First published on Medium 5/3/2020

There aren’t many whose lives haven’t been affected by the spread of the novel coronavirus. The COVID-19 pandemic has taken children out of school and left parents wondering where their next paycheck will come from. Most folks going through these trials, however, haven’t been as hard hit as elderly citizens. In addition to making up the highest-risk group among us, they’re also often in situations where exposure is a foregone conclusion.

When coronavirus hit nursing homes, the potential effects were simultaneously unimaginable and frighteningly expected. Many senior care centers had to be evacuated when workers – fearing for their health – simply stopped showing up for work. As of this post, US nursing homes had more than 10,000 fatalities and accounted for half of total fatalities in Europe

These stories are only a sampling of what’s going on. Elderly care professionals aross the country are facing difficult realities. Of course, this pandemic will eventually be brought under control. For those who faced coronavirus in assisted living, though, nothing will ever be the same.  The lessons of the current pandemic will reshape the way eldercare is defined and delivered in a post-coronavirus world to meet the needs of a highly diverse and rapidly growing senior population.

COVID-19 Puts Eldercare in the Spotlight

More than 150 care facilities in over half of all US states have at least one resident with symptoms of COVID-19.

In the wake of crises nursing homes and long term care facilities, have stepped up efforts to protect them and those who care for them from exposure to COVID-19. 

Nursing homes and other residential facilities are limiting residents’ contact with the outside world and residential staff must take special precautions with cleaning and disinfecting, and when providing direct care to residents including new recommendations and regulations for people such as home health aides and physical therapists.  

Local businesses and services, too, acknowledging this high-risk population with initiatives like special senior shopping hours, volunteer check-ins and food deliveries.

These measures point toward a model for redefining a “new normal” for senior services in a post-coronavirus world. 

Pandemic Preparation Plans Become Crucial

If it did nothing else, the COVID-19 outbreak served as a bleak wake-up call. Government, nonprofit and private organizations have been touting the necessity of proper disaster preparedness for years. In 2013, the Federal Emergency Management Agency (FEMA) published a guide titled Elderly Need Special Plans to be Ready for a Disaster. In 2008, the Center for Infectious Disease Research and Policy proclaimed Many Nursing Homes Lack Pandemic Plan.  

Any emergency management professional will attest to the fact that preparation is key in surviving pandemics, but for years, this key aspect was often overlooked by professionals in elderly care. The problem is that people become complacent when problems aren’t actively occurring. This issue gets even worse when they see so many potential emergencies (e.g. Ebola, H1N1) sail by without affecting them. It’s like watching coastal residents choosing to stay home while a hurricane is bearing down upon them.

Unfortunately, the importance of pandemic preparation was a hard lesson learned. Coronavirus hit the senior care industry like a ton of bricks, and in many cases, they failed to acknowledge the dangers that were so obvious to public health professionals. Whether it’s an inherent need to protect the lives entrusted to them or a fear of the eventual onslaught of litigation, pandemic preparation in assisted living communities is going to be taken much more seriously.

Eldercare Services Improve Staff Training and Support

On average, direct care providers in all areas of eldercare earn $11 per hour. Many have no formal training or qualifications other than personal experience caring for a relative. On the job training is often minimal, and there are few if any opportunities for advancement. And because wages are low and opportunities limited, many direct care staff must work at multiple jobs in order to make a living wage. As workers juggle multiple clients, that makes it easy to spread infection from one location to another.

In the post-coronavirus world, eldercare services of all kinds will need to invest more resources toward recruiting skilled staff and providing essential training on protocols for preventing infection. Some eldercare advocates have called for higher wages for both home care and residential workers in an effort to find and retain quality staff, and that will become a key issue in making sure that vulnerable seniors receive the best care possible during a pandemic.

Social Distancing is Here to Stay

Anyone reading this has likely felt the sting of social distancing. While many people may simply be annoyed by the inability to grab a drink with friends or catch the newest movie in theaters, elderly individuals face a much harsher reality.  Social distancing conventions will shape human interactions of all kinds, with less emphasis on social touching such as hugs and handshakes, and more awareness of the consequences of every cough or sneeze in the presence of older adults.

Research consistently shows that seniors in social isolation experience increased depression and suicidal thoughts on top of negative changes to their immune and proinflammatory responses.

Even with this being the case, it’s likely that the elderly have taken note of the dangers they face and plan to respond accordingly. This means more and more aging individuals will opt to remain inside their homes rather than moving to assisted living facilities. The trend has already been moving in this direction. Between 2004 and 2015, the number of nursing home residents dropped from 1.5 million to 1.3 million – and this was while the aging American population was ballooning.

It’s difficult to deny that many nursing home residents affected by coronavirus would’ve been better off in their own homes. This is a realization that aging citizens and their adult children will have to deal with. With increasing at-home care options and seniors becoming more tech-savvy, though, opting to remain in their homes is both conceivable and potentially beneficial.

Nuclear Family Status Changes

Cynics and critics have long decried the disintegration of the nuclear family. Of course, concerns such as these are often overblown. Even if the number of two-parent households has been decreasing, the majority of American children still live in these traditional family units. As Rebecca Onion over at Slate has pointed out, though, COVID-19 has taught many parents that the nuclear family is simply not enough. This reality will have major implications for senior care in the future.

Parents who are struggling to deal with their out-of-school children while also handling employment issues would typically be begging their elderly parents for help at this point. Unfortunately, it may not be safe for them to do so. Once the coronavirus has released its death grip on the world, though, the adult children of aging individuals might not be as quick to consider assisted living communities.

One could also envision the nuclear family permanently extending outside of the parents-and-children model. Everyone thought they’d be able to spend time with their elderly family members with occasional visits, but now there’s no indication of when this might resume. This has resulted in grandchildren “visiting” their grandparents via FaceTime and Skype. Once this pandemic has passed, people are likely to put renewed focus on these often overlooked relationships.

Regulations Regarding PPE Stockpiles in Nursing Homes

Medical workers experienced severe shortages of the personal protective equipment (PPE) that were needed in minimizing their exposure to COVID-19. Many had to reuse masks or forego protection altogether.  What’s even more discouraging is the fact that many assisted living facilities fall into regulatory black holes. In California, for instance, health workers were only mandated to wear PPE when a case of COVID-19 has been identified in their facility. Since the virus could take up to two weeks to present symptoms, though, it’s possible that therapists, doctors, assistants and other nursing home employees could be unknowingly spreading the pathogen.

It’s important to note that this California regulation could change at any time, and this is likely something we’ll increasingly see in the coming months and years. The probability is also very high that increasing attention will be given to citations in the future. A full 75 percent of nursing homes have been hit with citations for failing to control and monitor infections in the past few years. This statistic has gained new significance in the world of COVID-19, so everyone should expect increased and better enforced PPE regulations.

Changes to the Senior Housing Real Estate Industry

Although it’s a niche property type, senior housing has gained a prominent place in the commercial real estate industry in recent years. The investment market into this property type has reached upwards of $270 billion. Now that coronavirus is upending the assisted living world, though, it would be naïve to not expect significant changes in this area of the real estate industry.

Even elderly citizens who choose not to stay in their homes will be far more selective regarding their eventual senior housing. They’ve seen daily on the news what can happen when assisted living workers are unprepared and facilities don’t have the resources to respond to predictable emergencies.

This means professionals in the senior housing industry will have to rethink and modernize their offerings to attract and maintain residents. This will be done in many ways, but the real focus will be on technology. Remote patient monitoring, Telehealth, voice activation tech, and free Wi-Fi will be just a few of the focuses. This will ensure all needs – physical, emotional and social – are met while maintaining distance when necessary.

Considering all the likely changes to assisted living after coronavirus has run its course, though, the senior housing market is only the tip of the iceberg. Big changes are coming – and in reality, they should’ve gotten here much sooner.