A few weeks ago, Harry Hammond drew my attention to an opinion piece in the Dallas Morning News. It was written by three senior-living experts: Jacquelyn Kung, Robert G. Kramer and Ed Frauenheim. The title was “How the senior living industry can heal itself and all of us.” Here’s the link:

https://www.dallasnews.com/opinion/commentary/2021/01/17/how-the-senior-living-industry-can-heal-itself-and-all-of-us/  (You must provide your email to get access to the story.)

Betty Warner also received the article from Harry, and she passed it on to many others. In this post, I will be quoting responses to the article that both Harry and Betty provided.

The article’s authors point out that the large number of Covid-19 cases and deaths in senior living facilities, especially nursing homes, has given the industry a bad name. They quote a December 2020 article in the AARP Bulletin: “Residents of long-term care facilities constitute less than 1% of the U.S. population, yet 43% of all COVID-19 deaths through June occurred in those places. The number has changed little since.”

In Pennsylvania, the situation is even worse than that: using PA Department of Health data for March 19, 2021, I calculate that an astonishing 52% of Pennsylvania Covid-19 deaths (12,847 out of 24,741 deaths) occurred in long-term care facilities. (At least in Pennsylvania’s case, the independent living portion of a CCRC is not included under “long-term care facilities”.)

The Dallas Morning News piece does not distinguish between independent living, personal care, and skilled nursing. As a result, some of their comments apply only to more limited “nursing homes” and some apply more broadly to retirement communities (such as Kendal-Crosslands) that include independent living. In my comments below, I’ll try to draw that distinction where necessary.

The authors suggest five steps that will be “vital for repairing and renewing the industry”. They are:

  1. Trust through transparency. Facilities must “be willing to publish real-time information on such matters as COVID-19 infection rates and deaths, risk-mitigation protocols and staffing policies.” Kendal clearly gets high marks for that. As Betty points out, “Lisa and Donna were as open as HIPAA allowed.”
  2. Digital Transformation. The authors see three pressing digital needs: “video communication among residents, staff and family members for peace of mind; virtual health care; and social connection.” I think Kendal’s use of Zoom has handled those issues well for the most part.
    People worked hard to keep personal-care and skilled-nursing residents connected. I would single out our resident Laszlo Szabo (who figured out how to keep Zoom programming coming to our medical wing via our closed-circuit channel 15.1) and our medical staff (who provided loaner tablets and support services for those in the medical wing who needed them). Digital services were not always available to independent-living residents who were not computer savvy, however. 
  3. Onsite health care delivery. Facilities can’t be satisfied with “a van shuttling residents to the doctor’s office or an ambulance ferrying sick residents to the hospital.” Here again, Kendal has provided top-quality health services, on site. Our medical team even made house calls to residents in independent living during lock-down periods. Betty notes: “the very existence of our COVID19 isolation rooms here, the fact that we administered monoclonal antibody therapy, and the use of telehealth coordinated by our staff in some cases shows that we were doing much more than simply driving a van to the hospital.”
  4. Workplace culture. “… research suggests that providers with the most positive work environments have lower staff turnover rates and better care outcomes.” I’m not in a position to evaluate the workplace culture in our medical facility, but my sense is that it is very positive. As Betty points out: “A stunning 90% of our staff received the vaccination.  Compare that with … 50% reported at many nursing homes.  …  Education for staff about the vaccination was ongoing; even beauticians were included.”
  5. A new story for senior living. Finally, the authors propose that senior living be redefined: it should be less about caregiving (a “declinist” narrative) and more about meaning and community. They propose that seniors engage with young people in need of educational support, because “one of the biggest problems we face is faltering progress by students from poorer and disadvantaged backgrounds.” They mention tutoring programs in Dallas and San Francisco that pair retirees with young people from disadvantaged backgrounds.

I’d say Kendal is doing a good job at maintaining “meaning and community” in spite of the pandemic. And—until the pandemic hit—we were also doing the kind of tutoring and outreach the article describes.

Betty says: “I haven’t given up on hoping that we can restore tutoring, relationships with Kennett Square Hispanic population and both Cheyney and Lincoln University.  I sincerely believe that much meaning in life (and life-changing!)  came from those experiences.“ She notes that a number of residents have continued their work with our Kennett Square neighbors throughout the pandemic.

An opportunity and a cautionary note. Harry points out that the broader implication of the article is that senior living facilities currently have an opportunity to “renew and improve their services” and generally “set things right.” And it’s not sufficient just to address the specific points mentioned in the Dallas Morning News article: in the past, one of the authors, Robert Kramer, has warned retirement communities that future cohorts of retirees, though larger in number, will on average be less able to afford high-end retirement communities.  And larger percentages of seniors will want to live in multigenerational settings.

(I would add that some future retirees won’t even want high-end housing: our two children, now both in around 40, have relatively few possessions, live in relatively small spaces, and don’t own cars, largely as a matter of principle. Kendal will need to be ready for them and their friends.)

Harry continues: “Kramer’s list of developments/strategies give us a short list of outcomes to avoid:  too many costly units; segregation of seniors (within the community and within the surrounding multi-generational community); and, for KCC, any reduction of one’s ability to use any of the community facilities. When the KCC Property Committee and afterward the KCC Board settle on the features of the revitalization (repositioning), I’ll be looking for the features—as Kramer put it—that offer for residents what’s needed for feeling ‘deeply alive.’  And wouldn’t it be great if KCC’s outward facing activities could become even more reciprocal (people of all ages serving each other).” 

The authors of the Dallas Morning News piece end by saying: “The senior living sector can lead the way, prompting a polarized, battered nation to wake up to its sense of interdependence.” Here at Kendal, we are already well on the way. We have the opportunity—both residents and staff—to take up this leadership challenge. I’m not sure if we can really “prompt the nation to wake up to its sense of interdependence.” But if any senior-living facility can do it, Kendal is the place.

We can even go beyond repairing the damage that the pandemic did to the industry’s reputation and getting back to the “sense of interdependence” we were starting to develop through our tutoring and outreach programs before Covid struck. As Harry points out, we have the additional opportunity to help Kendal become the place it will need to be for future generations of retirees.