On the surface, it would be easy to assume that assisted living facilities and their leadership teams would rather forget the past year. A global pandemic, growing uncertainties, misinformation and bad press were just a few of the challenges experienced in the industry during 2020 and early 2021 that had never been dealt with before. As tensions ran high, staff members – from corporate executives to nurses and administrators – adapted, adopted and pulled together in a responsible, uplifting fashion.
As the pandemic spread in March 2020, fears began to arise concerning the vulnerability of health care facilities like hospitals, assisted living facilities and nursing homes as it was soon discovered that the novel coronavirus (COVID-19) left seniors and those with pre-existing conditions more susceptible to contracting the virus. As speculation ran rampant and PPE (Personal Protective Equipment) concerns grew, assisted living facilities started to see fewer and fewer new residents as families chose to keep seniors at home rather than take the risk of going to a community. However, many assisted living facilities – like Premier Senior Living Group, LLC – presented a significantly lower mortality rate than the national average.
Today, inoculations are underway and health officials are predicting a “return to normalcy” at some point during the next calendar year. As many assisted living/senior care facilities to move beyond the pandemic and look to the future, the lessons learned in 2020 and early 2021 will not be soon forgotten.
Premier Senior Living founders Robert Borsody and Wayne Kaplan recently sat down for a reflective Q&A to discuss COVID-19, the current state of the assisted care industry in the wake of the pandemic, and where we go from here.
Kaplan has more than 30 years of extensive experience in senior housing. At Premier Senior Living, he focuses on the optimization of the day-to-day operations of the company to promote revenue, profitability, and growth.
Borsody helms the company’s financial and acquisition operations. He directs the Finance Department in managing the financial operations of the company’s properties, including required reporting to lenders, investors, and debt guarantors (including HUD) to ensure adequate and timely payment of debt service, returns to investors and compliance with all covenants.
The two managing members represent assisted living facilities in five states: Michigan, New York, North Carolina, Ohio and Pennsylvania. Their unique and all-encompassing perspective comes from decades of collective experience in the assisted living marketplace.
Q: What’s the one thing that resonates with you the most about the pandemic? What did you learn and how did it change you and your work?
Kaplan: “We learned to adapt and adopt on a large, mass scale. From securing PPEs for our staff and residents to upgraded sanitary measures and new cleaning protocols, we were forced to look at – and react – to everything.”
Borsody: “In our industry, we’ve encountered things before. We’ve had 7 feet of snow in Buffalo and hurricanes in North Carolina – stuff like that. Just the worst. But this was something completely different on another level. To see 700 to 800 staff members pull together was heartwarming.”
Q: Looking back, what do you consider your greatest success of 2020?
Kaplan: “We were able to limit the number of deaths we experienced. We had very few deaths per capita. There were a total of 23 deaths across our 23 properties. That’s a rate of about 2 percent at a time when the national average was in the 5-10 percent range.”
Borsody: “We operate in a number of states, and the bottom line is that you’re always going to have sickness, flu, etc. It almost becomes second nature to deal with things. We’re always on our game, but I feel like the pandemic got us functioning at a higher level.”
Q: What was the biggest challenge over the past year?
Kaplan: “Initially, there was concern over the vaccine. About 50 percent of staff didn’t want the vaccine. I think they were taking a “wait and see” approach. I think part of that was some misleading information in the press at the time, but that’s been cleared up at this point. We didn’t have any issues with the residents getting the shot. They wanted it. About 90 percent of residents have received at least one vaccination at this point, and many have their second or third completed or scheduled soon.”
Borsody: “In-room dining was a significant challenge. We didn’t have in-room dining previously; it was all handled in our dining areas. Once it became clear we couldn’t gather in groups to eat, we had to significantly change everything. We quickly transitioned to room service in-room dining and everyone had to pitch in to make it happen. From preparing meals and delivering them to simple things like getting enough disposable silverware. We were starting from scratch.”
Q: How was your experience working with local, state and federal agencies like the Center for Disease Control (CDC)?
Borsody: “We operate in several states, so we had a unique perspective. Some had clear guidelines, but there was some fumbling in some counties. The CDC guidelines were generally clear.”
Kaplan: “In many instances, you’re working with the state health department, but also with the city and the county. And those three don’t always agree.”
Q: Did you experience any barriers in getting PPE for your staff and residents?
Borsody: “Not really. We had an existing supplier, so we were able to get what we needed. The only issue was the supplier wouldn’t ship to our individual locations.”
Kaplan: “To compensate, our national purchasing director [Travis Shreffler] placed the orders and received all of the supplies. They were stored in a stocked garage and sent out to our facilities as needed. Travis stepped up and it worked really well.”
Q: How did the pandemic affect general morale at your facilities? What did you do to alleviate stress or help people cope with everything going on?
Kaplan: “Daily communication was the key. We made it a point to communicate to our staff, residents and families on a regular basis. We have a lot of dementia patients, so it is critical to keep the lines of communication open between family members so they know what’s going on – the good news, the bad news and everything in between. Especially during times when we were limiting or restricting in-person visits.”
Borsody: “We gave bonuses in March 2020 to our employees – everybody. It was a time when there was a lot of panic about what April, May and June might bring and we wanted to try and help. We also kept the door open for our employees to help come up with creative solutions to issues we were experiencing.”
Q: What was your greatest challenge in communicating with residents and family members that your facilities were safe?
Kaplan: “In senior care and assisted living, there’s not always one point of contact for a resident. In many instances, you might have three grown children each calling to check on Mom. We don’t have time to field endless phone calls, so we try and use social media to relay what’s going on.”
Borsody: “We love to showcase the activities of daily living that take place at our facilities. When we post photos, information and details on social media, families can see what we’re doing. It puts them at ease.”
Q: In retrospect, what would you do differently, knowing what you know now?
Kaplan: “I think two things. First were PPEs – like goggles, gloves and masks. The second would be in-room dining.”
Borsody: “We didn’t have paper plates, we had China. It’s just one of those things that you really don’t think about until it happens. We needed paper plates, plastic silverware – items like that. And we were trying to get them at a time when everyone was trying to get them.”
Q: Have you changed your clinical model since the pandemic?
Borsody: “Years ago, we followed a more social model. We were just housing. Today, we do so much more. We’re like a nursing home was 15 years ago. As a leader in the industry, we’re always focusing on new ways to do things. Just like a hospital is more than a hotel. We’re trending in that direction. “
Kaplan: “Times have changed. Residents are coming to us older. We’re still caring for the Greatest Generation. We’re not getting Baby Boomers for another 10 to 15 years.”
“We’re not getting little old ladies who play Bingo. Those types of people go to an independent living facility. We’re assisted living. Our residents are older, frailer. They need a walker. The average age is something like 89 or 90. … As our residents have changed, we changed. People are also living longer.”
Q: How has your new business model affected 2021 and moving forward?
Borsody: “Financially, we took a big hit. There was some funding available – and we needed it. On the sales and marketing side, we found new ways to reach potential residents.”
Kaplan: “The challenge was getting the message out to that 50-year-old daughter who’s caring for Mom at home and letting them know that, at a 2.3 percent death rate, we’re the safer place to be. Once we got that message out, our census began to improve.”
Q: Are Microsoft Meetings and Zooms the new norm, or do you see a return to more face-to-face interaction?
Kaplan: “I think both. It’s certainly part of the future, but we still need staff to go to the properties and check compliance. Obviously, the vaccine will help. We try to lead by example. When the COVID-19 vaccine came out, Bob and I both got shots to show everyone it was OK.”
Borsody: “We like to get out at least once a year to the communities and, of course, we had to stop that when the pandemic hit. We’re hoping to resume that – there is some traveling now.”
Q: What measures have you taken to ensure employee retention?
Borsody: “We did increase financial incentives in some places. But there was an overall sense to serve during the pandemic, and we kind of saw that here. Our employees were eager to work and seemed to be tougher, stronger and even more dedicated.”
Kaplan: “We have an outstanding benefits program. We started PSLU University, where staff can take courses to improve competency and advance in their career. And, of course, make more money.”
Q: Has capital lending or acquisitions changed? Are there more assets for sale now after owners went through 2020?
Borsody: “We’re always in the market for new properties. Right now, there are some bargains, but not many. Interest rates are low. Senior housing is a good long-term investment, but there are a lot of buyers.”
Kaplan: “We like to say that the market is not recession-proof, but it’s recession resilient.”