Senior living complexes caught in COVID-19 limbo
Residents don’t have same access to testing as nursing homes
SPRINGHOUSE SENIOR LIVING in Boston offers older adults three options: independent living for those able to stay in their own apartments, assisted living for those who need additional help, and memory units for those with dementia or Alzheimer’s.
The three different living options are all located in the same building and have a lot in common. All residents can eat in a communal dining room, access social and recreational activities, share housekeeping staff, and use on-site health services.
But when the National Guard came to Springhouse Senior Living to do free COVID-19 testing this past spring, assisted living and memory residents were tested but independent living residents were not. The independent living residents were told they could pay a private ambulance company for testing.
Independent living resident Patricia Burns, 76, who previously worked in public health, said she saw no reason why she should not have the same access to testing. “The independent living people really felt like they were left out,” Burns said. “In a situation like this, we really do all need to be able to get the benefits, not just say independent people are independent so you can figure it out yourself.”
As COVID-19 ravaged state nursing homes, state government ramped up testing and instituted reporting requirements. But independent senior living facilities have generally been left out.
In some ways, it makes sense to treat these facilities differently. Some seniors in independent living are capable of isolating in their apartments in a way nursing home residents, who live together and need more hands-on care, are not. Some senior housing is simply apartments with a building manager.
But other communities share on-site activities and amenities with the other senior living options and are often attached to health care facilities like nursing homes.
“These populations are nearly identical in terms of their medical complexity and their function. Their risk for COVID and their risk for dying from it are similar and very high,” said Terrence O’Malley, a geriatrician at Massachusetts General Hospital and the medical director of a skilled nursing facility. “The fact that policy is directed only at nursing homes…still leaves out a large population of similar risk.”
The elderly have unquestionably been hit hardest by COVID-19, and nursing homes have been devastated. Of Massachusetts’ 114,700 cases and 8,600 COVID-19 deaths, long-term care facility residents or workers comprise 24,500 cases and 5,600 deaths. The state tracks and publicly reports cases and deaths at nursing homes and assisted living facilities.
The prevalence of COVID-19 among seniors living in independent housing complexes is impossible to know because it is not tracked. One of the earliest publicly reported outbreaks was at the Jack Satter House in Revere, an independent living community run by Hebrew SeniorLife, in late March. Twenty-seven residents of the 285-person home contracted COVID-19 and 11 died.
Among Hebrew SeniorLife’s 1,600 seniors in independent living, there have been only 10 additional COVID-19 cases and three deaths outside of the Jack Satter House. The rate was higher in settings with more hands-on care: Hebrew SeniorLife had 295 cases across the organization, which includes 3,000 seniors in nursing homes, assisted living, and independent living.
“It’s consistent with what you’ve seen across the industry – that independent living is not hit anywhere near as hard as long-term care,” Brooks said. “In independent living…you can separate people a lot easier, get people to start steering clear of each other, and staying away from each other.”
Elissa Sherman, president of LeadingAge Massachusetts, an association that represents nonprofit senior housing providers, said the Jack Satter House outbreak actually helped curb the virus’s spread across independent living facilities since it caused other service providers to institute precautions.
“I think after that, a lot of communities took steps to really shut down,” Sherman said. Communities took furniture out of common areas, closed communal dining rooms, and restricted visitors.
Anecdotally, some complexes say precautions contained the spread.
Lasell Village, a senior living complex at Lasell University, has a small nursing home and supported living unit and 225 seniors in independent apartments. The nine supported living apartments were hard-hit, with six COVID-19 cases and five deaths. But the independent living apartments were largely spared, with five cases and one death.
Lasell Village President Anne Doyle said early on, the facility began conducting health screenings of staff, restricting visitors, requiring masks, and reminding seniors to socially distance. Doyle said the community tried to create a “culture of compliance” – a culture that was held up as a model in a New Yorker article by Atul Gawande, whose mother lives at Lasell Village.
Mike and Benita Ross, residents of Newbridge on the Charles, a Dedham independent living community run by Hebrew SeniorLife, say they feel safer there than they would have at their previous home in Canton. Since early March, their meals have been delivered, communal spaces have been closed ,and the community has been essentially locked down.
Mike Ross, 74, participates in book clubs and resident association meetings online; Benita Ross, 72, worked on an effort to raise educational scholarship money for Newbridge employees. They walk on nearby nature trails.
Because Hebrew SeniorLife takes care of all their needs – from cooking holiday meals to fixing a broken air conditioner – they don’t have to leave. “I imagine had we been in our (former) home, it would have been a much more difficult situation,” Benita Ross said.
There has been a legislative debate over whether elderly housing complexes should be required to report cases to the Department of Public Health.
The Legislature passed and Gov. Charlie Baker signed a COVID-19 data reporting law, which requires reporting on cases at nursing homes, assisted living facilities, and senior housing complexes. But Baker then proposed another bill that would remove the requirement on senior housing complexes. Baker said the reporting requirement would have fallen on private landlords, who have no access to or right to their residents’ private health information. The Legislature never passed Baker’s bill so the original legislative requirement remains law, but the state is not collecting the information.
Sherman said a lot of senior housing is essentially large apartment complexes. “Because it’s not a health care facility, a tenant who may be sick and may or may not have actually been tested, there’s no way for that information to necessarily get back to the building management,” she said.
Brooks said organizations like Hebrew SeniorLife want to know about cases so they can help with contact tracing, but they have no official source for information. “You could be reporting on word of mouth,” Brooks said. “You don’t have medical records You don’t have confirmation of the case.”
But Rep. Ruth Balser, a Newton Democrat who chairs the Elder Affairs Committee, said if the information is known, it should be reported. “A lot of independent living, they’re in the same building with assisted living or memory units. They often share dining rooms. It seemed to me this is a vulnerable population,” Balser said.
Tania Friedman, president of the Independent Living Residents Association at Springhouse and a former administrator at Harvard Medical School, and her husband, Jerome Friedman, a Nobel Prize winning MIT physicist, submitted testimony to the Legislature urging them not to distinguish between independent senior living and assisted living. The Friedmans note that, at Springhouse, all units share the same staff.
“The virus spreads readily in dense communities like ours and does not make a distinction between independent and assisted living residents. If the virus does not make a distinction, why should state policies do so?” they wrote
“The concern is that we’re being totally ignored, and it makes no sense,” said Tania Friedman, 89, in an interview. She said one Springhouse resident who she used to have dinner with tested positive for COVID-19 and died.
For some, the data reporting issue continues the disparity they saw when the state sent the National Guard to test nursing home and assisted living residents but not independent living residents. The Friedmans wrote they were “surprised and dismayed” when the National Guard tested only some Springhouse residents.
According to the Department of Public Health, National Guard testing was provided to nursing homes, rest homes, and assisted living facilities. Independent senior living is not licensed or certified by the state to provide supportive or medical care.
Advocates say testing remains a problem. Sherman said without rapid testing on-site, seniors cannot return to normalcy with communal activities. “I think there’s a big fear among a lot of senior living providers across the spectrum that we may see another surge in the fall or winter and their populations are vulnerable,” she said. Sherman compared it to colleges that need rapid testing to keep students safe in congregate settings.
Brooks said the availability of mobile testing now depends on where a community is located, and it is not funded. She too said there is a need is for surveillance testing, to make testing available consistently, not only when someone gets sick. “Especially in communities where people are in and out, out and about as we start to open up different parts of business, we need surveillance testing,” Brooks said.Boston City Councilor Matt O’Malley wrote to Baker in April asking him to expand testing to all residents of senior housing developments, noting that seniors with different living arrangements often share a campus. “As it currently stands, a resident who lives independently will not have the same access to testing and services as his/her neighbor who lives in an assisted living unit despite the fact that they share an internal wall, common area, and hallway,” O’Malley wrote.
In an interview, O’Malley called the administration’s approach to testing “short-sighted.” O’Malley said he hopes if there is a second virus surge – or a vaccine – senior housing developments will be reclassified “so we don’t have unequal access to testing or support, which is what we have now.”