case of COVID-19?
Does this resident have an advanced directive? Will they be capable of making changes?  This requires that some sensitive discussions happen quickly. 

These resources may help: VITAL Talk and The Social Work Hospice and Palliative Care Network.

In a CCRC environment, will you admit an Independent or Assisted Living resident with COVID-19 into your Nursing center?

As you see in the Skilled Nursing News survey, 24% already have. Once you have a case, or if you’ve set up a specially isolated unit, this may become a reality. 

Even ahead of that, what will your policy be, at least with what we know right now? How will you explain this to the many stakeholders who will want to know the rationale?

How will we handle the first death (or even worse when the volume climbs)?
Start the conversation with your funeral home partners in your area. Are they prepared for a timely removal of the deceased?  Simple logistics of storage and who will be responsible for transport?  

Last Thought

And by the time I press send on this article, there will be at least five more key decisions that will need to be made and policies or guidance to be given to staff or residents. My message is to get ahead of it, even a few days before you are under the gun to make the call. And at the end of each decision is a “to-do” item around communications. At K4Connect, our technology, K4Community, provides a variety of reliable and scalable ways to do that.

 “In survival mode, our vision narrows. Reactivity replaces deliberation. Threat can help mobilize our attention, but when it comes to solving complex problems, we need our highest cognitive resources,” said Tony Schwartz in his recent HBR article.

Let’s use our best reconnaissance and stay one step ahead of COVID-19!

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More COVID-19 resources are available on our dedicated COVID-911 Resource page, linked here.