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Considerations for Balancing Seniors Housing Residents’ Safety as Communities Reopen

A Strategic Approach to the COVID-19 Pandemic


Seniors housing operators face unparalleled challenges in our shared COVID-19 related public health crisis. With safety as the maximizing function of efforts to date, operators have relied on quarantine-like protocols — strict visitor restrictions and minimal resident interaction with staff and other residents.

Operators recognize, however, that these protocols, prolonged over time, may pose a different set of risks to residents. Isolation, lack of engagement, and loneliness can contribute to functional and cognitive decline as well as depression and anxiety. As societal risks from the COVID-19 pandemic continue for the foreseeable future, and with states relaxing restrictions, seniors housing operators are responding with strategies to minimize both COVID-19 transmission risk and the risks of poor outcomes resulting from isolation.

There is no easy answer for when and how much to loosen highly restrictive protocols, especially when residents, staff, families, and states often have differing opinions about risk tolerance and desire for safety. However, given that long-term isolation also poses serious risks to residents, the industry is moving ahead pro-actively to prepare for, and manage, COVID-19 transmission risk in a long-term, non-zero risk environment.


We partnered with the American Seniors Housing Association (ASHA) to understand their member operators’ efforts to date to prevent and contain the spread of COVID-19 in their communities and their plans for reopening communities.

With input from ASHA members, ATI Advisory prepared a paper that highlights seniors housing operators’ efforts to create the safest, practicable environment through a range of restrictions and protocols and their plans for restoring continuum of support and access to communities. ATI synthesized operators’ strategic considerations for their phased approaches to relaxing restrictions and allowing movement in communities.


Our discussions with operators revelated many seniors housing operators have quickly built proficiency in containing outbreaks and preventing new infections, working with rapidly changing CDC guidance and imperfect information about COVID-19 and its transmission.

Operators face a new challenge—a long period of risk management through which they cannot rely solely on safety-first strategies without impacting resident well-being. Operators must continuously assess risk, intervene and prevent transmission, and monitor progress. Each operator will weigh considerations in light of unique circumstances and market.

In preparing this strategic framework, we highlight that policymakers have an important role to play in helping to balance these risks as they prioritize access to testing and other resources. Action is needed to ensure the consistent availability of rapid turnaround testing to establish baseline results and monitor residents and staff, on an ongoing basis, to detect the potential for outbreaks. Senior living communities and their frontline staff require ongoing support to ensure they have adequate supplies of personal protective equipment (PPE) to halt spread of the virus from asymptomatic carriers and once new, positive cases are identified.

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