Reintegrating – in cautious phases

We are anxious to return to business as normal as soon as we can! However, we must remain mindful of the continued risk COVID-19 poses, especially with the increased risk COVID-19 presents to seniors.

Through the remainder of 2020 we will be following the guidelines of our Phased Reintegration Plan that was recently sent to all residents and families. The plan is a top-level overview of policies, services, and practices that will expand into increasingly fewer restrictions until all communities return to our new normal.

Sharing The Data

We want to be forthcoming and transparent with the data we are gathering to understand how to come out of COVID-19. Below, you will see a chart of that data that describes several metrics we are following. Before heading there, however, it is important to understand a few key points about what you are reading. Click on the summary on any of the tiles below for additional information.

Senior communities are regulated by various agencies at every level of government and each of those levels has rules and regulations controlling how communities are able to open. The phased integration plan reflects the broad categories of services that are being re-introduced into the residents’ daily lives. Many of those services, such as salon services, have additional regulations beyond senior living that communities must follow.

The pivot point for communities opening is 1 case per 1,000,000 residents of the state. This number is generated by taking the reported data from the state, analyzing the trend of infection, and then generating the total cases per 1,000,000 residents of that state.

This number can, has, and will change day-by-day and is really the heart of the path forward.

In phase 2 of the chart, you will see three columns that represent how and when properties are projected to open. The state threshold is the daily new cases the state needs to be averaging case 1 per 1,000,000 residents statewide. The state current is the recent average daily new cases for the state. Once the state current is below the state threshold we will begin Phase 2 for that state. We are tracking the trending average new cases for each state and based on those trends estimating a date range for states will meet the Phase 2 criteria. These estimates are located in the trending column.

If a state is increasing the number of new cases on average we are unable to estimate a date. We are monitoring the averages and will add projections once a state is averaging down in new cases.

Unfortunately, there is no way to really predict what will change day-by-day as communities implement the phased reintegration plan. That really means that we are being cautiously optimistic about the dates in the chart and could see wild swings one way or the other. In practical terms, it’s fair to say that a projected opening date could be stable or it may suddenly move to a sooner or later date very quickly. We are doing our best to monitor the trends over a longer period of time to increase the stability of the plans to reintegrate the communities, but dates are subject to change without notice and may change very rapidly.

One of the single greatest challenges we are facing as we move through the phased reintegration of communities is a dramatic increase in the number of cases in any state. We may be well into a phase and then suddenly move right back into a fully restricted period should the number of cases rise. There is no way to predict whether or when something like this could happen, and if it does the phased integration plan would begin over again. We understand how frustrating and disappointing this would be to residents, families, and staff, and we share those feelings.

For those who are looking for more information on how and why these decisions are being made

Where is the data from?

Our primary source is USAFacts.org. They aggregate data from the CDC and local health departments and make it available for download daily.

Why use 1 per 1,000,000 as the threshold for Phase 2?

This is a common threshold in many proposed plans and models, including the Institute for Health Metrics and Evaluation model from the University of Washington. This is a level at which many experts believe local health departments can effectively use testing and contact tracing to contain any outbreaks. While many different thresholds have been presented in many different plans all agree that vulnerable people, which includes many people we serve, should exercise extra caution through the reopening process.

How is the state threshold calculated?

2019 Census State Population Estimates divided by 1,000,000.

How is the state current calculated?

All COVID data is reported as cumulative totals. We calculate the daily new cases as the current day cumulative total minus the previous day total. Daily cases per 1,000,000 residents is calculated as the daily cases divided by state population and then multiplied by 1,000,000. We track and report a 7 day rolling average to better monitor trends.

How are Phase 2 dates projected?

We use a simple trendline projection that identifies the average change over the previous 14 days. That trendline is then projected forward as a daily straight line increase or decrease from the current actual state new cases. The date at which that projection first falls below the state threshold becomes our trending date for Phase 2. This is a very simple projection that only considers historical trend. Many different models exist that try to account for all the variables of this disease and changes in social distancing. We have chosen to use historical trend due to wide model variability, consistently evolving understanding of the disease, and a limitation in that models generally project outcomes instead of cases.

What is the Phase 3 criteria?

Once a state reaches phase 2 by having current new cases below the state threshold, phase 3 requires a state to maintain that level of cases for 14 days. This means 14 days of the state 7 day rolling average new cases not exceeding 1 per 1,000,000. Because we use a rolling average the impact of single day spikes is lessened as long as the general trend is low enough. 14 days was selected because this is two incubation periods for COVID-19. This stepped approach is common to many plans for reopening including the White House’s guidelines for Opening Up America Again.

Estimated phase start dates

PHASE 1

PHASE 2

PHASE 3

STATE

STATE AND LOCAL GUIDANCE ALLOWS

AVERAGE NEW CASES BELOW STATE 1 PER 1,000,000 THRESHOLD

14 DAYS AFTER PHASE 2 WITH SUSTAINED LEVEL OF CASES

State Threshold

State Current

Trending

Florida

5/4/2020

21.5

34.4

not projecting down

Iowa

5/15/2020

3.2

107.5

early July

late July

Illinois

5/30/2020

12.7

170.6

mid September

late September

Indiana

5/1/2020

6.7

73.8

late July

mid August

Missouri

5/4/2020

6.1

23.5

late June

early July

Ohio

5/12/2020

11.7

47.4

late September

early October

Updated 5/28/2020