New Technologies Help Blunt Impact of Pandemic

by Jeff Shaw

Operators leverage advancements in COVID-19 testing, telehealth and social media to protect mental and physical well-being of residents.

By Eric Taub

While the COVID-19 pandemic forced the nation to institute physical isolation to save lives, it’s a tragic irony that the strategy actually worsened the health of many of our most-vulnerable citizens — our seniors — as researchers have discovered.

Forced to spend their days mostly alone behind closed doors, senior living residents have largely lost the actual in-person contact of their family and friends, which is vitally important to maintaining both physical and mental health.

“COVID-19 caused us to institute social distancing, when what we needed was physical distancing. This did not have to happen,” says Kian Saneii, CEO of San Diego-based Independa, a social engagement technology that utilizes the familiar TV, rather than a Wi-Fi tablet, to help seniors stay in touch. 

As disruptive as the last 18 months have been to senior living community operators, their staff, residents, and family caregivers, imagine if this pandemic had happened 20 years ago, before the popularity of the Internet and ubiquitous Wi-Fi access.

A pandemic that started in the early part of this century would have had far more deleterious effects. Communication with family and staff would have been constrained to pricey landline phone calls. The only visual communication available to shut-in residents would have been a variety of linear cable channels with programming that could be viewed only at specific times.

Those who needed to see a doctor would either have had to accept the fact that a physical visit could cause them to become infected, or they could have opted to remain at home and go untreated. What’s more, patient records would largely have been inaccessible outside of the doctor’s office. Exercise classes, lectures or participatory activities would have been available only by purchasing VHS tapes or audio cassettes. 

More than one year after the COVID-induced shutdown of many of the institutions and services that are part of our normal lives, senior living communities have largely adapted thanks to today’s technological advances. 

In-room resident Wi-Fi and high-speed Internet access, thought of as a “nice-to-have” technology just a few years ago, has become as essential as electricity in today’s locked-down environment. Without it, communication would be impossible.

To help residents stay in touch, governments in states including Florida, Massachusetts and Texas have donated tablets to skilled nursing and assisted living communities. 

In Orlando, Arjun Verma, a high school student, and his sister started Telehealth Access for Seniors by distributing smartphones and tablets for free to seniors and assisted living communities. To date, the group has collected, refurbished and donated 3,000 devices.

“Clearly, every senior living community is ramping up Wi-Fi and Internet access if they can afford to do it,” said Laurie Orlov, founder of Aging and Health Technology Watch.

In-person classes and lectures have become virtual, streamed through video conferencing applications such as BlueJeans, Teams and Zoom.

Those and other technologies are used by families to stay in contact with their relatives in senior living residences from whom they are forbidden to physically meet, and to communicate with staff. 

Healthcare transformation accelerates

Telehealth, now eligible for expanded Medicare reimbursement and touted for years as a viable alternative to in-person doctor visits, has skyrocketed in popularity as residents are either forbidden from, or anxious about, making an actual visit. 

And as COVID illness and death pervaded senior living homes, many residences scrambled to create the safest environment possible, from requisite social distancing, to procuring personal protective equipment (PPE), to finding ways to stop and slow the spread of the virus that could sicken or kill its residents and staff.

With false negatives, standard COVID tests have always been an imperfect detection device. To catch a possible outbreak before it happens, Enviral Tech, based in Eugene, Oregon, has devised a way to test surfaces for the presence of the coronavirus. A positive result indicates that an infected person had previously entered the area.

It’s a strategy that appealed to Anne Doyle, president of Lasell Village, a continuing care retirement community in Newton, Massachusetts, with 265 residents spread across 15 buildings. The community signed up for the $500 per month procedure, which uses eight swabs to test any one particular area.

While most Lasell Village staff and residents have now been vaccinated, a swab test in December after residents received their first shots revealed the presence of the COVID virus in a fitness center. Tracing its visitors, the community located a resident who, despite having received his first shot, was asymptomatic and had visited his doctor outside the community. The advanced detection enabled the community to isolate the individual and prevent a further outbreak.

A previous positive surface swab test at another building also allowed the community to find an outside caregiver who was carrying the virus. 

“Using the Enviral Tech test allows us to keep our COVID infection rate very low,” says Doyle. “We’ll continue surface testing until COVID is over.”

Electronic records crucial

While finding instances of COVID presence is key to keeping the infection rate down, it’s equally important to track who has been infected, their physical state, whether they’ve been vaccinated and the presence of any side effects.

To accomplish this once the pandemic began, Yardi, the Santa Barbara, California-based developer of senior living property management software, created additional modules that it incorporated into its electronic health records application.

A new Yardi infection dashboard documents an individual’s vaccination record as well as side effects and any COVID-related symptoms, allowing staff to track suspicious physical conditions and stay alert of any potential outbreaks.

The company also enlarged the tools available in its RENTCafé family and resident portal. Family members can now sign up for text alerts, automatically receiving information as to any community COVID outbreaks and, with permission, access a resident’s electronic health record. In addition, a wellness feature in the portal allows family members to view a residence’s community calendar and sign up the resident for various events.

Virtual gatherings the norm

By necessity, public community events during the time of the COVID lockdown must be structured very differently than those held pre-pandemic. Social distancing dictates that physical gatherings must be severely restricted or eliminated. Visiting performers addressing large crowds in community spaces have in many instances been replaced by hallway events, or converted to strictly virtual gatherings accessed via a digital device.

“Never in our wildest dreams did we expect this environment,” says Meghan Lublin, North American chief marketing officer for McLean, Virginia-based Sunrise Senior Living. “We went from a warm, loving  set of communities to one that had to be turned on its head.” 

With the need to quarantine its residents, Sunrise quickly scrambled to figure out how to keep them socially engaged. The operator purchased hundreds of Apple iPads and created virtual activities, including access to concerts, church services, virtual museum visits and pen pal groups. 

The company’s Smile app, introduced this past September, allows family caregivers to access a resident’s activity calendar and contact community staff. Using FaceTime or Zoom, Sunrise also holds monthly “family nights” with its care providers, keeping loved ones informed about community developments.

Forced to ban physical gatherings, Seattle-based Merrill Gardens, a 7,000 resident group of communities across 20 states, shifted to virtual meet-ups. Working with Google, the organization procured hundreds of Google Nest Max devices to install in the apartments of its 1,000 residents in its eight Washington communities. By next year, management hopes to have a device in every apartment in its group. 

Similar to an Amazon Echo device, the voice-activated Nest allows users to communicate via voice and video, to watch movies, educational and instructional videos. Google redesigned the standard user interface for the residents, increasing the size and reducing the number of buttons, while simplifying the screen layout.

“Technology has literally been a lifesaver for us,” says Tana Gall, president of Merrill Gardens. “Before COVID, our residents were used to going to dinner and socializing with their friends. Now they use their Nest devices to call each other and have their own virtual happy hours.”

Gall hopes to eventually equip every resident with a Nest. But until Merrill Gardens does so, the Seattle residence uses large smart TVs on carts, transferring a video conferencing stream from a tablet to an HDTV to allow residents to easily see and speak with their loved ones.

New twist on sing-along

While Merrill Gardens has learned to pivot from a physical to a virtual world for its residents, third-party providers that have always only offered in-person services were faced with a steep learning curve when the pandemic hit.

SingFit, a music therapy initiative, uses singing to help improve health. Its program, according to the company, has been shown to regulate cortisol, dopamine, and endorphins, thereby elevating mood and reducing pain.

Prior to the COVID pandemic, the SingFit program was only available as an on-premises product. Trained music therapists conducted sessions, and used printed materials to help participants follow along, engage in musical quizzes, and sing along with fellow residents.

Once the pandemic arrived, “we did a considerable pivot” says Andy Tubman, co-founder of Los Angeles-based SingFit. Where sessions were previously held collectively, now residents participate in the program in their own rooms. 

Tubman researched the spread of aerosols released while singing or speaking to determine if singing, a key component of the program, was still viable. Its findings enabled the company to prepare materials that included diagrams showing how residents could stand in the hallways and safely sing, using speakers to hear others.

The company also created SingFit PrimeTime, a video-based movement, singing and trivia program that residents and their caregivers can access on demand using a digital device. “It’s a very clinically advanced version of ‘Sing Along with Mitch,’” says Tubman.

Because the new versions of SingFit are virtual and digital, utilization costs are much lower than the in-person version, which requires a trained music therapist at the facility.

Tubman points out that not only does SingFit have psychological benefits, helping those aging and with cognitive decline to increase their social awareness and interactions, but singing also has physical health benefits.

“Singing on a regular basis increases immunity. Sedentary people in wheelchairs cannot clear their lung fluids, increasing their chance of getting pneumonia. Singing clears lung fluid and helps regulate breath control, all especially important during the COVID pandemic,” says Tubman.

Mental health is paramount

As important as maintaining physical well-being is during this crisis, there’s no question that the pandemic has taken a toll on the mental health of many elderly individuals. Physically isolated, unable to be in the same space as their friends, with many never leaving their rooms at all, the restrictions caused by the pandemic shutdown have greatly damaged the mental well-being of many senior living residents, says David Schwam, chief executive of WellQor, based in Melville, New York. 

With a team of 90 licensed professional psychologists and social workers, the company provides mental health services across 40 states, specializing in services to senior living communities.

That’s up from serving just seven states before the pandemic, when all of WellQor’s therapists physically visited patients, and Medicare did not reimburse telehealth psychotherapy sessions. Now, WellQor conducts all of its sessions virtually. 

“Before the pandemic, getting therapists to communities in rural Wisconsin and Texas was a challenge for us. We had to say to them that they were too far away. With telehealth now eligible for Medicare payments, that problem is gone,” says Schwam.

The biggest emotional problems affecting residents due to the pandemic, according to Schwam, include adjustment disorders, depression and anxiety due to individuals unable to physically meet either their family members or fellow residents. 

Understanding that its work depended on ubiquitous Wi-Fi access, WellQor extended its mission, supplying tablets and kiosks to various residences, and acting as an unofficial information technology support system for both residents and staff.

“WellQor’s been very beneficial for our community,” says CC DeGraaf, executive director of The Kensington, an 80-
resident assisted living and memory care community in Sierra Madre, California. 

“They gave us an outlet for residents to share their frustrations and anxieties. Their therapists became another source of connection and allowed our residents to speak freely without feeling they needed to censor their thoughts.” 

When the worldwide lockdown began early last year, few people would have expected it to last this long. And figuring out the best response to it to keep individuals mentally and physically healthy became a learn-as-you-go endeavor for most.

“We’re writing this book as we go,” says Gall of Merrill Gardens. “If we ever have a pandemic again, we’ll be more prepared with technology to deal with it.” n

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