Hi, I'm Juliana Bilowich with LeadingAge. I'm happy to be here today with Gus Keach-Longo. Welcome, Gus. Thank you so much for having me. It's a pleasure to be here. I'm the president and CEO of The Towers in New Haven, formerly Tower one Tower East. I'm so excited. Thanks for this opportunity. Absolutely Gus. Gus, what can you tell us about your communities? I know you have a really unique and cool model for serving older adults. Where are you located and who do you serve? Great. Thank you. We are a low-income housing, senior housing site in downtown New Haven, right near the train station. We actually have about 328 apartments. We have a 2O2 facility, that is an independent housing facility, but we also have assisted living units. We actually were able to receive a grant a long time ago to convert some of our senior housing units or independent living into assisted living. We have a 130 assisted living apartments in our building and we take care of people from 62 on up. About a third of our folks are in their 70s, another third in their 80s, and another third in their 90s. We have quite the span. Wow, that is quite the span. What can you tell us about the income level, especially in a hard assisted part. We have Tower one and Tower East, and we're all one community. Tower East happens to all have some form of subsidy for our folks. Those folks tend to be a little bit more lower income. The Tower One building, we have a 170 apartments there, and about 88 of them are actually considered market rate. In those market rate apartments, we have people who are middle class, people who have worked their whole lives and they've had either a pension, also security. But they typically don't have enough money to afford the private pay assisted living model that's out there. If they have about $4,000 a month in income, they can afford all the same services here at The Towers, as they would pay somewhere else for $8,000 a month. We're about $2,000 more cost-effective than all of the other facilities in this area. You're really feeling a need for older adults. [inaudible] oftentimes can't find a place to go because they fall in between to a place where they could have subsidy if they were lower-income, or if they have enough resources to go to another model. We fill that gap, as well as have low-income apartment. That's fantastic. Excellent. Let's talk about resonant behavior in these independent living settings. Especially in terms of the pandemic, what are some of the behaviors that you're encouraging or discouraging at your housing communities to help keep everyone as safe as possible? Well, when the pandemic started happening, we started really looking at how are we going to keep our folks safe in this environment? There's a strong sense of community here. We were started by the Jewish community back in the 1960s. Over time, and we were very diverse, but we do have a cultural aspect of us where people tend to know each other and spend time together. We also have a centralized dining so that people can come down to a dining room or café. There's a lot of interaction with our residents. One of the challenges is, how do you start to help people be motivated to stay in their apartments? We started writing memos, actually pretty early on where we started sending them out to about 2,500 people in our community and in our network, and started to explain what was going on around the state. Because Covid really started happening, I think it's not even a 100 miles from here in New York City, and it started making its way into Fairfield County. It was on its way to us. Originally, people were starting to focus mostly on people in nursing homes and other care centers. But it was not too long into it, that they started to realize that the folks who are living in settings like ours, were highly at risk because there's so many people coming and going out of our building. By sending out memos, pretty much every few days saying what was going on, we needed to start taking action. People really did start to take it seriously. When we closed the dining room, there was those group of people who are angry with me, and they were going to the board and expressing their anger and felt that they were being kept trapped in some way or another. Then a few months later they contacted the board and said, "Oh my God, you kept us alive." Because we didn't have a single bit of community spread inside the building. I've had some people also share with me that they heard about things from our memos before they heard about them on the news. That has a lot to do with LeadingAge honestly. Because LeadingAge was always keeping us abreast of what was going on. Between the most challenging parts of the beginning of this was, we had calls with DPH, we had calls with Hive, we had calls with LeadingAge, we had calls for every one of the other associations. It got to the point where we were on calls constantly trying to absorb what was going on. I would put those into our memos and I think that because we had good accurate information from the very beginning, people started to trust what I was writing and people started to really trust the fact that we were ahead of the curve and a lot of ways. Between that and being a sense of community where people were all here for each other, people have been very good at following our direction. We have had a pretty good success rate as far as people staying in their apartments. Once we started delivering meals to their apartments and things like that. We did have to take away all the furniture, for example. One thing that I learned a year ago, I have only been here about three years, when we first had a little bit of a GI [inaudible] going for the building, when we kept the furniture in place, people said, ''Yeah, yeah, yeah, whatever.'' They would go and sit down and they would hang out with each other and stuff. We learned pretty quickly that we had to remove all the furniture so that there was no place to sit and we had to disconnect the televisions in the common places and all of that. A combination of closing down our spaces and keeping people informed and when we did start having some cases that were brought in by caregivers, we shared those pretty openly and of course we kept people's privacy and of course we didn't say who was who. But we were saying that we had cases and these are the reasons why we have the cases. We had a couple of scenarios where we had somebody who snack somebody into our building after we had closed up the doors, and it was an interesting experience because we had a senior gentleman who tested positive and he said, ''Absolutely not, there's no way I could be positive. I haven't gone anywhere.'' We're saying, ''But the results says what it is.'' When we were talking to his daughter, his granddaughter overheard the conversation and started screaming because she was the one who snack into the building to visit her grandfather. [inaudible]. We've shared some of these stories with our folks, they have taken it very seriously so, we haven't had too much other than some anger in the beginning, and then slowly got that one over. Wow, it really sounds like communication made all the difference. That's fantastic. I know that when we think of resources in the community, we often think of PPE and staff time, but information as a resource is not to be overlooked there. As a housing provider, there's a lot that you may not be able to do in terms of requiring or enforcing pandemic specific health behaviors, especially for independent living, so how are you navigating that with residents? Our model is a little bit different in the sense that we have independent housing all mixed in with assisted living. That becomes complicated because it's a great model because people don't have to move from their apartment if they start to need help. As they do start to age and they are aging in place, the help can just be adjusted. We have independent folks living amongst assisted living and vice versa. When we're trying to keep our independent folks safe, we treated them all the same, because it was all in our case, one large community. When the state did say that we had to start testing all of our assisted living residents, there was no way we could test our assisted living residents without testing our independent housing residents. Going back and forth with the state, they were saying, ''No, you don't have to test the independent people.'' But the independent people are living with the assisted living people, so it doesn't make any sense to do one group, because they're exposed to the other group. When we started rolling that out to our community, we didn't define assisted living versus independent living, we just started testing everybody. People were able to go along with it. I have had some colleagues who have shared with me how hard it's been for them, because one thing we have is, we have 24-hour security here. The fact that we have somebody at the front desk, means that we can control the flow inside and out of the building. That actually works out well for us because we're able to really know who's coming in and out of the building where one of my colleagues is like, ''Look, I don't have somebody there 24 hours a day.'' In some cases, it really can be hard because I can't imagine not having somebody here to be able to control some of the flow of the traffic when we're trying to make sure that we keep people safe. When it comes to independent housing, it's definitely a model that we can figure out how to support may be a little bit differently in the future. Not quite sure how to do that, but we need to think about that. Absolutely, Gus. Well, I don't know either, but I know that together we'll be able to figure out how to do that. Tell us a little bit more about how this testing and the shift came about, that has been such an important part of recovering from this pandemic, but it's been so hard for housing providers in particular. How did you all make that happen? We actually locked out in a way, because when the pandemic started to really start making its way from Fairfield to us. The city and the Haven's local health department, started realizing that there were several housing sites within the city, that really were on their own, and many of them don't provide services necessarily like assisted living or anything else. Were on a joint call with the mayor and our local health department, and I was explaining what we were doing as far as putting up signs, removing furniture, starting to restrict what was in access within different parts of the building, all of that stuff. Our response to that was a little bit different than the other sites around town, and I think that started to really concern in a positive way. Started to concern the city to say, ''Oh my God, what do we do with these housing sites and help people stay there?'' They started reaching out to testing partners and they came across the testing partner called Murphy Medical Associates out of Greenwich and Stanford, and I'm so grateful to them, because as soon as they were able to really connect with us, and we could figure out how to start testing everyone. We started to have a trial in the beginning of June. We knew that we didn't want everyone to have a high rise building, we're 21 stories on one side and 13 on either side. We didn't want people traveling on the elevators, and we didn't want people coming downstairs to a central location to be tested, it just made absolutely no sense. We did have a testing part downstairs on the ground floor. In fact, we built these little booths so that people could be in them when they're being tested, and that was mostly for the staff. But when it came to the apartments, the Murphy's Medical Associates were in two teams, and they went from apartment to apartment, to apartment. The first time around it took them two and a half days to get through all building just because of how big we are. It was a good learning process for all of us because then we started looking at this going on, how do we reap all this information, and who needs this information, and who legally has the right to have the information versus not having information? We had to keep figuring this out as we went along. That first week was a great learning process for us. But then the state decided that they wanted to mandate testing in all assisted livings on the 28th of June, which was the final week of June. We were already ahead of that. We started testing around the third week of June and then we were continuing testing ever since. We test everybody every single week, regardless of anything. That has really helped because now we worked out a system where the provider for the testing actually does the labs as well. That has become key because labs have been in data, and they don't get results back for three, four, five, whatever days. We usually get our lab results back either the same night or the next morning. That took a while to get to it because we're testing 400 people back then a week, and now we're pushing them on 600 people a week, maybe 550 I think this reasonable. But, it's impossible for their physicians to call 400, 500 plus people a week with their results. People don't answer the telephone because they don't recognize the telephone number. But then we had them put our main telephone number on their system to look like somebody was calling from the towers, that helped through a little bit. We also tried our best to tell everybody, pick up the phone and answer the phone, but it got to the point where they just never could get through to all these people. The most important part of the whole thing is that I get a text message from the doctor if someone is positive as soon as it comes off the machine. As soon as they take off the vial and everything from the machine, they have the results, he texts me whatever time of day or night it comes through, and then we end up having to wait for the doctor to contact the person or resident, or maybe a family member. Once we know that has happened, then we contacted the family member or the resident, and we start doing the contact tracing from there. We've had zero spread in the entire building. We've had the virus get into the building several times but it hasn't gone any further than that one person. That has really made a difference because as soon as we get the text message, we are on it and we're trying to do the contact tracing. Getting this up and going, I'm very thankful to the city of New Haven for making that connection. Then the other piece of it is the Murphy's Medical Associates, they're really go-getters. At one point, in the beginning, we had mostly national gov people here helping doing the testing and trying to get us through those times, but as we got into the summer, we got into a routine, then we started getting into a system. We now have decided to close our building to anyone who doesn't get tested within the prior 10 days. You have to literary show a negative test that's dated within the previous 10 days, or if you've got tested here, then you have to be on our cleared list, cleared to enter. Whenever someone has missed positive or negative, within that stuff, we just say the person is able to come into the building. That made a huge difference. What amazing system? Even when we closed down all the way as much as possible and we had no visitors for a while and all that, we still had 150 people coming in and out of this building every day. This part of staff, caregivers, aids, whatever the case might be. Keeping control of this really came down to having to be able to control the entrances. Yeah, absolutely. How did you manage that with independent living? Residents who, maybe they needed to apt into the testing or how did you navigate that? We learned a couple of things. In the very beginning, we realized that when we close the cafe and the dining room, that people were going to need food. We didn't know how we're going to pay for it, but we figured, let's just start feeding everybody and making sure that there's nobody sitting in their apartment without food. We started doing this as an opt-in process, assuming that people were going to call us and say, hey, can you deliver meals to us? We did have a whole bunch of donations from the community to help subsidize the meals, our folks pay half of the meal cost and donation pays the other half of the meal cost. There are some people whose income is so low that they can't even pay half and we just adjust those numbers. But we learned, I got a couple of calls basically from family members saying, "My dad is upstairs and he says that he's fine and he has food, but he shares with me that basically he has Girl Scout cookies and English muffins, is it good?" I'm like, "That's not good", and now she is worried, "I can't get to him, I can't really get him groceries, all this other stuff, and you won't tell me that he needs meals, and he's never going to tell you that he needs meals." I'm like, "Good." We started sending it out. Within about a week or so, we realized, for our community, opting in doesn't work. They would have to be proactive and make their decision and take an action and stuff. It doesn't really work that way. We switched from opting in [inaudible] opting out. About a week into it, we just started feeding everybody, three meals a day, seven days a week, and then people could contact us if they didn't want the meal and that worked out much better because people didn't want to either have the bill or they were able to cook for themselves or whatever the case might be. So we ended up getting about 200 people on our meal plan that way. We've been hovering around 197 people who get extra meals every single day. That worked out much better. When it came to the testing part, we knew that lesson now. So if we started to do it where people had to opt in, they weren't going to take the action so we decided to start from the very beginning as an opt-out and that made a big difference. In the very beginning, we had about 70 people who opted out of testing out of our whole building. I would share that with our memo saying that we have 70 people who have decided not to take the test and have the tests on a regular basis which really made our community upset because people felt that this was not safe enough for them. They were also putting them at risk, and of course nobody ever knew who opted in or opted out because residents can come in and out of the building freely of course. It's only the family members or caregivers or staff or whatever. We've never adjusted that at all. Now we're down to about 44 people who decide to not take it. I think a part of that was we had two different organizations. One has the powers, which is our physical plant and when we do receive the subsidies from high and there has to be spent on the Physical Plant and such, but then we have the Towers Foundation, which is a supporting entity of the towers. That's the entity that we use to receive donations to go for grants, and that's the entity that pays for the volunteer coordinator and the activities coordinator and all these other things. The programs all run through the towers foundation, not through the towers itself. With that, we said you have to be tested in order to go to our program. We had closed down all the programs, but as we started to see people declining and people really starting to have more health issues, we were getting nervous, especially by the time summer came at the end of the spring, summer started coming. We were seeing that our folks were declining, a lot more rapidly than they normally would. So we started figuring, how can we do this? How can we get it to the point where we can start to open up just enough so that it's safe for people to come out of their apartments. Because of the testing every single week, when we started that in June, by the beginning of July, we started having programs again. We were all social distance. Everybody has to wear a mask. We have tape all over the floor and all that kind of stuff, but in order to be in our programs, whatever our programs happened to be, you have to be a person on the cleared list, which basically means that they're getting tested every week. If you're not tested, then unfortunately, we say that you're not allowed to join those [inaudible]. That has motivated people too, being able to be a part of stuff and get tested. There was a lot of fear in the beginning at the same time, what was the test like? How is it going to feel? We use the long swabs and stuff. There were other places around us, like there was a drive-through site that was using those rapid tests, but the failure rate was so high that we didn't go that route. Once people had those test the first time, they were like, "It's not so bad. It's not a big deal." But of course, one person who is complaining and then I have the senior who's telling them, "Fuck it up you've been through a lot worse than this." So they connect to each other and they say, "Yeah. You're fine." Because of the testing, we can do some programs. Because of the programs, I think we've motivated people to take the test. At this point we've loosened up a lot more. Even though we're being very careful, even to the point where we started seeing a lot of visitor concerns. They were struggling because people were not being able to see their loved ones and it was months and all this stuff. We started saying that you can come and visit if you get tested and you get tested on a regular basis.. That has loosened up a little bit too. Incredible. You guys have done such an amazing job and I know the residence. Your community are just so grateful for everything you've done. Testing and treatment. Communicate. The interesting part is that at the beginning we had cases that were probably asymptomatic, but then now we're only worried about the cases that are pre-symptomatic. The ones that are after exposure will [inaudible] for those first couple of days because everybody is in the cycle now so we really have to watch out for those pre-symptomatic case. We're getting a positive case just about every other week at this point. With that, every other week we end up really being able to keep track of the contact tracing and we haven't had any spreads so we keep going. Amazing. Well, Curs, thank you for sharing all of that with us. Hopefully that can inspire and inform some other providers across the country. My pleasure. Thank you very much. I appreciate it. Thanks.
