Senior living communities across Massachusetts are girding themselves for the arrival of an unwanted visitor: Covid-19.
Many are ordering protective gear, updating emergency procedures, and poring over public health guidance on everything from alcohol-based hand rubs to special respirators for staffers who may be caring for infected residents.
But despite a heightened readiness for the coronavirus spreading worldwide, operators of nursing homes, assisted living centers, and other facilities housing the state’s oldest and sickest residents say much of their preparation isn’t much different from what they do for the seasonal flu they confront each year.
“We’re on hyper-alert,” said Amy Schectman, president of 2Life Communities, which runs senior housing complexes in Brighton, Newton, and Framingham. “But all the guidance is the same old thing: wash your hands, call your doctor if you’re not feeling well, don’t come to work if you’re sick.”
Nursing homes and other long-term care institutions could be on the front lines of the state’s efforts to fight the new virus because many of their residents have weakened respiratory and immune systems and live in close quarters where infections can spread rapidly.
The risk was underscored Saturday when health officials in Washington state said a resident and a health care worker at the Life Care Center of Kirkland had tested positive for the coronavirus. The nursing facility has 288 residents and staffers.
Yet state and federal agencies have issued relatively little guidance about Covid-19 risks specific to older residents or senior communities.
A coronavirus Web page of the Massachusetts Department of Public Health, for instance, offers guidance for clinicians, schools, and long-term care facilities. But the long-term care guidance includes advice on the most efficient use of special N95 respirator masks that are more widely used in hospitals. Although some senior home operators say they’ve ordered some of the respirators, many say they have limited supplies, if any.
The precautions are gearing up at a time when just one Massachusetts resident has thus far contracted the novel virus. But the global outbreak has increased the risk of wider infection.
“We’ve been getting ready, and now it’s going to speed up,” said Joe Carella, executive director of the Scandinavian Living Center in Newton, where staffers have been waiting for several days for the shipment of their first respirator mask. “The coronavirus is everywhere ― Italy, Iran, Korea. We have to prepare for the worst and hope for the best.”
Some physicians think the respirator masks may not be effective or needed in long-term care facilities because residents who contract the virus are more likely to be quarantined in the infectious disease units at hospitals in the area.
“The masks have some protective effect when used by health care providers in hospitals who are working with infected patients,” said Dr. Douglas Huber of Newton, a retired physician who worked in the epidemic intelligence service at the Centers for Disease Control early in his career. “In the nursing home setting, they’re not taking care of acute patients.”
At the moment, Huber said, a new strain of influenza that has been spreading in the United States poses a higher risk to older people in long-term care centers than the coronavirus.
While the trajectory of Covid-19 transmission remains unpredictable in the United States, the coronavirus has taken a toll on older people in China ― especially those with conditions like diabetes, lung disease, or cardiovascular disease.
Drawing on data and projections from the American Hospital Association, a national nonprofit called LeadingAge estimated that nearly 110,000 US adults over age 70 will die from the virus if it follows a course similar to that in China. By comparison, about 50,000 Americans of all ages die yearly from influenza.
“Older adults are going to be disproportionately negatively affected,” said Dee Pekruhn, director of life plan communities services and policy for LeadingAge, which represents more than 5,000 aging organizations. “How we prepare is basically the same as how we prepare for flu. It’s just a much greater magnitude.”
Coronavirus has a higher mortality rate than influenza now partly because the vaccines and antiviral medications available to those who get seasonal flu haven’t yet been developed for the new virus, said Dr. David Hooper, chief of infection control at Massachusetts General Hospital. But he cautioned that experts still don’t understand everything about Covid-19. “There’s still uncertainty about all the ways this virus can spread,” he said.
Hooper said a higher proportion of older people infected in other countries have had severe reaction to coronavirus. “As you age, your ability to mount an immune response to fight off infection isn’t as strong as when you’re 20,” he said.
At assisted living facilities, staffers are being told to immediately follow up on reports of residents with flu-like or respiratory symptoms, said Brian Doherty, president of the Massachusetts Assisted Living Association in Waltham.
Doherty said many facilities have installed signs in their reception areas encouraging visitors to remain at home if they’re feeling sick. Other steps include wiping down common surfaces, cleaning with germicidal bleach, and surveying staff and prospective residents about travel to high-risk areas.
At South Cove Manor at Quincy Point, where most of the residents and many of the staffers are of Asian descent, two employees who have traveled to China in December were monitored for symptoms. The nursing and rehabilitation center instituted a policy in January requiring anyone traveling to China to stay away from the facility for two weeks upon their return and get a doctor’s note. That policy prompted other employees to cancel trips to China during the outbreak.
“We were out in front of this,” said president Bill Graves.
The coronavirus could create particular challenges for the state’s memory care centers, where residents with advanced stages of dementia can’t always be relied on to wash their hands or cover their mouths when coughing or sneezing.
“If there’s a concern they could be contracting a virus, you need to have a procedure to make sure public health protocols are being followed for residents in memory care units,” said Jim Wesler, the Waltham-based chief executive of the Massachusetts and New Hampshire chapter of the Alzheimer’s Association.
2Life Communities has put in place a “reverse 911” phone system to communicate urgent information to residents and staff in their native languages, but thus far there’s been no need to use it. The staff at Scandinavian Living Center has scheduled more frequent “risk management” meetings for its staffers.
But how, and when, to communicate with residents at the senior living communities remains a tricky issue.
“There’s a line between alarming people and letting them know we’re prepared,” said Brooke Cabot, business manager at Scandinavian Living Center. “We have to strike a balance.”