The senior living industry has done much to prevent residents and staff from contracting Covid-19 over the past seven months — but even necessary safety measures have a cost. Now, providers are dealing with the ripple effects of Covid-19, as deteriorating resident wellness leads to worse health outcomes and possible drags on occupancy.
After months cooped up in their rooms, some residents are feeling more socially isolated, depressed and anxious. This is perhaps leading to an uptick in prescriptions for mood-stabilizing medications for some, which can in turn increase their risk of falls, heart attacks or strokes. Many residents are also at risk of worse health outcomes related to months of reduced physical activity.
Faced with a deadly pandemic on one side and a possible decline in health outcomes on the other, senior living providers including Dallas-based Pegasus Senior Living and Hickory, North Carolina-based ALG Senior have employed a variety of strategies. These include connecting them with mental health services via telehealth, physical therapy or more passive wellness-focused practices such as light therapy and aromatherapy.
“As an industry, we’re all trying to take positive approaches to this, and find ways to adapt to the new normal and the continued challenges we have with Covid,” Dr. Sandra Petersen, who is leading Covid-19 efforts for Pegasus Senior Living, told Senior Housing News.
Indirect impacts
Although necessary to stop or slow Covid-19’s spread, restrictions around activities and fitness have meant that residents are getting less physical stimulation and exercise than before.
“Mobility certainly is a huge issue,” Petersen said. “And when you have a decline in someone’s mobility, you’re obviously going to see an increase in the number of falls.”
Meanwhile, many providers have had to shutter or scale down visitations and social programs, leading to a heightened risk of social isolation, boredom, depression and anxiety among residents.
“Over time, isolation takes its toll,” Petersen said. “Naturally [residents] will be more prone to depression or anxiety, perhaps worrying about family that they’re not able to see you with the restrictions.”
That’s a trend playing out across the industry, including at the nine communities operated by Birmingham, Michigan-based Bloom Senior Living.
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“Some people have a little bit of depression that we have to work to combat,” Melissa Campbell, the company’s director of education and development, told SHN. “Some people are more fearful than others. Some are more cavalier.”
The pandemic and its disruptions to daily life also have an effect on memory care residents, especially those who live with moderate to severe Alzheimer’s, dementia or other cognitive issues.
“The scariest thing for the person who has moderate to severe dementia is not knowing what comes next,” Petersen said. “It definitely impacts them, and when it’s a sustained situation like this, certainly you see the resulting cognitive decline.”
To mitigate the effects on mental health, some residents have begun to take more prescription drugs — but doing so carries its own risks, according to Dr. Kevin O’Neil, chief medical officer at ALG and medical advisor to Maple Grove, Minnesota-based Grace Management.
“I’ve heard from our pharmacy providers — maybe somewhat anecdotally — that we’re seeing an uptick in scripts for benzodiazepines, antipsychotics and mood-stabilizing drugs in senior living,” O’Neil told SHN. “And that that concerns me because … these drugs have serious toxicities, including a higher fall risk, even a higher risk of heart attack, stroke and death with the antipsychotics.”
But that trend may not be occurring evenly across the entire industry. Crestwood, Illinois-based Medication Management Partners has seen a “small decrease” in the prescription of psychoactive medications between September 2019 and September 2020, possibly “due to reduced prescriber visitations and prescriber activity,” CEO Labinot Avdiu told SHN.
Residents’ loved ones are also taking note of the pressures of the new pandemic age. One sibling of a resident living in a community belonging to a regional West Coast provider described to SHN the “devastating” effect of residents having less human contact and exercise during lockdowns.
“For the most part, they have been confined to their rooms for months, and only recently were permitted to meet with their families for 30 minutes a week, preferably during the work week,” they told SHN in an email last month. “While I understand the need to keep the environment safe, at what cost to the residents by keeping them in a virtual prison?”
Not only do these challenges take a toll on the wellbeing of residents and their loved ones, the situation also affects senior living providers’ bottom lines, which have already been hit by the increased cost of testing and personal protective equipment (PPE).
One risk is that family members may choose to take their struggling loved one out of a senior living community, whether or not they can provide better care at home. For providers already dealing with fewer move-ins, this could hit census like a one-two punch.
“I think there’s an occupancy challenge that has continued on across the industry,” Petersen said.
Likewise, senior living residents who experience a significant adverse health effect — whether it’s related to a new prescription drug, less physical activity or general mental stress — are also more likely to leave the community where they live, according to O’Neil. This can make all the difference in the world for providers which are struggling with slimmed down margins and rising expenses.
Mitigating the effects
Senior living providers have employed a variety of tools and techniques to mitigate the pressures of the pandemic and its restrictions.
For example, Bloom is monitoring residents for signs they’re struggling with things like loneliness or mobility, and scheduling virtual visits, physical therapy or other interventions when needed.
“If we have a resident who is struggling, we might reach out to their family and say, ‘Hey, would you be interested in scheduling a visit?’” Campbell said. “And if somebody was at more risk of falls … or if they’ve had changes in cognition, we would engage therapy.”
Pegasus in June partnered with Melville, New York-based WellQor Management Services, a provider of behavioral health services for senior living companies and residents. Through that partnership, Pegasus residents have access to mental health professionals who are specifically trained in the needs of older adults, either for telehealth or in-person visits where allowed by state regulations.
“With WellQor, we do a transitions program where they actually are introduced to the resident prior to move-in so that they have a relationship with the therapist,” Petersen said. “If they’re dealing with depression, grief or loss … we can help them navigate that.”
ALG also connects its residents with mental health services. The provider has relationships with primary care providers, as well as a company called LifeSource, to link residents with therapy and other mental health services.
“We’ve been really fortunate to have mental health providers who have been doing telebehavioral health even prior to the Covid-19 pandemic,” O’Neil said.
To help residents with the physical toll of pandemic restrictions, Pegasus has implemented physical and occupational therapy services from partner company Genesis HealthCare (NYSE: GEN). Pegasus has also leaned on other service providers to encourage activity, such as Los Angeles-based Musical Health Technologies, purveyor of musical therapy service SingFit.
In ALG’s toolbox are handouts detailing exercises that residents can safely perform by themselves. And the company is working with therapists who are experienced in the Otago program, which is designed to help residents reduce falls by performing strength and balance exercises.
“Having physical therapists who are experienced with the Otago program really can make a significant impact on improving physical function as well as some of the behavioral issues,” O’Neil said.
ALG is also working with its health care provider partners on other non-pharmacological interventions, including the use of robotic pets, aromatherapy, passive music therapy and light therapy. But in the end, it will likely take a blended approach of many methods to keep senior living residents feeling well, according to O’Neil.
“We have embraced what I like to call an integrated care model. We don’t want to lose sight of the social and hospitality aspects,” O’Neil said. “Being able to address the medical and health needs of our residents, we felt, was critically important.”