Studies of those hospitalized in China suggest that 80% of COVID-19 cases are considered mild; however, with a mortality rate of 8-15% among older patients, the 2.2 million Americans living in long-term care settings are at significantly greater risk than the general population. Residents of elder care facilities run the risk of serious complications from the coronavirus due to the triple threat of age, underlying health conditions, and close living conditions.⁶ The emergence of the virus at a long-term nursing facility outside Seattle, Washington took the life of at least 14 residents and hospitalized over 54 others.⁹ Of the facility’s 120 residents and 180 staff members, more than 100 have demonstrated possible infection.^6,9

The senior living industry has long had infection control protocols in place to manage other serious illnesses including influenza and pneumonia. While the strength of this virus and its potential for infecting large numbers of residents and staff is raising alarm, adhering to current CDC and public health guidelines to implement effective preparedness plans and communicating proactively can help senior living facilities mitigate the risks of COVID-19.

BE PREPARED: MONITOR & FOLLOW CURRENT GUIDELINES
Being prepared means planning for the coronavirus in accordance with the Centers for Disease Control and Prevention (CDC) guidelines. It’s recommended that facilities review emergency plans and create alternate staffing arrangements as an outbreak could dramatically affect staff availability.⁵ Operators should also stay informed about the coronavirus’ spread through communication with state and local health departments. Depending on the severity, a coronavirus outbreak in a particular area could last for an extended period, and local public health officials may recommend specific actions aimed at keeping citizens healthy, reducing potential exposure, and slowing transmission of the disease.

The consequences of failing to plan could significantly impact operations if large numbers of staff fall ill or if hospitals become inundated, leaving no place for affected residents to receive treatment.² It’s not enough to simply put the plan on paper, facilities should work to educate staff about COVID-19 and actively train to enact preparedness plans. Correctly implementing aggressive infection control measures is vital to protecting staff and limiting virus spread. The CDC and Society for Post-Acute and Long-Term Care Medicine recently released guidelines calling for increased hand hygiene, isolation of infected patients, visitor screening, use of personal protective equipment, and daily temperature checks for both residents and staff.⁶ Administrators can learn more about the CDC’s current guidelines for preventing and managing the spread of COVID-19 within long-term care facilities here.⁷

COMMUNICATE PROACTIVELY & CLEARLY
Due to constant media coverage and widespread concern, it’s likely that facility residents and their families will have questions about the coronavirus. Administrators should reach out via all available channels (i.e. social media, email, website updates, etc.) to proactively communicate regarding the protective measures in place.⁵ It’s important to clearly describe the protective actions taken by the facility and explain what residents and others can do to protect themselves and those around them. Facilities should provide clear answers to frequently asked questions and supply regular updates regarding changes to admission, non-urgent care, and visitation policies. The CDC also recommends publicly posting signs at facility entrances advising visitors not to enter if they’re experiencing respiratory infection symptoms such as fever, cough, or shortness of breath.⁷ Finally, ensuring that all staff are communicating a consistent and clear message can reduce confusion, helping to prevent panic and reassure residents and families.

REVIEW INSURANCE POLICY LANGUAGE
It’s also important for facilities to understand the insurance policy provisions that may apply to a COVID-19 outbreak. In some circumstances, evacuation may be considered an appropriate response to aid in managing the spread of the virus. When evaluating the necessity for evacuation, operators must consider how moving residents could impact patients and staff at hospitals or other facilities. Communicating with those community healthcare partners will enable operators to make informed decisions that protect the most vulnerable. If a move is deemed appropriate, administrators should review their specific policy language to determine if Evacuation Expense Reimbursement coverage is included. While there are exceptions where this provision provides up to $100,000, most carriers extend a sublimit of anywhere from $25,000 - $50,000. Taking the time to review possible coverage triggers can help confirm if the decision to evacuate is at the discretion of the facility to protect residents.

Carrier responses to COVID-19 claims could also be impacted by the presence of a Communicable Disease Exclusion in the policy. This exclusion may be present in the General Liability policy, while remaining silent in the Professional Liability portion. As a result, any claim for damages alleging negligence or breach of duty of care arising from a communicable disease would need to be made under the Professional Liability provision. Looking ahead, CRC Group will continue to monitor exclusionary endorsements as it is likely that other carriers will begin introducing similar exclusion language and/or sub-limits.

BOTTOM LINE
As the situation evolves, senior living and healthcare facilities should stay vigilant, ensure they’re operating in alignment with the CDC’s most current guidelines, and review insurance policies to understand the coverage available.2 No one knows how prevalent COVID-19 will become and hazards can affect each facility differently. Productive concern at this stage looks like identifying possible hazards that would arise due to a coronavirus outbreak, planning to mitigate impacts, and creating contingencies to maintain operations during the outbreak.³
Any facility that believes it has been exposed to COVID-19 should contact their insurance carriers as soon as the situation allows. Going forward it’s expected that markets will begin requesting copies of infection management protocols for review prior to quoting. Agents should encourage administrators to start reviewing their pandemic and infection control policies and procedures to ensure they’re taking all appropriate steps to manage outbreak risks. Taking action now will strengthen underwriting submissions as renewal periods draw closer.
Agents with any questions should contact their CRC Group producer to discuss how we can help clients prepare for and protect against the effects of a serious illness outbreak.

Contributors

• Rusty Hughes is a Senior Broker with CRC’s Birmingham, AL office specializing in the healthcare and assisted/senior living industries.
• Truitt Taylor is a Senior Broker with CRC’s Birmingham, AL office specializing in the healthcare and assisted/senior living industries.

ENDNOTES

1. Coronavirus Disease 2019 (COVID-19) Frequently Asked Questions and Answers, Centers for Disease Control and Prevention, February 14, 2020. https://www.cdc.gov/coronavirus/2019-ncov/faq.html
    
2. ‘Could be Devastating’: Senior Living Industry Braces for Coronavirus, Senior Housing News, February 27, 2020. https://seniorhousingnews.com/2020/02/27/could-be-devastating-senior-living-industry-braces-for-coronavirus/
    
3. Protect Your Longterm Care Facility From Novel Coronavirus Before It’s Too Late, McKnight’s Longterm Care News, February 3, 2020. https://www.mcknights.com/blogs/guest-columns/protect-your-long-term-care-facility-from-novel-coronavirus-before-its-too-late/
    
4. First Coronavirus Death in the US May be One of a Growing Number of Cases from an Unknown Source, CNN Health, March 1, 2020. https://www.cnn.com/2020/03/01/health/us-coronavirus-sunday/index.html
    
5. Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (COVID-19), Centers for Disease Control and Prevention, February 29, 2020. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/steps-to-prepare.html
    
6. Nursing Home Outbreak Spotlights Coronavirus Risk In Elder Care Facilities, Kaiser Health News, March 1, 2020. https://khn.org/news/nursing-home-outbreak-spotlights-coronavirus-risk-in-elder-care-facilities/
    
7.  Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF), Centers for Disease Control and Prevention, March 1, 2020. https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html 
    
8. Coronavirus Covid-19 Global Cases by Johns Hopkins CSSE; March 9, 2020. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
    
9. This nursing home is at the center of Washington's coronavirus. Here's what one first responder saw there, CNN, March 8, 2020; https://www.cnn.com/2020/03/08/politics/coronavirus-washington-nursing-home-life-care-center-kirkland-cnntv/index.html