Safe housing for seniors gets more attention during pandemic

Three out of every four COVID-19 deaths in Boulder County have been in a long-term care facility. Each of the more than 40 deaths in these facilities was a parent, grandparent, extended family member or a friend with a special smile, twinkling eyes, a unique personality and rich life experiences.

"It's tragic. There is not a better word. Our most vulnerable and cherished population has unfortunately become victimized by this," said Bob Murphy, president of the Colorado chapter of AARP. It's one of many organizations on the state, national and local level looking for ways to help older Americans survive and thrive, now and in the future. They're getting a lot of attention because of the coronavirus pandemic as people look for ways to protect loved ones in facilities or keep them out of facilities in the first place.

The Boulder County Area Agency on Aging, or AAA, said it has been getting calls to its helpline (303-441-1617) for a wide variety of issues related to the pandemic, on top of the questions and requests they field in normal times. AAA has resource specialists answering questions in English and Spanish. They connect people with various agencies or programs that can handle specific needs. One of the most critical things they do is provide direct information on home health services and long term care facilities.

AAA contracts with local home health agencies for its program called Choices at Home. It's for people 60 and older who have a demonstrated inability to do activities of daily living such as house cleaning, making meals, showering and other activities of everyday life. The services are for the individual but also for their caregivers who may need help with their responsibilities. Choices at Home offers financial assistance to those who need it, making sure that everyone who needs help can get it.

Those home health services allow people to stay in their homes for as long as possible, avoiding the additional risks of living in congregate housing where the coronavirus is more likely to spread. Early in the pandemic, people who relied on these services stopped using them as much, according to Carol Cross, who has managed the AAA call center and now works on strategic planning. Older people and their families put a hold on services because they were concerned about workers coming into their houses, possibly spreading the virus.

Cross said AAA has monitored the services and their ability to obtain PPE for workers. They've also encouraged the Choices at Home clients to use their home health vouchers in different ways that avoid close contact such as grocery shopping and other errands. As the number of new COVID-19 cases has declined, Cross said the home health services report that clients are slowly resuming services and new people are signing up. That's welcome news for AAA with its focus on supporting aging in place, a trend that Cross said has been happening over the past decade. The idea is to keep people in the home of their choice as long as possible.

AARP's Murphy said the risk of COVID-19 is an added concern, but that there are a lot of other reasons for society to emphasize aging in place, including the expense. He said that for someone to stay at home, there needs to be support for caregivers. "There is a financial, emotional and mental risk that comes with that," he said. AARP is advocating for legislation that includes tax breaks and paid leave for the 48 million Americans who are caregivers for family and friends.

Supporting caregivers and modifying homes so they are safer and easier to manage are some of the solutions that make it possible to age in place. "We need to remove barriers so people can stay in their home longer. We can make short term investments that have a long term payoff for the emotional health of our loved ones as they age," Murphy said.

But there may come a time when the older person needs more care than can be provided in a home. If that time is now, during the pandemic, AARP has six questions to ask a facility if a loved one is living in a nursing home or might be moving to one in the future. "We are asking people to be thoughtful and ask questions," Murphy said.

Choosing whether to move into or out of a long-term care residence is especially challenging right now, said Erica Corson, the Boulder County AAA ombudsperson. "It depends on your situation. We have some guidance on indicators on whether the needs are too much for a home caregiver." AAA also provides information on how to choose a facility and how to navigate the decisions that come with making that transition.

Corson's role is to advocate for older people once they are in a long-term care facility. Her job is more challenging because of the pandemic since much of the work is done on-site at various facilities. Outside visitors are not currently allowed in the facilities per state orders. Corson is working on setting up phone calls and video calls for residents and families who have concerns.

She said those concerns are not currently out of the ordinary even with the current elevated health risk. The issues she regularly addresses are around respect, discharges and evictions, medication concerns and care planning. "COVID just adds another whole layer of complication," she said.

Boulder County Public Health and AAA have been in regular contact with facilities as they work to prevent more outbreaks and more deaths. Corson said some facilities are better equipped to deal with the complications of COVID-19 than others. Some have more resources, others have fewer. Staffing is a perpetual challenge in an industry that pays relatively low wages, she said.

The state of Colorado keeps track of outbreaks in long-term care and other facilities. In Boulder County. Some long-term care residences have had devastating outbreaks and others have had none. Corson said it's hard to know exactly why. She said the Colorado Department of Public Health and Environment is doing surveys that may yield answers. "It will be some time before we know why one place did better than another place," she said. The data may help prevent future outbreaks in long-term care settings and in other places where people are in close contact, such as meat-packing plants and prisons.

While facilities have been scrambling to find short-term solutions, the impact of the pandemic could change the way long-term care is designed and operated in the future. There could be more outdoor spaces, interim housing for staff, surfaces that are more germ resistant, better air quality, more telemedicine, partitions that separate areas of a facility to create pocket neighborhoods, or smaller buildings with fewer residents that would limit spread of disease.

Longmont's Hover Senior Living Community has a skilled-care housing option that is part of the Green House Project,, a concept that creates residences that feel like a home. Each of the 12 residents gets their own private room along with a shared kitchen, living room and other common spaces. "There has been a movement for years to change the institutional feel of long-term care," Corson said. But she added that smaller housing developments are more expensive and may not be financially viable for much of the public.

It's not clear whether local long-term care facilities will see fewer residents because of the fear of COVID-19. Atria Longmont said that move-ins have slowed, but haven't stopped. Balfour is still taking reservations for its new facility in Longmont. The company declined to talk about anything related to COVID-19, but said it is still on track to open this fall.