By Alec Pruchnicki, MD
The deadly effect of COVID on the elderly, especially those in hospitals and nursing homes, has been in the news since the start of the pandemic. But there are other institutions that care for older adults which have not gotten much publicity; assisted living facilities (ALFs). There is very little in the mass media, medical journals and even the ALF grapevine to tell us what is happening there. This article is to fill that information gap.
The ALF where I have had my primary care medical practice for the last 18 years is the Vista on 5th ALF (previously the Robert Lott ALF). It is a community run, non-profit, Medicaid support program on Fifth Avenue and 108th Street overlooking Central Park. It contains about 127 studio apartments which allow each resident to have their own place without any shared rooms. The Medicaid support allows us to take in people who could not afford the expensive private profit-making facilities, and so has a population that is economically and racially diverse. Its mission is to provide services to people who need a little help to stay in the community, but aren’t sick or debilitated enough to require a nursing home.
Before COVID, the facility was completely filled with a several month-long waiting list. Starting in early 2020, when COVID first appeared, regulations were quickly imposed for NPI (non-pharmacological interventions) precautions like mask and glove wearing, quarantine in their own rooms, extensive hand sanitizing, elimination of all group activities, and the banning of visitors usually including family members. Eventually, testing of staff and residents became available. In spite of these precautions, two residents who were transferred to a hospital for other medical problems died there. It was not completely clear if the other medical problems caused the deaths, or COVID did, or some combination. But in the following year about a dozen other residents became infected and were hospitalized. All survived and most returned to Vista after the hospital or rehabilitation facility, although a few had to stay in the nursing homes permanently, which is what usually happens.
What was different was that people stopped moving in. It’s not clear why this happened, although at the time it seemed that some new residents or their families were worried that any facility, including an ALF, might be having horrible mortality rates like the nursing homes. The facility started to get empty.
When vaccines became available in early 2021 almost 90% of residents received them. Initially, only about 60% of staff agreed to vaccinate, but this slowly increased over the year to about 90% until the state required vaccinations for all health care staff. The number is now 100% with no resignations of staff due to vaccination refusal. Although some residents who were hospitalized for various medical reasons caught COVID there, and some died, the cases in Vista dropped significantly. The combination of vaccines, boosters, and some remaining NPI precautions resulted in no new COVID cases in Vista since June 2021, although asymptomatic cases are possible.
But, the facility itself has not recovered. What was 100% occupancy has dropped to 85% with a massive budget deficit that Federal and State funds have only partially covered. Applicants might still be worried about institutional care being dangerous. Another possibility is that with so many people working from home, there are now family members available who can care for older relatives in their own homes, making ALF placement unnecessary. There are many other facilities that are facing the same situation.
So, for those whose loved ones might need an ALF soon, this is a buyer’s market. Although I think Vista would be excellent due to the high level of services, ability to admit people regardless of their income, and excellent Manhattan location, there are probably many facilities to pick from. Although living at home in the community is usually preferable, there will still be people who need additional services and this is the time to access them. Availability won’t last forever.
TO CONTACT Vista on 5th • Phone: 212-534-6464, prompt 5 then ext. 5153 for applications, or vistaon5th.org
