Covenant Living Communities and Services has taken a full-scale approach to infection control and prevention. With 16 communities in nine states, it is one of the largest not-for-profit retirement living organizations in the nation. Its continuing care retirement communities offer independent living plus many more levels of care, including assisted living, skilled nursing, and, often, memory care and rehabilitation.

Bill RabeCleaning and disinfection of all skilled nursing rooms happens at least twice a day as a practice the company implemented at the beginning of the COVID pandemic and continues to employ amid different COVID-19 variants. Leadership took the step of reviewing all of Covenant’s housekeeping policies in each level of care and released an organization-wide safety program known as Our Safer Home Commitment. 

“This program focuses specifically on examining cleaning frequencies and practices and retraining our staff on how to properly clean and disinfect rooms and spaces that our residents visit frequently,” says Bill Rabe, senior vice president of enterprise operations at Covenant. “It also allowed us to make a fresh, new commitment to our residents and their families that their safety is our No. 1 priority.”​

How Disinf​​ection Measures Up

With Covenant’s new commitment, leadership wanted to take the next step of ensuring the new practices really measured up. “We quickly realized we wanted feedback and a quantifiable way to assess our cleaning practices,” says Rabe. “To do that we made an investment in ATP luminometer testing, which is a way to test the cleanliness of hard surfaces by scrubbing for a molecule.” 

Adenosine triphosphate (ATP) is a molecule found in all living cells that is responsible for transferring and storing energy. The effectiveness of a cleaning process can be checked by testing surfaces for ATP levels, which act as an indicator of whether an environment has been properly cleaned.

“This is a practice used in the food service industry and acute-care setting, but we find it extraordinarily valuable given the higher risk that COVID-19 puts our residents in,” says Rabe. “It helps us understand, first, how clean our facilities are overall and, second, how effective our cleaning is.”

How It’s Going​​

Staff have appreciated the clarity that Our Safer Home Commitment procedures provided, says Rabe. They also appreciate the tangible, quantifiable feedback that the ATP testing provides. 

“The feedback on the results of the cleaning process is captured and tracked for accountability,” says Rabe. “This helps us identify opportunity for improvement in our cleaning and disinfecting process.”

As part of the program, Covenant also rolled out survey cards with access to an online survey tool to capture feedback on the program from guests staying in guest or resident rooms after cleaning and common areas such as dining. “So far, the feedback has been overwhelmingly positive,” says Rabe.​

Other S​teps

In addition to the statewide cleaning program, Covenant has taken other steps to control for infection, including updating its Minimum Efficiency Reporting Values (MERV)-rated filters in its HVAC systems to the highest filter that the system would allow.

Covenant has also started to roll out a new telemedicine program and equip all facilities with communication technology where physician visits and visitation can be done virtually and on demand as needed. “This includes utilization of iPads for FaceTime visits with family members or utilizing Microsoft Teams,” says Rabe. “In addition, we’re using the iPads for virtual telehealth consults with resident physicians.”

In addition, a new guest registration screening process with automated technology now allows Covenant to screen visitors with or without assistance from staff. “We use a product called VT Shield from Toshiba,” says Rabe. “This product allows us to ask questions that are in line with CDC [Centers for Disease Control and Prevention] requirements and take the temperature of our guests prior to entering the building.” Once passed, the system will provide a visitor pass. The data are saved within the system for auditing purposes.

​​Communication at the Heart

At the heart of all Covenant’s modifications is communication. “We have started to roll out a resident and family communication app to improve communication with our residents and their family members,” says Rabe. 

The app is called myCovLife. In addition to keeping residents and families up to date on the latest company-wide infection control and prevention tactics, Covenant staff use the app’s basic features to send communication to the residents for a number of purposes. 

“We can provide them access to key contacts in the community, a resident directory, information about the community, what’s on the menu for dining, transportation requests, and the ability to sign up for activities,” says Rabe. The app is being rolled out over a period of several months, and so far the residents have been enjoying becoming familiar with it and using it, he says. 

​Looking Ahead 

Thinking about the future conjures up images of fine-tuning modifications for continued infection control. “This would include smaller, but more dining space options in our communities to reduce capacity, longer dining hours to reduce capacity based on the needs of individual communities, and extension of outside space area,” says Rabe. Enhancements in building air circulation are still in use, which are different based on each community.

Rabe says that the pandemic has reinforced the need for repetition in education and protocols. With that comes a heightened focus on training and education and more audits to ensure compliance. 

Rabe’s advice: “Develop a process to follow and implement state and local regulations,” he says. This is even more difficult with national providers serving residents in multiple states. Requirements are different between states and local counties, and they can become very confusing.

Regular communication can help reduce that confusion, Rabe says. “Develop a robust communication plan,” and along with it, identify tools to deliver consistent messaging. 

“During COVID we utilized several forms of communication to ensure we were able to keep residents and families up to date,” he says. “This communication came in the form of virtual town hall meetings delivered to our residents’ rooms, use of kiosks and information slides through our resident channel, push notifications and content delivered via our engagement application, along with updates on our website and family letters.”