Lynne Katzmann
Analyst · Capital One. Please go ahead
Okay. Thank you, Wendy, and thank you, Clint and Pam, I apologize. Today I’m going to be talking about COVID-19, the impact of COVID-19 from an operator’s perspective. And as Wendy said, Juniper’s property span the continuum, however, today I’m going to be focusing primarily on the AL and memory care experience during COVID. To summarize my comments briefly, I want to let you know that I want to share with you an understanding of COVID-19 and its impact on senior housing through a chronology of events. I want to talk with you about Juniper’s COVID-19 journey, our strategy, as well as a three phase approach to the pandemic. And lastly, I’d like to share with you some of the lessons I believe we’ve learned. First, I want to talk about the COVID-19 reality. The CDC issued its first public alert to the U.S. on January 8 of this year. The first death in the U.S. occurred at Evergreen Health Care Center in Kirkland, Washington, on February 29. On March 11, there were 1,100 confirmed cases in the U.S. and it was on that day that the WHO declared COVID-19 to be a global pandemic. On the next day, on March 12, the helping human services group placed their first order for N95 masks. At that time they expected delivery around the end of April. By the end of March, there were 164,000 confirmed cases with over 3,100 deaths. Four months later, as you all know, we stand at 150,000 Americans dead with just 1,200, with an additional 1,200 being added yesterday. So the extent of this pandemic is huge, and the timeframe in which this has happened is incredibly short, which has made it that much more difficult for all of us, but especially operators who care for chronically ill older adults to take action. Juniper’s COVID-19 journey, as I said, has three phases. One, we called the crisis phase, which started in March, late-March and went through May; phase two is what we are calling our path forward or the beginning of recovery; and phase three, which we are, have not yet experienced is what we’re doubling the new normal. I want to now tell you a little bit about our 30,000 foot view of our strategy. Our goal has been to keep our residents and our associates healthy and safe. And our approach has been one which we considered to be proactive and has involved primarily at testing and infection control policy. Part of our strategy has evolved because of our understanding of what successful countries have done; other successful countries have done in combating COVID. And looking at the infection prevention strategies, which have led them more success; among those are Germany and South Korea. Our crisis management strategy included four key points. The first was testing contact tracing and isolation, where we define the problem, identified our risk, and implemented protective actions that related to what we had identified. Our second piece of our crisis management process related to stepped up infection control practices, which included everything from hand washing and social distancing, to cleaning and disinfecting, and most importantly, the proper use and availability of Personal Protective Equipment or PPE. The third part of our strategy involved associate training and support, particularly to assure widespread adoption of appropriate practices. And last, but certainly not least was a new system to ensure enhanced accountability and to document results. As I said before, our testing strategy was patterned after South Korea, which used a test early and universal strategy, regardless of someone’s symptoms. We use – we initiated testing in late-March. We used a private lab and our decision was to test all residents and associates, not just those with significant symptoms, substantially different than what was happening at the time. We started by testing in hotspots in two communities, both of which were LTC Properties, one in Colorado and one in New Jersey. Roughly 50% of the people tested were positive. But most notably, of these, 70% to 94% were asymptomatic, 72% of residents to be specific and 94% of our associates. This is hugely important because it told us that this disease was transmitted without someone having symptoms, and that, despite what we were being told by the CDC, we needed to do more. Juniper used that information to put together what we considered our battle plan, which we believe has been fairly successful. I want to also note that the majority of our communities tested 100% negative. And in those communities what we did is essentially sheltered everyone, including our staff in place. A fun example of this was something we call camp wellspring, which took place in memory care. And as many of you may know, memory care residents are harder to isolate. They naturally like to come out of their rooms and oftentimes wander. And so isolating them individually in their suites is often more difficult. By creating a safe environment, by sheltering in place, by creating small cohorts, we were able to keep people safe and healthy. More importantly, or equally importantly, I should say is that we created a fun environment, one which had tremendous positive impact on our residents and our team members, as well as their families. We created an RV camp in our parking lot and each of the cohorts, cohorts are like neighborhoods, and so we assigned staff to each of those neighborhoods. They were not allowed to go to other parts of the building. So similarly they had to shelter outside of the building in their time off in a distinct location and we created those. At the end of the day, many of our residents felt that they were on vacation. They thought it was great fun. And we’ve now dubbed at camp wellspring. So that’s a fun story about that. I will also just note, as I’m telling stories that in the communities that sheltered in place, we now have three new babies of women who sheltered in place gave birth shortly thereafter. I want to let you know that in terms of testing right now, we are doing viral testing weekly, but the key to the strategy working is rapid accurate, affordable, and regular testing. Testing affords us the data to keep people who are likely – who are likely communicable and who can transmit the disease out of the community. That enables us to create a safer environment, which keeps everybody healthy and we’ve been quite successful in doing that. As of the time we reported to LTC, we have no cases of COVID anywhere in our system, among residents and staff. Moving along, I want to talk a little bit now about some of our other infection control practices and then briefly about staff issues. Infection control practices, including stopping nonessential visitors from coming in, screening at the door, taking temperatures of old people. But some of the other things we did included stratifying our residents in terms of risk, understanding their chronic conditions and monitoring those who were more susceptible to the disease more often. As I mentioned before, we cohorted residents and staff, which was probably one of the more effective measures we took. PPE, we had an adequate supply. We spent a lot of money on it. One of the more important things we learned is that we had to train people in the use of PPE. And as we all know, wearing a mask is new to many of us, it was to our residents and to our teams, and training people in how to use them, how to put them on, how long to keep them on, how not to touch them, and then doing compliance audits are all extremely important in a proper infection prevention. In terms of disinfecting, we went green, which is something that Juniper has done repeatedly over our 30 years. We used a nontoxic disinfectant, which was EPA and FDA approved and utilized foggers to make sure that we disinfected the whole building. The other thing we did that I think was really important, which you may not consider a direct infection control practice, but we considered an infection prevention practice is communication. We communicated early often and I believe transparently. As of July 17, we had communicated 1,980 different with all of our residents’ families and their powers of attorney as appropriate. So communication for us has been critical and getting the support of our teams of our residents and our families. I want to talk briefly about staff issues. One of the things that really impacted all of us as senior living providers is staffing. If someone’s sick, obviously they need to be out of the building. If someone’s exposed to someone who’s sick, they too need to leave. And as such, it meant that in several cases, all of a sudden, within a very short period of time, the staffing you needed was or your regular staffs were no longer available in the same numbers they were before. If you add to that, senior staffing has become difficult, particularly in hotspots. The cost of that staffing has gone up as we’ve provided appreciation pay, otherwise known as hero pay, and some people call it hazard pay as well. In addition, personal protective equipment needs to be accessible, which we were able to do and used properly. Now what’s the solution to these staffing issues? Well, for us, it was to train all of our available associates to be universal workers, to extend pay when people were sick or exposed to protect them and their families to provide appreciation pay, particularly in areas where we had COVID positive residents. To provide additional incentives for people to shelter in place to essentially create a bubble around our communities. And lastly, we used our salespeople as recruiters and found this to be extremely effective in helping us fill empty positions while people were sick. I want to talk to you now about the second phase, which we call the pathway forward. For us, the goal of this phase is to restore profitability while keeping residents and associates healthy state and engaged. Our approach has been to jumpstart move-ins and implement what we call the five pillars, which in notable Juniper fashion alliterate, so they are prevention, people, program, place and packaging. Prevention has to do with our testing strategy and infection prevention, including cleaning, disinfecting, and again, cohorting. People has to do with the schedules for our associates, their assignments, again, relating to cohorting and different pay programs. Programming in the pathway forward us about reopening dining, restoring activities, and perhaps most importantly, establishing safe visitation for families. In terms of place, we were have been working on making sure there were visible signs that we are being to return to normal, while maintaining successful infection prevention and control strategies. And lastly, under packaging, which you might consider marketing and sales, we focused on message and the delivery of that message. In terms of driving sales moving forward, I want to tell you a little bit about what we’ve done in the results to date. In terms of our efforts, we utilize a golden triangle approach, which includes the Executive Director, the Director of Wellness and the Director of Sales and Marketing. Those three people come together to focus their effort on outreach and in working together to close sales. We’ve resituated our sales office. We’ve changed our tour protocols and moved our model suite to areas which they can be easily accessed without going through other parts of the building. We’ve created new messaging. We’ve trained for that. And then we’ve also demonstrated competency among the appropriate people. We’ve added additional sales support for target communities who had significant reductions in census over the past period, we put together tool kits for rapid movements and we’ve instituted new rewards. What have we achieved? Well, in terms of digital leads, which has major source of leads at this point in time, our July 2020 digits leads are up 33% over April of 2020, and our July 2020 digital leads are up 48% over July 2019. So we are seeing substantial growth in leads. We have put in place some special campaigns and they are working. We’ve started doing virtual tours. They’re catching on. Our communities are now able to do backstage tours as well as virtual tours. And I’m proud to say that our July 2020 results will not – where are they were pre-COVID, we are seeing net census gains and we’re very happy about that. Some of our operator pandemic imperatives that I think you need to know about is that we continue to screen for social isolation issues among our residents. We have expanded telehealth for mental health care as well, and we’ve continued to increase access to the internet and smart devices. And just so you know, we have done over 12,000 virtual visits with families since the start of the pandemic. We’ve added a variety of different ways for people to meet with their healthcare providers online and have done over 1,400 window visits. What are the lessons learned? Well, in terms of leadership vision and the ability to use data to set a proactive course has been extremely important. I think a second lesson learned is that technology is extremely useful and really critical in generating the data and communicating appropriately in times of crisis. Some of the technology that has been increased in its use is of course telehealth. We’ve used a variety of ways to communicate with residents and families, and we’ve used technology to support activities both social and fitness related. Some of you have, may have seen the joint effort between LTC and Juniper to develop an industry accessible virtual connections program, which is – provides a whole host of opportunities for people in our communities at varying levels of care and service need, as well as in the community, that’s accessible via slvirtual.com. And I think LTC for that. I will say that in my mind be a new one model of senior living as we move forward, it may not involve massive restructuring of what exists, but it does involve an emphasis on safety, on dedicated staff, on looking at buildings in terms of small neighborhoods and increasing social engagement through a variety of ways of integrating what we do with the community at large. In terms of phase three, our new normal, it’s a work in progress. We’re not there yet. It will involve a variety of different things, including continued use of data of technology that is for data communication, provider access, digital marketing, and resident’s engagement. We will continue to integrate health services with other providers outside of our communities. Our neighborhood designs are very important, particularly for cohorting and keeping people safe and giving families and prospective residents an understanding – a visible understanding of how we manage during this type of pandemic. That will be gated entry, where we take temperatures and we screen very tightly over who enters the building, and of course, cleaning and disinfecting has changed and needs to be visible. So, all of those things will be part of our new normal. And I think that concludes my comments. And I want to turn it back over to Wendy. Thank you.