Hi everyone. I'm Juliano Gilovich with leading age. Now, we'll be talking about managing and promoting behaviors at the community to reduce risk during COVID-19. Starting with our learning objectives, we'll be reviewing types of risk behaviors at senior housing and communities. We'll also identify activities that reduce that risk in each category and strategies to overcome obstacles. Then we'll discuss options for improving health outcomes through behavior. Because COVID-19 is mainly spread through interactions, let's review the types of exposure risk that occur most often at a housing community. First, there's resident-to-resident interaction. From the housing provider perspective, this pertains mostly to public parts of the community where residents stand together in an elevator or meet in common areas and other examples of resident-to-resident interaction. Next, there's staff-to-resident interaction, especially for processes that happen because of the housing setting that you're in. This starts as soon as a new applicant is screened for moving and continues through every step. The actual physical movement paperwork that needs to happen at the beginning and then throughout occupancy, and of course the maintenance and service coordination programming at the community and then they move out. Lastly, there's interaction between residents or staff and external stakeholders. That could be visitors or care providers, but it also includes vendors or contractors, inspectors, delivery people, or moving personnel, and so on. All in all, there are a lot of opportunities for exposure through various kinds of interactions that housing communities, but also a lot of opportunity for adaptations that limit risks through behaviors. Let's take a look. Promoting COVID-19 safe behaviors that yours in your housing community is a really important way to reduce spread. We'll take a look at starting with resident-to-resident interaction, different strategies that you can use. This type of interaction is very difficult to control in independent housing, because housing providers can't restrict movement of residents. There's just a lot of opportunity for exposure between residents. That said, there are some strategies for reducing unsafe interactions and promoting safe interactions. A big one is closing common areas or at least removing furniture so that residents don't have the opportunity to sit close together, and the same goes for group programming. Another big one is requiring masks in public spaces. In this case, the word public refers to anywhere outside the residence units. These are not easy to implement or to enforce, but we'll talk more about that in a minute. Next is interaction between staff and residents. Once again, there are both structural and systemic adaptations that you can make. Structural meaning installing physical barriers like plexiglass or other barriers to separate staff from residents during processes like income recertification for HUD housing or signing the lease agreement. In terms of systems adaptations, this is a great place for housing providers to leverage technology like using remote files or tablets for residents to sign documents. In fact, in the spring of 2020, HUD issued guidance allowing the use of electronic storage transmission, and even signatures in multifamily housing communities, including those serving seniors. The guidance goes through exceptions and considerations that you should keep in mind, like how to keep electronic files safe through digital encryption, for example. Keep in mind that you're not required to move to electronic files just because it's now allowed. Lastly, we have resident or staff to external stakeholder interaction. In some ways, this is more easily controlled by housing providers because building access decisions are made at the property level. This means, you can implement screening mechanisms if you have the staff and resources like taking temperatures at the entrances or utilizing questionnaires about COVID-19 symptoms. The weak point here is care providers for individual residents, because it is so important that residents retain access to those services. In these scenarios, you can try working with the agencies that are responsible for care providers to increase precautions or at least be aware of them, and you can restrict visitors that are non-essential. Again, if you have the capacity to enforce that or to at least encourage it. Throughout each of these types of interactions, using PPE is really the best thing you can do if the interaction itself can't be avoided. Now let's talk about some challenges. Any big policy shift or even a small protocol change that disrupts the lives of residents and staff may have the potential to bring up tension. That could be between staff and residents where the staff is trying to maintain certain procedures and the residents are just not buying into the change, or amongst staff, some of whom are perhaps working remotely while some are working on site. That gives the potential for tension to come up, especially if you have different policies for on and off site staff. For example, you might require staff to quarantine after returning home from an out-of-state vacation. But staff working remotely would likely be exempt from that requirement. Or if you're offering appreciation pay or flexible hours for on-site stuff, but not offsite style. Lastly, there's the opportunity for tension among residents. For example, when residents see others not conforming to community policies. These stressors are not to be overlooked when you make policies and also as you communicate and enforce them. These stressors are not to be overlooked as you make your policies and also as you communicate about them and enforce them. There are, however, certain tools at your disposal to help ease those tensions, including educational actions and enforcement actions. Let's look at an example. Mask requirements have been tricky for housing providers because some residents have been more compliant than others. Education has really been key here. The CDC has recommended that multifamily housing providers, especially those serving people who are at higher risk for the virus, utilize door signs and other notices to remind residents and visitors of the signs and symptoms of COVID-19, and to remind of the steps that should be taken for precaution like wearing masks, staying six feet apart and washing hands. Housing providers have found that educational is a better route to take than enforcement. But housing providers also have some enforcement tools available, especially if your state or locality has mandated masks in public through health directives or other guidance. That in the absence of those requirements, housing providers can amend house rules or fall back on provisions in the lease agreement regarding endangerment of others. But above all, it's critical to keep lines of communication open and foster a sense of community where possible, again, through education and accountability. One last thing on promoting behaviors. Housing providers can play a role in resident health outcomes, not just through behaviors that happen at the community, but also beyond it. This is where partnerships with care providers for residents or health departments become so vital. Those entities can partner with housing sites to provide health or informational resources. Federally qualified health centers, for example, are great partners for housing providers because they receive federal funding to provide affordable medical services to underserved populations. Examples of health resources that housing providers can partner with during the pandemic are not limited to COVID-19 specific activities like testing and vaccines. It can also include flu shot clinics to help keep older adults healthy and avoid trips to the hospital where they may contract COVID-19. While there are many opportunities for collaboration for improving resident health outcomes, housing providers also have various limits and restrictions in this regard, because they're not health providers. For example, housing providers partnering with a health entity to provide COVID-19 testing at the community, should not be put in a position to receive medical results of the testing, especially with personally identifiable information. If a housing provider does become aware of a confirmed case, they should take care when notifying other residents in the community not to disclose the name or unit number of the impact of resident. Any health activities or resources that you organize for the community should be adapted for COVID-19. For example, for a flu shot clinic, instead of having residents congregate in a large room while waiting for their shot, you could arrange for a sign-up sheet with time slots and implement one-way traffic to and from the area where the clinic is setup. All in all, housing providers are going to great lengths to keep communities safe during COVID-19. While there are many challenges, there are also many opportunities for doing so.
