Hi, Catherine. Welcome back. Let's talk this time about community access. Other providers that we've talked about already serving older adults like nursing homes or assisted living communities had really clear guidance on visitation during the pandemic. What about your independent senior living communities? What kind of guidance have you all had? What have you had to follow? There was no real guidance for independent living facilities when the pandemic began. We basically follow the more strict guidance given to assisted living facilities, along with the guidance that the CDC provided to the general public. Then, I took the sense that we were going to err on the side of caution, and so we kept our buildings locked down pretty tight from mid-March for really the protection of residents and staff because we don't have a large staff. I couldn't afford for anybody to be out sick at that point. Then, we had quite a bit of the senior staff out already because of just being over 65 or having underlying health conditions. As the wider community began to open up, we realized that our residents were able to leave the buildings and do what they wanted to, but my decision was, "That's great, but we're going to still keep our properties as tight as possible." We require mask and social distancing. We sanitize high-touch services in our buildings multiple times a day and over weekends and holidays. We only allow two people in the elevators at one time. Our common areas remained closed. We continue to do tray service. Obviously, we allow essential visitors into the buildings and residence, they wouldn't have as much control on weekends and after hours. Some residents will bring people in, but we try to make it clear to everybody that if you're in our buildings, you've got to follow our buildings' protocols. Even as the county health orders change and things become a little bit more lenient for our population, that's not great. That just means that there's more chance for exposure. Whatever control I can take, I do, but still considering mental health issues and social isolation. Yes, absolutely. You mentioned tray service. Can you talk a little bit about that? I think that might be something that not all housing providers have. Sure. One of our five properties has a mandatory meal program. We have a commercial kitchen and we serve breakfast and dinner seven days a week to a population of about 164 residents. It's a building with three wings. It's four storeys and has three wings. We have to basically prepare all the meals in our kitchen. We have cooks and kitchen staff. Then, all of those meals are put into special containers. We had to order that retain the heat and they're delivered to all the residents twice a day. It's a lot of work. It's very difficult on the staff. They have to wear full PPE. We require the residents to come to the door with a mask on. There's pretty much hands-free. We set the tray down on a little stand and then the resident takes it from there. That's how we're operating our mandatory meal program. We're not ready to open up the dining room. It's just we don't have the staff to monitor social distancing and limiting the number of people in there. That's one of our higher-cost, actually, on top of PPE, is ordering these containers that are expensive because we want to be able to serve residents meals that are still warm. Yes, absolutely. Well, getting back to community access. These are really porous buildings, right? How many entrances are we talking about? I mean, can you even screen visitors? What about vendors? How can you at the same time make sure that residents are still getting access to their essential service providers? It's been tricky. We do have multiple entrances to the buildings. There's always a main entrance, but we have, depending on the building, between three and maybe five other entrances that obviously, we can't monitor all of the entrances. We'd have signage at all of the entrances asking visitors go to the main entrance that they should sign in. We have a log and a hand sanitizer at the main entrance, because obviously, we want to make sure we know who is in another building. If we do have to do any contact tracing, we can go straight to that log. We're still online as Central Visitors and we're keeping our doors locked. But we can't monitor after hours and weekends when we have visitors coming from the outside, whether it's an essential visitor for a resident or if it's an outside vendor who's doing something on the building, we have them log in. We ask them a few screening questions and we have our touch-less thermometer, which takes their temperatures and we keep a log for that. We've also added reliably and residents and tell them that for their protection, that they're responsible for their visitors. If they do have visitors coming in they need to really tell their visitors, please wear a face mask, it's required in this building. We just want to make sure that they know that they play a part and who comes into the building. We do as much as we can during business hours, but they also have to help us out and so far they've been really great about that. That's great. I'm sure that's what has helped you keep your exposure so low. Can you give an example of an essential service provider or an essential visitor versus a non-essential? Sure. Essential service providers would be, obviously, anybody medical, a doctor, if they needed a doctor. Care-givers are essential workers. Some people have outside family who comes in to take care of them and we reconsidered those essential workers, which is a fine distinction because we wanted to discourage social visit versus central visit. Then anybody delivering meals. At the one property we have that mandatory meal program, at our other properties, we have meal being delivered and other organizations to deliver hot meals. So those would be essential visitors as well. If we had no water leak or something where we had to have if it was a health and safety issue that we needed to address, those would be essential worker. For people that for non-essential workers would be family, children, especially within one child in the buildings, initially, pretty much anybody who wasn't well potential. I know that's such a tricky line, but so important in keeping everybody safe. What can you tell us in terms of visitation and community access, how you responded to COVID-19 early on versus what you're doing now and, maybe what you wish you'd known sooner? Sure. As soon as the pandemic here, for us, this was like mid-March when everything did it once. We created a timeline to show when and why we made certain decisions and what the current guidance was at that time because they changing hourly and decision for change depending on the latest information and so that timeline we still continue. Then I also began writing a memo, took all of the residents, it was distributed to all the residence weekly explaining the current health order ban, the CDC guidance that affected our population specifically because it was getting very confusing for them what applied to them, for example, what did shelter-in-place mean in the context of our buildings? Defining who essential visitors were? So our initial response was to quickly lock down our buildings, close down common areas, and the dining room, began to trace service, and then provide all of our employees with essential worker letters to keep with them at all times so they could actually get to work. They would be allowed to get onto the property. In hindsight, I think we all would agree that everyone polishing started wearing masks from day one, but that wasn't the guidance at the time, that we've learned a lot about supply and demand, and PPE and having a healthy stock of PPE. That will definitely be in our disaster planning going forward. Yeah. We've all learned so much. Well. I mean, because it's independent living really, you all have done such an amazing job. But how have the residents responded through all those policy changes, all the restrictions, and what about your staff? The residences have respondent extremely well. I was very concerned about that in the beginning. I think it's helped the residents and the staff that management has been extremely transparent about what we're doing? Why we're doing it? We've over-communicated, which I think the residents have appreciated. They haven't felt as isolated, just watching something on the news. The resident feedback wasn't mostly positive. They seem to appreciate that we're doing everything we can to protect them. They're very appreciative of the maintenance staff, janitorial staff who are sanitizing the buildings and just really there to protect them. Then we found that the more hands-on trainings that we have done with our staff including drills, has really lowered the anxiety level of the staff. The staff were very anxious about coming in. We saw that anxiety level dropped when we were giving them real life scenarios like we have drills where one staff person would be a COVID case. What would we do? How would you get their meals to them? How would you get their laundry from them if they had no one to help? How would you collect their garbage? We had an empty unit and we just did role playing. The more they did that prior to us ever having a case, it didn't throw them when we ended up having a case. Now, we have only the two cases in all of our buildings that were not doing really well. But at first, I was unsure how the staff would take this information of you've got to wear all of this stuff that's scary, but we worked through that and that helped. As soon as we heard of a case, we only have the two cases, but we've had about three scares where it turned out not to be a positive case, but at the time we weren't sure, and we found that if we just immediately told all the staff what was happening, they were fine. They just felt like as long as we were open and honest with them, they didn't feel like there was something right on the corner that they didn't know about. I think having really open communication with the lower back levels has really increased their trust in us, its management and their comfort level with being in the building and using PPE. It also helps us because our staff, they're the ones out in the building and they can spot if a resident isn't looking quite right that day, if a resident isn't wearing a mask, if they're supposed to be isolating and they're not, and they can report back to management. We can catch these things quickly before we have a problem that results in a cluster which is a person's worst nightmare. Yeah. Wow, amazing examples of leadership and just your transparency that's helped you through the crisis. It's so good to hear and so let's project forward a little bit. I want to say five months, but who knows? It could be five years from now. Where are your communities with these policies? What changes do you see sticking? Well five months out, I don't see too much changing. I don't see our current policies changing much until there's a vaccine that works for older adults. Short of that, if there was inexpensive rapid results testing, that would maybe be a prompt to relax some of our restrictions, but it's a judgment call and you just don't want to make the wrong decision. It's a balancing act between social isolation and physical protection. We're trying to now navigate a balance with that, we're trying to think of maybe some small outdoor activities with a limited number of people. But I just don't have enough staff to pull that off safely right now, so it's just in the beginning phases. We are reaching out through technology. We're trying to determine how many of our residents have Internet so that we can have our services coordinators do some more interaction through FaceTime or Zoom to get them re-socializing. We're just using any phases of that. Hopefully that will develop. My concern is that the counties around us are opening up, and so that's increasing the danger outside of our building. I want to keep limiting that danger inside the buildings without crossing too far over that and having a bit too isolating and having mental health issues. Yeah, absolutely. You've mentioned a couple times the words, nightmare and fears. What's keeping you up at night? What keeps me up at night is, contemplating what is our weakest point of entry? What don't I know? Or what have I missed? I feel that we've really trained the staff well, I feel that the residents have really stepped up and are appreciative and are doing the right thing. I think about the weakest points of entry. How can I tighten up the outside care givers coming onto our property caring for our residents, that's where I have no control because we don't hire them, they're hired by the residents directly. I have to rely on the residents to communicate with these outside caregivers. That's probably the thing that keeps me up at night because my fear is that you have one case, you have a cluster, it affects the staff and now you're in a disaster scenario. Yeah. I'm so glad that hasn't happened yet. It sounds like you're making all the right judgment calls, so thanks for everything you're doing. Thanks for being here today. Thank you.
