April 20, 2020
People have compared retirement villages to cruise ships for years. The common reference is that cruise ships are retirement villages-on-sea. Recently this comparison has been reversed with more than one commentator suggesting that retirement villages are cruise ships-on-land.
This cruise ship comparison has taken on an altogether different meaning in the Covid-19 era, one which retirement villages would do well to avoid.
Retirement villages are different from rest homes. Rest homes are care centres that provide hospital level care for old and frail New Zealanders. Retirement villages are more like subdivisions, full of standalone houses and apartments where people live independently.
For this reason, I’ve never agreed with the cruise ship comparison. The small cabins and internally accessed lifts in cruise ships differ markedly from modern retirement villages, which often expand over 12+ hectares. The average age might be similar, but that’s where the comparison ends, or rather, where it should end.
What they do have in common, is shared communal areas where Covid-19 clusters can rapidly take hold. So far, in New Zealand we have only seen this in rest homes where three isolated cases quickly grew into clusters. Transmission between people at rest homes is very hard to eliminate despite the infectious disease protocols that all rest homes have.
We haven’t yet seen this kind of rapid contagion in retirement villages where people live independently in houses and apartments (very different from rest homes). Lockdown has been effective, but eventually people will be free to come and go from their house, leaving the village and returning as they please. They will also start receiving visitors again.
This presents a significant risk. The speed with which the virus moves and the potential for silent transmission means that we could be facing an even bigger problem in the villages once lockdown restrictions are eased.
Retirement villages typically accommodate 4-5 times the number of people as a rest home. They are full of independent and active people who regularly congregate around a central lodge which includes a restaurant, a bar, a pool, a library and many other shared facilities. Group activities and exercise classes, a mainstay of retirement villages, were suspended before we entered level 4. Operators will need to be cautious when planning post-lockdown activities, even the bowling green is a potential source of transmission.
The steps operators take to manage their villages in a post lockdown world will determine how they’re viewed. If they’re proactive and take bold measures to protect their residents and staff, they could be regarded as a safe harbour. Do nothing and they risk being seen as a cruise ship.
Most industries will need to change but few industries have a greater concentration of older people than the retirement village industry. This makes them particularly vulnerable to clusters with higher rates of fatalities. For this reason alone, operators must urgently and adequately prepare for a post lockdown world.
When (or if) the lockdown is lifted, and people can move freely, there is a possibility that hotspots could emerge in villages. Any village could be struck by an outbreak at any time and the effects of this could be devastating for residents, staff members, family members and operators.
If a cluster takes hold in a retirement village of 300 people, the local DHB could quickly become swamped and the ICU could be overwhelmed. Industry leaders and public health officials must work together to prevent this by setting new Covid-19 standards for retirement villages.
This is where healthcare technology could play a huge role. There is technology available that can help with detection, triaging, assessment and containment. It won’t ever eliminate the threat, but it can mitigate it, which operators are duty bound to do.
Installing this kind of technology is a step in the right direction and something tangible that operators can do right now to fulfil their duty of care. Having the right technology in place will also improve public perception of retirement villages. In a post-lockdown world, people might prefer villages with technology that can help with social distancing, help with avoiding high risk areas such as GP waiting rooms and help with access control to communal areas where people gather.
I’d love to hear what healthcare technology solutions are being planned by village operators and what standards are being set. As the end of lockdown approaches, we need strategies to protect our most vulnerable citizens. In the interests of national wellbeing, it would be good to share them.
This blog post originally appeared in eHealthNews.