Effects of the Pandemic on Life Plan Communities

In this time of uncertainty, HCM’s design experts have been exploring options and potential solutions for how senior living facilities can adapt to the new normal. In this series, principals from HCM’s Senior Living studio share their personal perspectives. We stand ready to work with our clients to create tailored and thoughtful solutions for what’s next.

Over the past weeks I have had numerous discussions with our senior living clients about what’s next. How will they adapt in a post-COVID pandemic world to keep their residents, staff and their families healthy? One particularly challenging portion of the market, where many of our most at–risk citizens live near each other is Life Plan Communities (also known as Continuing Care Retirement Communities or CCRC’s). These environments house seniors who have a wide range of acuity.

Protecting Residents

Skilled Nursing and Memory Care residents are the most susceptible of the entire continuum due to a myriad of factors driven by their living environments. The Skilled Nursing residents are the frailest within the overall population and live in the closest proximity to each other. They generally require close contact with caregivers daily, ones who live outside the community and interact with the greater world. I asked several community leaders about what life was like for them, the staff, and the residents in this unique situation. I was especially interested in understanding how design may change in the future to accommodate more ability to segregate the seniors in the communities from the outside world in a pandemic.

Residents in Life Plan communities seem to be mostly adjusting well to the new normal with a few exceptions. Most are quarantined in their apartments or rooms to prevent any spread should the virus get beyond the doors of the community. While Independent Living residents have the freedom to come and go from the campus, they have been discouraged from doing so, and most have respected that directive. The Skilled Care settings, including Memory Care and Assisted Living in some communities, have been restricting access to keep the threat of the virus at bay.

Meals and Activities

Communal dining has been put on hold in favor of meals delivered directly to the residents’ homes no matter which setting they live within. This generates additional cost for the communities; most Independent Living residents do not normally take a full three–meals-a–day plan. Serving those additional meals adds staffing challenges for cooking and delivery.

Retirement communities have experienced many changes in programming, from exercise programs moving to online and television–led classes, to outdoor classes where the residents participate from their balconies. Much of the technology that had emerged in the last decade is getting not only increased use, but being asked to do more, such as virtual town hall meetings for the residents and staff. The availability of groceries and everyday goods has increased, beefing up the in-house convenience store with food for incidental meals, but limiting access for social distancing. This allows less meal service, with some communities opting for one to two full meals a day, all delivered to the resident. Most residents are willing to wear masks –and in many cases, residents with the ability have been making masks for the greater community.

Staff Challenges

Staff at the communities have been challenged with balancing delivery of these additional services while maintaining social distancing protocols themselves. Most staff in this economically stressful time are happy to be at work and to retain their employment. Considering that many food service workers in other industries have lost their jobs, and that front-line staff in hospitals are struggling with the virus and personal protective equipment supplies, working within the retirement community is proving to be a relatively safe environment from many perspectives. The staff at most retirement communities value their relationships with the residents and this added stress has only made what interaction they can have even more valuable. Many residents who moved to these communities for the socialization aspects are feeling isolated, so the personal touch that staff bring is an added benefit to both parties. Some staff—like marketing, HR and fund development—have actually been sent home to do their work remotely in much the same way the rest of the world is operating, but that is only a subset of the entire staff that makes these communities run. While many of the key on-site staff had initially been a bit reluctant to come to work, but most have adjusted to doing what is necessary to serve the residents. Care staff in one community have been provided clean scrubs for every shift, and a former resident activity space has been converted to a changing space to allow the caregivers to leave their street clothes for travel to and from the community, limiting the exposure for the residents, and in turn, their own families.

Subtle Changes to the LPC Model

Most of the leaders of the communities that I talked to do not anticipate fundamental structural changes for the future of their communities going forward. What attracts residents to these environments has been the social aspect of living within a Life Plan Community. Most of the owners and operators I spoke to see the future as continuing to provide a place to live comfortably with peers in a social and vibrant atmosphere, and within a space that is open and welcoming to visitors and families. Necessary infection control measures will aim to be subtle and not as obvious to the resident. Technology can allow temperature screening at entrances and more control of who accesses the community and when. Much in the way the Active Adult communities have provided for aging in place in subtle ways, the increased security and vigilance against disease and access will most likely be unseen and relatively not felt by the residents—yet will still help to provide as safe of an environment as possible for our Seniors.

David Segmiller, FAIA directs HCM’s senior living practice in Charlotte and is directly involved in design and client relationships. He is an expert in design for an aging population and has taught and lectured extensively on the topic at both national and local conferences. He brings a unique viewpoint on the design and development feasibility of projects through his studies and teaching experience in real estate at Johns Hopkins University and the Erickson School for Aging Studies. David has served as Lead Instructor for Senior Living Development at the Erickson School and he previously worked with Johns Hopkins University and the NIC to develop the curriculum and served as faculty for the JHU/NIC Senior Housing and Care program. He has served on the LeadingAge Business Firm Advisory Committee and many of his projects for seniors’ have received design awards from Design for Aging and the National Association of Home Builders. David is a former chair and founding member of the Urban Land Institute’s Senior Housing Council.