The shadow of COVID-19 has made the past two years particularly long and difficult for the nation’s senior living and long-term care facilities. Which is why administrators of these communities in Arkansas are so jolly about the resumption of holiday traditions for the 2022 season, even as steep challenges await in the new year.
“We’re gathering safely but we’re gathering again, and that’s very exciting for us,” said Vickey Kirkemier, administrator of Superior Health and Rehab in Conway. “It is joyous to watch the volunteers return to the facility. It is a blessing to see church gatherings are now back in place. Christmas will be normal again.”
Kirkemier said outside groups and volunteers have been trickling in for some time, but the holidays add a special meaning to the visits.
“We’ve already begun seeing more visitors from local schools and churches, and we are looking forward to children singing Christmas carols,” she said. “Our residents cannot wait for their songs to fill our hallways again.”
Following 20 months of pandemic-related restrictions, the federal Centers for Medicare and Medicaid Services kicked down the door on its own regulations last November. In its revised guidance, CMS dismantled most of the remaining restrictions that were put in place as a way to contain the COVID-19 pandemic and prevent infections among the nation’s seniors, a population among the most vulnerable to the virus.
Citing high vaccination rates, lower monthly infection numbers and widely available booster shots, CMS stated, “continued restrictions on this vital resident right [to visitation] are no longer necessary.”
The new guidance directs the nation’s 15,000 nursing homes to open their doors and allow unrestricted indoor visits for all residents, without limiting numbers of visitors or requiring advance scheduling.
Now, a year after the guidance was issued, senior living and health care community administrators are preparing for holiday festivities and guests more on par with pre-pandemic levels.
“The Centers for Medicaid and Medicare Services and the Centers for Disease Control and Prevention put these guidelines in place to keep our residents as safe as possible,” said Melissa Curry, CEO of Methodist Village Senior Living in Fort Smith. “We are extremely excited that friends and families can now come in and be with their loved ones.”
The pandemic had a devastating effect on older Americans. Despite representing just 16% of the U.S. population, adults 65 and older account for 80% of COVID deaths, according to the Kaiser Family Foundation. Untold millions more residents and their families suffered the mental and emotional distress of loneliness and being separated from loved ones.
Given this, retirement communities, assisted living centers and long-term care communities have continued to employ protocols to limit new infections and contain cases to prevent wider outbreaks, even as they have adopted the new, more relaxed visitation guidelines. Many of these strategies and processes are based on the hard-won knowledge gained during the onset of the pandemic in 2020.
“We’ve learned a lot from COVID,” said Kirkemier. “We’ve had to make adjustments, and I’m sure we’ll have to continue to make adjustments. The challenge for long-term care today is the same for us as everyone, to gather up what the pandemic has left behind and return to our normal. Long-term care has been through a lot in the past three years.”
Rachel Bunch, executive director of the Arkansas Health Care Association, the trade group for the industry in Arkansas said, “The difference is that we now have a playbook. We have a vaccine, we have protocols, and we know how to contain it. We’ve learned a lot and now know how to handle it.”
Holidays or not, merely bringing the challenges of COVID under control doesn’t buy the industry much time to relax. Rather, it simply moves other challenges from the back burner to the front of the stove.
Such challenges directly affect companies’ ability to serve the communities in which they operate, starting with personnel. Bunch said between a systemic shortage of nurses dating back decades and those taking early retirement or changing fields due to the pandemic, staying staffed is one of the most serious challenges facing the industry in Arkansas and nationwide.
“It’s not about the number of facilities or beds, but the fact that we have a nursing shortage in Arkansas,” Bunch said. “The industry as a whole has and will continue to meet the needs for long-term care, but we’re also looking at ways to fuel the pipeline to get more certified nursing assistants and nurses into the field.”
Personnel is a particularly complicated issue in communities offering more than one category of elder health care services. Superior Health and Rehab, for instance, offers a full suite of short-term rehabilitative services in addition to long-term care, the vision of Michael Morton, owner of Central Arkansas Nursing Homes Group, parent company for the Conway facility.
“It has always been a priority of Mr. Morton to provide what is needed to take care of the elderly in Conway and the surrounding areas to help the community as much as possible. That’s why we find it beneficial to have both rehab and long-term care under one roof,” Kirkemier said, while noting the additional services require staffers with specialized skills.
Methodist Village is similarly diverse, with 45 independent living apartments and capacity for 71 assisted living and 145 long-term care residents. Curry said the day-to-day stress of the job combined with the added pressure of the pandemic took a toll on health care workers, including in the elder care space.
“I think often that health care workers don’t get the recognition they deserve,” she said. “The majority of people taking care of seniors do it because they have the heart for it. I promise you, if you didn’t love seniors, you wouldn’t still be in the field after this pandemic.”
Bunch said the association has been at the forefront of things since the pandemic began, advising members of latest guidance and helping establish consistent protocols to keep residents and staff alike safe. As senior communities turn their attention to other pressing operational and staffing issues, the association has pitched in anew, working to lure traveling nurses back to Arkansas and creating partnerships with colleges and universities as they educate new generations of health care workers.
“These collaborations help promote long-term care as a viable work option,” Bunch said. “We are starting to see a rebound in staffing and hope to continue that trend by continuing to do more and more partnerships with colleges and students across Arkansas.”
Another familiar issue, reimbursement, has also reentered the headlines of late, as elder health care companies continue to struggle with the gap between the rising cost of providing services and the level of payment received from sources such as Medicare. CMS has already promised additional funding to skilled nursing companies, but at the cost of a raft of new guidelines and regulations, the long-term financial consequences of which are as-yet unknown.
On top of that, baby boomers continue to move into independent, assisted and long-term care communities in record numbers, bringing up issues of capacity. Put it all together and you’ve got a multifrontal assault of market challenges for the industry.
Bunch said while progress on such complex issues is often measured one step at a time, the association is in it for the long haul to help operators provide the best care to clients regardless of such challenges.
“We are working with facilities to make sure each has the tools and equipment needed to deal with patients who have more complex medical issues,” Bunch said. “We will also continue to work with state leadership regarding care for elderly patients to improve issues such as access to private rooms, medical transportation and continued training for staff. It’s a work in progress.”
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