[MUSIC] Hi everybody, today, we're joined by Catherine Evans, really excited to talk to you Catherine. >> Thanks Juliana it's great to be here. I am the Executive Director of, Lesley senior communities which is a nonprofit, that provides affordable housing to low and very low income seniors in the Bay Area, specifically San Mateo County, California. We have five properties and four of those properties are HUD subsidized. So we work very closely with HUD. >> Catherine, you've run several senior housing communities in California as you said, what can you tell us about those communities and about the residents that you serve? Sure, sure, [COUGH] so we provide 532 units of affordable housing to low, to very low income seniors in five different properties in San Mateo County, California which is in the Bay area. We have about 540 plus residents. And the average income for these residents is about $15,000 a year which is about $1,250 a month. And rents in the Bay Area are incredibly high, $3,000 is a good deal sometimes around here. So, there's a very strong demand, and the high need for affordable housing for seniors especially, who are really on fixed incomes and some are only receiving Social Security. So you can imagine, the need is great. It is independent living, so we're not a skilled nursing, or an assisted living or non medical, the average age of our residents is mid 80s. And they all fall into the high risk category for COVID-19, some are more frail than others. We have many residents who have lived with us so long that they've become frail to the point that they probably should be in assisted living, but they can't afford it or they don't want to leave. And so they hire outside caregivers to come in. And some of these outside caregivers are provided by the San Mateo County in home Support Services Program, or sometimes residents hire family members or friends to help them out as well. We recently had two case of COVID-19 at one of our properties, and one of the cases was one of my favorite residents who has some underlying health conditions and was already having a tough time when he was exposed. And he just recently returned and we're so happy to have him back but he was great. He contacted us immediately. We work with him, talking to him every day when he was in the hospital and then when he was recuperating at a skilled nursing facility until he was strong enough to come back here. So, we were able to keep that line of communication open and it just really brought home how COVID-19 affects people you know, and so when he came back, it was really a good day for all of us. >> Yeah, I know that you're doing everything you can to keep folks at the community safe. And I also know that you have a really tight-knit team that's helping to keep everything operational through the health crisis. So what has the pandemic meant for your communities and also for your staff? >> Yeah, so we do have a very tight-knit team, we run our properties on extremely lean budgets, very lean staffing. So for our 540 plus residents, we have about 50 staff, and that includes janitorial maintenance and kitchen staff. And so when the pandemic started back March, April, May, that period of time we were really short staffed because many of my senior staff are over 65 or have underlying health conditions and the directive at that time was to have those folks stay at home. So with as time passed and we established PPE and social distancing, Plexiglas barriers and that kind of thing, we've been able to bring everybody back on site. They're all essential workers, everybody's back working on site. And then but I should also say, back in March, April, May, even the staff under 65 was really scared to come in. So we were faced with getting creative with ways to incentivize employees to come into the buildings. For the residents, the biggest, I would say the biggest problem or issue that they've been facing is the social isolation due to the closing down of our common areas and the elimination of our activities program for now. >> Yeah, yeah, and I also know that because you're a housing provider, not a health care provider, your hands are tied in a lot of ways in terms of how you can respond to a health crisis. So, what can you tell us about what has made your job especially challenging in this pandemic context? >> Right, right, so you're correct, we are non-medical. So unlike an assisted living or skilled nursing facility, we don't know as quickly if one of our residents is displaying symptoms or has been diagnosed. So, in addition, we're not allowed by HUD to even ask residents if they've been diagnosed or if they aren't feeling well. But once we know from a resident who voluntarily tells us that they're either not feeling well or they have COVID-19, we can't afford to wait for the county get involved and do their contract tracing. That can take 24 to 48 hours, and we have residents living in congregate living. So for us who avoid clusters, we immediately do our own internal contract tracing to ensure any impacted residents are isolating, and to find out what we can do to help them. We were doing this without any real guidance until about September when I was able to take a contact tracing course through John Hopkins. And then I modified that for our purposes and since we're not counting contact tracers, but internal contact tracers. So, the difficult thing is that the channel of communication with respect to COVID-19 is doctor to patient or resident, doctor to county, the public health nurse, or the contact tracers that the hospitals are required to report cases. But nowhere in there is a doctor to housing provider contact. So we have hundreds of units filled with high risk individuals who live very near each other. But we don't have the option of getting that information as fast as we would want directly from a doctor. So, once we do though find out, we hop on it right away. One of the difficulties we have is affordable senior housing is, like I was saying earlier, we have residents who have caregivers come from the outside. We don't provide caregivers are not assisted living, but through in home support services, they might have their own caregivers or they may even hire family members to help them. So that's kind of our weakest point of entry that makes me the most nervous, is that we have people coming into the building, that we have no control over. And because of HIPAA, even if a care an outside caregiver came in their agency can't tell us if one of their caregivers has been diagnosed, they can't disclose that. So we're really limited in our information and we have to really rely on our residents to inform us of what's going on which is an uncomfortable position to be in with COVID-19. >> Yeah, absolutely, yeah, I know you're doing, [LAUGH] everything is as well as you can. And what can you tell us about the tools that make all the difference in helping older adult residents aged in place as safely as possible? And really also what's the tool that you wish you had at your disposal? >> So, [COUGH] for residents and just in general aging in place and affordable senior housing, I think the biggest tool for them is having outside help. Like I said, we have a lot of residents who are frail enough that they probably should be in assisted living but they can't afford it or they don't want to. And so be available leave assistance is a great tool for them that we are just somebody who can come and do light housekeeping, deliver food, help with laundry help with showering, especially during COVID-19 delivering food and supplies when we were quarantining, basically in residence were sheltering in place and and only leaving for essential items. But I would say outside caregivers and then the next best thing would be additional funding. We always need funding to pay for activities to help get the seniors engaged during the social isolation. And then like everybody else, if we could have access to rapid results testing for our residents and staff, I think everybody would feel more comfortable. >> Yeah, yeah, absolutely. And I think many of the challenges you're describing are in some ways unique to the affordable senior housing side, but many other settings, I think can also relate to the challenges and the solutions that that you're talking about. So, are there any trends or policy developments that you're keeping your eye on? >> Yeah, there seems to be a trend or a momentum building that is shining a light on affordable senior housing, which is the sort of section of seniors which is kind of ignored during a pandemic in favour of the more flashy news stories of skilled nursing and assisted living facilities. So there's this whole population that doesn't have access to the same things that skilled nursing and assisted living facilities have access to like random testing and other resources. And also regulations and guidance that came down in the initial stages of the pandemic was really directed towards skilled nursing assisted living facility. So we were sort of able to tap into that guidance which did help us quite a bit. But when we did end up having a couple of residents who tested positive in September, we were able to start building a relationship with the county's public health nurse. And we were able to kind of get some more specific guidance from her. But I'd say for us the trend of kind of reaching out to outside resources different from whom we normally do, we normally reach out to HUD when we were reaching out and getting guidance from the CDC. But once we had our first couple of cases, then the county sort of said, you're out there, and now we can provide you with some more guidance. So now I'm working with the county and the public health nurse to set up some more uniform procedures so that the outside caregivers coming in from like in home support services are following some standard protocols for specifically independent living, low income seniors are not part of skilled nursing, not part of assisted living. >> Wow, that sounds amazing. Well, Catherine, thanks for everything you're doing. Thanks for sharing with us today and looking forward to talking to you a little bit more later on in the course. Thanks. >> Great, thank you.
