Like the senior living industry at large, Artis Senior Living followed guidance from the Centers for Disease Control and Prevention (CDC), as well as state and local public health departments, in responding to the coronavirus pandemic.
But the information from those agencies was fluid in nature, and often contradictory. So Artis decided it needed a more uniform approach that went beyond the guidance from those agencies, President and Chief Executive Officer Don Feltman told Senior Housing News.
Last month, Artis announced the launch of the Artis Safety Council, a partnership with Johns Hopkins physicians and a cross-discipline group of Artis associates and healthcare leaders to focus on maximizing the safety and well-being of residents, associates and families.
The council’s initial focus is on actively strengthening the health and safety protocols for its Covid-19 response. It will base its guidance on the latest science of dealing with the virus, along with proactively looking ahead at other potential community health issues that could arise, to have an industry-leading approach to safety and resident care.
“It’s unprecedented — we don’t have a lot of textbooks to refer back to, in terms of what was needed,” he said.
Based in McLean, Virginia, Artis, Artis was founded in 2012 as a standalone memory care provider, and has since expanded to include mixed memory care and assisted living. Its portfolio consists of 13 communities in operation, as well as a robust development pipeline including 20 sites under consideration for development or undergoing entitlement processes. Feltman is an assisted living veteran with over 40 years experience. He started his career at skilled nursing giant ManorCare and worked for hotelier Marriott when that company had a senior living concern. It was at ManorCare where his relationship with Johns Hopkins began, and where the foundation for the Arden Court brand, and the modern dementia care model, was laid.
Artis is owned by the Bainum family, owners of Choice Hotels International — the same family that founded ManorCare and Arden Court.
In this interview, Feltman shares more insight on the Artis Safety Council, how the Bainums are responding to the virus, how assisted living and memory care have changed over the decades and if the pandemic will create an opportunity for a more affordable assisted living model.
This interview has been edited for length and clarity.
Can you share some more details behind the Advancing Safe Living Initiative?
Like a lot of senior living providers, it was a mad scramble for us when the virus showed up. It’s unprecedented — we don’t have a lot of textbooks to refer back to, in terms of what was needed. We were following the guidance of CDC, CMS, local and state health departments and sometimes [guidance] would be conflicting and difficult to follow.
We made the decision that we really needed some experts, and we reached out to Johns Hopkins University and were able, fortunately, to line up to physicians who are on the front lines, are experts in the field, and also very compassionate gerontologists, clinical specialists and infectious disease specialists. The three of them ultimately agreed to come on board the safety council that we formed, to focus on best practices, as well as a real time study of what we should be doing that we were not.
We’ve been engaged with them for quite a while and have regular meetings with them. We had one this morning, and we go over questions that are sourced by ourselves, get the latest on the vaccine front, latest in terms of what our protocol should be, which has been revised numerous times with their guidance since inception. Their focus is very current, and they bring the latest in research coming out of Hopkins, the oldest epidemiology program in the world.
To what extent was Artis hit with positive coronavirus cases, and how has the initiative with Johns Hopkins helped in that regard?
Some of the communities got hit worse than others, but it tended to be a limited duration. What we’re seeing at the present time is we’re down to about one-tenth of 1% of infections among our residents, and less than 1% among our associates.
One of the things that physicians helped us focus on is when there’s a resurgence in a [market], when it crosses a certain threshold, we should start testing our associates on a seven-day rotating basis, until such time as the there is either a positive case or there is a drop of the prevalence in the greater area below that [threshold].
From the very beginning, we tried to make sure we had enough PPE; we’re now at a point where we have a substantial supply. We also have gone to not only masks, but face fields, as well for our staff. That suggestion came out of Hopkins. We think that diligence is important, with the projections that this virus isn’t going away for quite some time.
I would say also, Artis has three sources of test kits, and a majority of our tests now could be turned around and we could have the results in 24 to 48 hours. That is helpful, to have made progress in that regard. Ongoing, one of the biggest challenges we have is to make sure that our associates are adhering to best practices. And it’s kind of interesting that the physicians from Hopkins are focused on the simple things. We are making changes in future construction of buildings that will include significantly better filtering of air, while their primary focus is washing hands frequently. Making sure you’re wearing a mask and face shield. Those are the most important things that they look at to prevent the spread. Which is pretty basic, pretty simple. But if everybody did it, we could end this life cycle a lot sooner than what we’re seeing out there with a lot of people who are not being careful.
What other design changes is coronavirus dictating in Artis’ communities that are under construction?
Our communities are designed from the inside out. They tend to have four residential neighborhoods, which is helpful if you need to quarantine or isolate. It gets a little easier if you have a fairly new building, or you may have a neighborhood that’s empty. Three-fourths of our buildings tend to be fenced on the outside, which allows us to have secured freedom.
Throughout the [pandemic], we’ve never closed our outdoor areas to our residents. They’ve had the ability on a nice day to go out, enjoy the sunshine, the flowers, the birds. We’re also fortunate and thankful that a number of states now have opened up to allow for outdoor visitation with family members. We’re tightly controlled in regards to the protocol. It’s a great thing because we can bring family members through the gate on the front of the building, without coming through the building, and have our residents escorted out. It’s been heartwarming, some of the stories that have occurred from that.
Most of our buildings have private rooms and private showers. We have some small cases where there may be a shared shower. If so, that area is disinfected after one person uses it, and prepared for the next person.
One of things we are encouraged by our Hopkins physicians is to increase the frequency of [cleaning] high touch areas. We’ve done that; we use eco lab products. The air filtering [changes] that we’re doing can help in flu season, as well. Once Covid-19 is over, it’s probably not the last virus we’ll see. And we have a flu season every year.
We have a standing committee that is looking at our building designs, as we go forward, and this is an element that is a part of their focus. When you’re dealing with dementia care residents, it’s difficult for them to avoid touching things and that’s why good old-fashioned [disinfection] is one of the best ways to deal with it. There is some technology that we’ve charged our folks to look at, with our design and construction team in particular.
Your relationship with the Bainum family spans close to 40 years. How have they responded to the outbreak?
They’ve put in a sizable infusion of equity in response to rising operating costs — I can’t disclose a dollar amount, per se, but it is sizable. The Bainums tend to be long-term investors. They measure more in generations in years, in terms of their vision and focus. They, as well as our senior team, are looking ahead for the future. Our most senior executive team on average has over 25 years experience dealing with seniors. So we’re fortunate to have a seasoned team with a lot of experience across the [care] spectrum.
We’re also fortunate that we’ve been able to line up financing with lenders who are taking a longer term view, while we’re minding the store and our people. We have quite a few lenders, as well as a credit line with Wells Fargo, which is helpful. Part of our focus as a company is there could be a vaccine by the end of the calendar year, but [more realistically] sometime mid to late spring which may be widely dispersed and utilized. There’s a lot of uncertainty, but we’re also looking well beyond that.
How has occupancy held up?
I’d say it’s been a mixed result, and it varies by community. We essentially shut off all new admissions for quite some time. And we have quite a few active deposits. And so part of it is, when are they going to move in? We have some communities where it’s flat or it’s a down census. One of our newer communities, they’ve got six planned move ins this month. So, it varies completely by the location.
How is Artis reviewing new development opportunities, as this looks to be a protracted outbreak?
We have two communities that are waiting for state inspection for licensure, which would put us at 22. We have another five under construction that we anticipate by the end of next year will be open and operational. And we control a number of very select sites beyond that, some of which are in the process of obtaining entitlement approval.
On the acquisition front, our doors have always been open to consider them, as with every company I’ve been involved with, with the Bainums. In the past, we’ve done some acquisitions. As of the moment, we just have not seen anything that makes economic sense, or the physical plant or location doesn’t meet our criteria. That’s something we’re also open to, as we go forward.
Is there a possibility that the coronavirus will open opportunities for a more affordable model of assisted living?
Private pay assisted living was born out of the fact that private pay nursing homes had certain elements of fixed costs. They were required by law to have minimum staffing patterns, which drove up the costs, which created an opportunity for lower care individuals to have a more hospitable model, that being assisted living.
As assisted living gets more expensive, then you look at other options for a more modest-priced product. And there are a lot of models out there — Holiday tried a model, and it worked for quite a while. At the end of the day, if it’s a model that allows people to age in place and their care levels go up, that’s going to cost more.
I think you have to look at the various cost elements, and there have to be incentives such as tax breaks and bond issues for developing land. Interest rates are now very low, so that’s attractive. And I think that they’re going to remain low for quite a while.
My primary focus is what we’re dealing with right now. But in my heart of hearts, [middle market] is something I’ve always had a passion for because Middle America is huge. If you can put the puzzle together to help solve that equation, the opportunity is huge.
How has assisted living and memory care changed over the decades?
The acuity [level] has increased, as has the overall staffing and the model itself. One of the things that we have found over the years is that there are some people who are very good at operating memory care, and they have a passion like we do. But there are others that are not successful and it may be because of the design, staffing or [quality of] care.
One of the things our team did a few years ago was create a new position: Director of Artis Experience. Each one of our communities has this position. The position is to support each department at each of our residences to ensure that the Artis Way is being lived. This person also assures that positive partnerships with our families, our resonance, and our residences are in place and are occurring.