Chapter Contents

Lessons Learned: Reopen and Recover

In the event of a pandemic that involves a highly contagious infectious disease, resuming “normal” operations for an aging services provider will greatly depend on reliable testing, contact tracing, workforce availability, and vaccination availability/acceptance.

The COVID-19 pandemic, in particular, drew significant focus on the aging services sector for an extended period of time. This much-neglected and underfunded sector faced unimaginable challenges with commitment to those served and with sustained resilience.

LeadingAge is seizing this moment to launch “Opening Doors to Aging Services,” a multi-year initiative to expand consumer awareness, understanding, and support for providers of older adult care and services as well as the millions of Americans they serve every day with dignity and compassion.


We have learned that reopening is not a moment, but an extended period in which we adapt and modify to keep residents, visitors, and staff as safe as possible.

Scientific study, research, and evidence of transmission mitigation will drive management decisions regarding the timing and parameters around “safe” reopening. Executive decisions will require a well-informed and thoughtful process, including a comprehensive understanding about the disease itself, and how it can be transmitted, detected, and contained.

Organizations will need to identify reliable sources of infectious disease information/data and will need to collaborate closely with state and local health agencies to ascertain the appropriate methods for testing/contact tracing and vaccine administration.

Testing and Contact Tracing

Many aspects of testing must be considered and provided: testing methodology, testing supplies, labs for test processing, reliability, speed and accuracy of testing results, frequency of testing, stakeholder groups that will be required or requested to participate in testing, and reporting of test results, to mention a few. The question of what entities will bear the burden of immediate and ongoing testing costs must be negotiated. Organizations should expect to work closely with their trade associations and advocacy groups to ensure that their needs and expenses are well represented to regulatory and legislative bodies with decision-making authority.

Contact tracing will also be of key concern to individuals, organizations, and state and local agencies. Aging services providers will need to be prepared to participate in and report on individuals’ contacts with others, should an exposure to a highly contagious, infectious disease occur within their stakeholder groups. State and local health departments will likely request this information, and providers of care and services will need to be prepared to monitor and protect such information accordingly.


Alignment of Federal and State Guidelines

Organizations may find that guidelines for resuming their operations will differ between federal and state agencies; multi-state organizations may discover that guidelines are marginally or markedly different between states. Navigating these differences may present a considerable challenge, and organizations should be prepared to allot significant time and resources to distilling these guidelines down to the essential requirements that must be met to ensure compliance with regulatory bodies such as CMS, OSHA, Life Safety codes, and others. Beyond those compliance-driven requirements, organizations will need to navigate guidelines that leave their implementation to the discretion of organizations themselves.

End-of-Life Issues

As organizations plan to resume operations, they may find it necessary to help residents, persons served, staff, and other stakeholders grieve the loss of life precipitated by the pandemic. Funerals, celebrations of life, and other customary memorial events that may be initially postponed due to the pandemic may now be possible as services and supports return to normal.

Organizations will need to be aware and considerate of these changes, and ensure they are prepared to implement whatever transitional supports or requirements are necessary in End-of-Life situations.

Organizations may find that guidelines for resuming their operations will differ between federal and state agencies; multi-state organizations may discover that guidelines are marginally or markedly different between states.



If a pandemic involves a highly contagious, infectious disease, admission of visitors and the general public to aging services providers may be completely restricted or permitted only in end-of-life or compassionate care circumstances. When the time comes to resume visitation, organizations should plan to do so in phases that ensure the safety of all involved, and minimize the risk of disease transmission. Policies and protocols must be developed that thoroughly prepare staff, persons served and family members for the visitation experience. Organizations should refer to their state and local health agencies and governing bodies for guidelines on how to permit safe visitation.

Congregate Dining Programs

To reduce the risk of disease transmission, aging services organizations may elect to pause, alter or reconfigure dining services programs in the event of a pandemic. Congregate meal programs may change significantly or be temporarily halted.

Undertaking the resumption of dining services and/or a congregate meal program will require careful planning and coordination. Organizations that plan to do so should seek guidance from state or local health departments, governing bodies, the Food and Drug Administration, the Centers for Disease Control and Prevention, and other agencies as appropriate.


Recovery from a pandemic can create a perfect storm of low occupancy, high/unbudgeted expenses, and staffing challenges—all of which may seem insurmountable. For some providers of long-term services and supports, their operations will ultimately be unsustainable. For others, there may be a period of widespread expense reduction, use of staffing agencies to supplement employees and repurposing of resident rooms. Above all, a post-COVID environment prioritizes protecting assets, implementing operational efficiencies, and supporting staff.

The intense financial pressure, uptick in merger/acquisition activity, and marketplace volatility has placed long-term services and support providers in one of the most challenging periods of our time—even worse than the 2008 market collapse. For the majority, who have begun to rebound from a stretch of unforeseen and unimaginable financial stress, a return to stability will be slow, yet steady.

Long-Term Services and Supports

  • Opening Doors to Aging Services is a multi-year LeadingAge initiative to introduce the wide range of aging services and care available to older adults and their families. Data from the initiative is part of the care economy debate that includes significant and much-needed federal investment in care and services for older adults. The foundational research (completed in summer 2021) is available now, and strategies and tools for members will be available in the fall.
  • Long-Term Care Policy after Covid-19—Solving the Nursing Home Crisis (New England Journal of Medicine): Nursing homes have been caught in the crosshairs of the coronavirus pandemic.
  • Post-vaccine: The future of senior living (McKnight’s Senior Living): Even though millions of Americans are now vaccinated, however, particularly for those of us who serve elders in communal living, we will not be automatically reverting to how things were before the pandemic.
  • Preparing to thrive after the COVID-19 storm (PDF, from McKnight’s Executive Power Panel): Industry leaders home in on specific ways long-term care providers can succeed, despite the ongoing pressures of the pandemic. They offered strategies and opinions on where operators should be concentrating. Topics included improving staffing levels and retention, digital workflow, infection control practices, rehab processes and more.
  • Long-Term Care and Care Facilities Post-COVID-19 Pandemic (Health Management Associates): A team of experts with expertise across the continuum of long-term care reflect on the initial pandemic response and share insights about the crisis, the response, and how to move forward.
  • Social Care COVID Recovery & Resilience (International Long-term Care Policy Network): Learning lessons from international responses to the COVID-19 pandemic in long-term care systems.

Psychological Effects


There’s a recurrent question of whether a pandemic can have a silver lining, and the response can be positive. Though a devastating disruptor in many ways, it’s been said that the COVID-19 pandemic pushed innovation forward 10-15 years out of sheer necessity. From virtual medical examinations to international, epidemiological think-tanks conferring over Zoom, to robots serving dinners to long-term care residents to limit human contact—it all happened at warp speed.

The following revelations, learnings, and processes have already emerged following the COVID-19 experience:

  • The pandemic cast an unfavorable light on the health care disparities long endured by minority populations in America.
  • The impact of a pandemic on the physical and mental health of residents and staff cannot be underestimated—despite outward resilience, pandemic impact deserves focused attention and a coordinated response.
  • We witnessed a willingness among international scientists to share new ideas and data—both immediately and transparently.
  • Daily news reports of untimely and voluminous deaths and emotional interviews of grieving families have inspired genuine human empathy.
  • Vigilant use and appropriately placed masks provide protection from pre-symptomatic and asymptomatic COVID-19 transmission, while also reducing the annual flu season impact.
  • Technology will have an ongoing role in the future of infection control, compliance, preparedness, telemedicine, and virtual visitation among residents and family members.

As we process these takeaways, it’s an advantageous time to reflect upon how to reimagine the delivery of care and services to older Americans. For example: 

  • The Mayer-Rothschild Foundation Designation of Excellence in Person-Centered Long-Term Care Project is developing a first-of-its-kind national standard of excellence for person-centered care in long-term care and assisted living settings.
  • According to the LTSS Center at UMASS Boston, a number of initiatives have been introduced to elevate the standing of CNAs within the care team, such as including CNAs in care plan meetings, teaching CNAs to identify early signs of illness onset, and offering CNAs instruction in methods that help to prevent resident decline. 
  • Expanding the development and influence of technology-based learning collaboratives will  positively impact long-term services and supports.

Reimagining Long-Term Services and Supports

Reimagining Workforce Management

  • Feeling Valued Because They Are Valued: A Vision for Professionalizing the Caregiving Workforce in the Field of Long-Term Services and Supports (LeadingAge LTSS Center@UMass Boston): “Despite the valuable work they do, direct care professionals are not valued by our society or its health care system. Too many of these caregivers earn low wages, receive inadequate benefits, and endure poor working conditions while carrying out an extremely labor-intensive job. Inevitable staffing shortages and workforce instability will lead to lower-quality care, lower-quality of life for consumers and their families, and unmet needs among care recipients.” This LeadingAge report also considers what a reimagined, professionalized direct care workforce would look like.
  • How to Do Hybrid Right (Harvard Business Review): When designing flexible work arrangements, focus on individual human concerns, not just institutional ones.

Reimagining Health Care

Lessons Learned: Reopen and Recover

In the midst of an emergency as impactful as a pandemic, we must often act first and reflect later. It’s common for leaders to ask themselves retrospective questions, such as:

  • Did I act too quickly or too slowly?
  • What could I have done differently?
  • Did my approach of choice work as well as I anticipated it would?
  • How can I improve my responses if a pandemic recurs?

And then, of course, there is a lengthy series of “What ifs?” that we ponder.

LeadingAge has received numerous Lessons Learned tips from members during the COVID-19 pandemic, which we are sharing at the conclusion of each related Playbook Section. In addition, a compilation of shared Lessons Learned may be referenced in the Playbook Appendix.

When the time comes to resume visitation, organizations should plan to do so in phases that ensure the safety of all involved, and minimize the risk of disease transmission.

LeadingAge Member Ideas and Inspiration stories:

Audio interviews from LeadingAge Daily Calls:

Other resources:

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