Boulder County long-term care facilities face challenges as coronavirus threat recedes – Boulder Daily Camera

Nursing homes and other senior-living facilities, hardest and most visibly hit during the COVID-19 pandemic, represented an industry seemingly on life support just a few months ago. They’re beginning to struggle back to their feet now, but they are facing a new set of challenges.

Even as state and federal restrictions began to be lifted early this spring, Colorado’s long-term care facilities averaged two-thirds capacity, and those empty beds meant financial turmoil that led several large operators to begin shedding facilities and even closing some.

Some care-center administrators in Boulder County chose not to speak about their situation, while others blamed the slow rebound in numbers of people served on shortages of nurses and other staff adequate to care for increasing numbers of seniors — and on families’ reluctance to bring their loved ones back to such a facility after heavily publicized outbreaks at nursing homes around the region and nation. But most who agreed to comment said business is at least edging back toward some semblance of normalcy.

Marc Williams, a spokesman for the Colorado Department of Health Care Policy and Financing, said he had heard of no significant capacity issues at senior-care facilities in Boulder County, although he knew that some had limited admissions in an attempt to control the spread of the coronavirus.

The numbers at Flatirons Health and Rehabilitation, a short-term rehab facility in Louisville, represent that drop-off and slow recovery well. It serves a maximum of 45 residents but housed only 30 during the worst of the pandemic, said Stacie DeGoey, its executive director. Its census has crept back to 39 or 40, she said, mostly because “we’ve built a good trust in the community.”

That foundation of trust was vital, considering that COVID has claimed nearly 2,500 lives in long-term care facilities in the state, so a family’s decision to place a loved one in such a center’s care has been far from easy.

“Everyone’s had concerns about family members,” DeGoey said, adding that as numbers have begun to rebound, “a lot of it’s been education, letting the public know how careful we’ll be, that we’re doing the required testing and doing everything we can to keep everybody safe and healthy.”

Flatirons, featuring all private rooms, saw no patient deaths and just one positive COVID test, DeGoey said, and continued to accept new admissions throughout the crisis. “We were very fortunate through the pandemic that we didn’t actually see a spread in our facility, patient to patient.”

The sprawling Hover Senior Living Facility in northwest Longmont, consisting of a mix of assisted-living homes and apartments and more traditional nursing-home care, also reported no deaths and just three positive tests, Holly Raymer, its chief executive, said.

Hover currently has 193 residents and 25 empty beds, Raymer said, adding that the current vacancy rate is the highest since the pandemic began but that inquiries have picked up recently.

“People are still afraid of a move during a pandemic,” she said.

Even though the Hover Community shut off move-ins for “four or five months” during the pandemic, she said, it also opened the first of four Katherine and Charles Hover Green Houses on Oct. 19. The innovative concept encompasses four houses containing a “household” of 12 seniors in private suites with round-the-clock skilled-nursing care.

The opening of the Green Houses is part of a national trend toward increased inventory of senior-living beds, largely the reason that senior housing occupancy in the United States held steady at 78.7% in the second quarter of 2021, according to new National Investment Center for Seniors Housing & Care data released this month.

“Second quarter data confirm anecdotes that occupancy at many properties improved as move-ins accelerated, thanks to limited property-level COVID-19 infections. However, inventory grew and outpaced demand, and that’s why we aren’t seeing an occupancy uptick,” said Beth Burnham Mace, the center’s chief economist, in an interview published last week in Providers, the flagship magazine of the American Health Care Association and the National Center for Assisted Living.

The Beatrice Hover Assisted Living Residence in Longmont had to suspend new admissions for several months amid the pandemic to prevent the spread of the coronavirus, but officials said interest has been rebuilding. (Matthew Jonas/Staff Photographer)

Those declining infection rates can only help facilities’ recovery. At the Hover Community, “we stayed very on top of infection control, and the director of each community stayed on top of what’s going on in our county,” Raymer said. Even though Gov. Jared Polis on July 8 declared an end to Colorado’s 16-month health emergency, she said, “there have been so many changes and state-fed regulations, and I was recently informed the state will probably be putting stricter guidelines in again because of the Delta variant.”

That amount of unpredictability, coupled with the number of empty beds at the height of the pandemic, has forced many operators to divest their holdings or leave the market altogether.

Georgia-based SavaSeniorCare, for instance, has been working to shed all 25 of the senior-care centers it operates in Colorado so it can focus on others. In Boulder County, it still runs Applewood Living Center in Longmont, but in April, operation of its Boulder Manor nursing home was acquired by The Ensign Group (Nasdaq: ENSG), the San Juan Capistrano, Calif.-based parent of a group of companies that invest in and provide skilled nursing and senior living services, physical, occupational and speech therapies, and other rehabilitative and health-care services. The 140-bed skilled nursing facility at 4685 Baseline Road has been rebranded Boulder Canyon Health and Rehabilitation.

Boulder Canyon Health and Rehabilitation, formerly Boulder Manor, was recently rebranded after its former owner, Georgia-based SavaSeniorCare, sold the Baseline Road facility to The Ensign Group, based in California. (Matthew Jonas/Staff Photographer)

Nursing-home operators fought several other headwinds as well.

SavaSeniorCare this spring agreed to pay $11 million to settle federal Financial Conduct Authority claims that its policies and procedures pressured its skilled-nursing facilities to bill for “medically unreasonable, unnecessary or unskilled services” provided to Medicare patients. It also entered into an agreement with the U.S. Health and Human Services’ Office of Inspector General, under which an independent reviewer will monitor patient stays and associated claims to Medicare in each of the next five years.

As Pennsylvania-based Genesis HealthCare (OTCMKTS: GENN) announced it wants to hand off operations of four of its 10 Colorado locations, the company that owns four of those buildings, Welltower, said it was terminating leases with Genesis at more than four dozen properties around the nation.

Even before the pandemic took hold in March 2020, skilled nursing facilities already were running on thin margins. The month before, LeadingAge issued a report that found that more than 550 nursing homes around the nation had closed their doors between 2015 and 2020. A survey released earlier this year by the American Health Care Association found that 90% of for-profit providers in the United States were operating at a loss or with profit margins of less than 3%.

Overall, however, the infusions of state and federal government aid were life-saving shots in the arm for nursing homes hit hard by declining numbers of residents, including those covered by Medicaid, and by increased operating costs linked to COVID including testing, new physical barriers and purchases of personal protective equipment for staffers.

In addition to several rounds of aid that skilled-nursing facilities already have received from the state and federal government, the Colorado Department of Health Care Policy and Financing announced June 15 that it would issue $16 million in enhanced payments to the state’s 189 nursing-home facilities that accept Medicaid patients, out of a total of 226 licensed by the Colorado Department of Public Health and Environment. The department, which manages the state’s Medicaid program, Health First Colorado, and monitors the Medicaid-member homes’ financial health, said the funds would be “directed to support continued infection-prevention efforts and rising costs of direct-care staffing.”

“That money is aimed at stabilization,” said Bonnie Silva, director of the department’s Office of Community Living, which administers long-term services and supports benefits for people with physical, intellectual and developmental disabilities. She said part of the money will help facilities address a severe staffing shortage that predated the pandemic, including “sign-on bonuses just to get staff in the door, and making sure people continue to get high-quality care while we expedite other solutions.

“But how do we elevate the position (of a staffer in a senior-care center) so people can see that as a viable career plan?”

About 10,000 people lived in care facilities in Colorado before the pandemic emergency erupted in March 2020, she said, and a year later that figure was down to 8,000. Since then, she said, “there’s been a slight uptick but not enough to say, ‘Oh, I have a trend.’ I think we need a few more months to see.”

But even that diminished capacity is tied to the staffing shortage, she said. “Providers are reporting they’re continuing to struggle to fill the vacancies they have, and some report they have to turn people away because they can’t find the staff” to care for them.

“It’s a high-risk setting, emotionally and physically taxing,” Silva said, “and even prior to the pandemic there was an 82 percent turnover rate. The pandemic just made it that much harder to attract them to this industry. Paying $12.30 an hour is not going to cut it.

“If you can work at Chick-fil-A and get Sundays off, we’re not going to be able to compete with that.”

Silva’s team also works to transition patients to other facilities when a facility is forced to close.

“We literally case-manage them individual by individual,” she said. “Individual transition plans for each person.”

The general shortage of nurses and nursing-school faculty also predated the pandemic, as well as the fact that Colorado is the second-fastest aging state in the country.

“All the cracks that we had prior have now become chasms,” Silva said.

“In addition to the incredible human toll that COVID-19 has taken in Colorado, the pandemic has also had a profoundly negative financial impact on long-term care providers,” said Doug Farmer, president and chief executive of the Colorado Health Care Association, in a June media release issued by the department. “A combination of significant cost increases and drops in occupancy is threatening the future of the long-term care sector and access to needed services for Coloradoans. These additional funds will undoubtedly help to keep these care centers afloat in the immediate future. We very much appreciate the support and partnership of the state of Colorado in recognizing our providers’ struggles and making these funds available.”

Nationally, according to the most recent statistics, senior-care and assisted-living communities have received about $14 billion of the $178 billion in the CARES Act’s Provider Relief Fund.

This funding has been instrumental for long term care, but the AHCA and National Center for Assisted Living have urged that the rest of the funds be released. Those groups released surveys this month that indicated that 92 percent of nursing homes and 62 percent of assisted living communities said the relief fund has been helpful during the pandemic, but that only one in four long-term-care providers were confident they can make it through to next year.

What will change as nursing homes emerge from the pandemic? Industry analysts, care-center administrators and the architects who design the facilities expect to focus more on disease control, with tighter scrutiny of heating, ventilation and air conditioning systems planned. They say they’ll also look for easier-to-clean, nonporous surfaces, anti-microbial materials such as copper for “high-touch” features such as hand railings, and voice- or sensor-activated controls for doors, lighting, curtains, faucets and toilets.

Senior-care centers “saw a zero decrease in 20 years followed by a massive decline in a year, and that was a big shock to the industry,” Silva said. “We’ve never been through a pandemic, so there’s no textbook. The industry will evolve in ways we haven’t seen. We have to re-evaluate how we’re delivering long-term care and set up facilities in a way that makes sure we have a good continuum of care.”

At the Hover Community in Longmont, Raymer said the biggest change is that “we no longer hire people who haven’t been vaccinated or aren’t willing to be, because it puts our elders at risk.

“Everything we put in place remains in place and always will.”