As of January 2021, the number of coronavirus cases have only continued to grow (87.6M as of date of writing) with more than 1.89 million cases worldwide resulting in death. Vaccine advisers to the U.S. Centers of Disease Control and Prevention have recommended that healthcare workers and residents of long-term care facilities be the first class of individuals to get vaccinated.

While vaccinations started back in December, nursing homes throughout the U.S. have started to receive COVID-19 vaccines, starting off the country’s mission in inoculating its most vulnerable citizens and allow patients to finally escape months of confinement due to quarantine restrictions.

At least a third of the United States’ more than 305,000 deaths have been reported among residents and employees of nursing homes, according to The New York Times. More than 787,000 staff members and residents were reportedly infected.

Unfortunately, long-term care facilities have suffered increasingly, playing host to nearly 20,000 cases and an estimated 5,000 deaths per week, according to the American Health Care Association and National Center for Assisted Living. However, some states like Florida, West Virginia, Connecticut, and Delaware have already begun administering vaccines at its facilities, as well as at Walgreens and CVS Pharmacies.

I wanted to learn more about what goes on behind the scenes at such a facility, which is what led to me reading “30 Summers More.” Its author Dwayne J. Clark is also the CEO of Aegis Living, a privately held assisted living and memory care provider that operates 32 communities in Washington, California, and Nevada. The company has 8 additional communities in development.

Thirty-five years ago, when Clark first launched his career in the senior housing industry, he never thought he would be overseeing the care of over 60,000 people in his role as Founder & CEO of Aegis Living.

With over 30 one-of-a-kind senior living facilities in the Western U.S., Clark has certainly absorbed lessons for longevity from those of all walks of life. Globally competent, the Aegis Living CEO has traveled to over 80 countries, interviewing hundreds of people between the ages of 80 to 100. His primary focus centered around better understanding longevity principles and cultural health practices. He compiled the expertise he has amassed through his firsthand experience with the science of aging, catalyzing the creation of his latest book, 30 Summers More.

Having traveled to 15 countries myself studying their legal landscape in comparison to the U.S., including, but not limited to Brazil, Ghana, South Africa, India, China, Vietnam, and Taiwan, I was hooked. 

His unique senior living communities are nationally recognized for their excellence of care to residents and employees alike, receiving a variety of awards including Glassdoor’s Best Places to Work List.

Clark shared with me his 35-year experience in the assisted living industry and how his company has continued to address the high demand of its residents in the middle of a global pandemic.

“I had a very unusual background coming out of college, thinking I wanted to be a criminal defense attorney; so I worked in the criminal justice system for awhile,” he told me. But, he also revealed that he had no idea that he would ever find his way into senior housing. Everything changed for Clark in 1985 when his sister, who was part of a government agency that supported aging services recommended he go to the library and read a study called “The Graying of America.”

“This of course was before computers, so when I went to the library, I found this to be a voluminous study. It taught me how many elderlies there were going to be in 10 to 15 years. My sister set up an interview on my behalf with a company called Leisure Care—phenomenal company, and after seven years, I was recruited away by a company called Sunrise, which eventually became the largest senior housing company in the world.”

In 1997, Clark went out to do something that most senior housing companies failed to do. “I wanted to tap into modern cultures, and not label our senior housing as ‘senior housing’ –instead, considering it to be a nice hotel.” Thus, Aegis Living was born.

“We were the first people to put spas into senior housing, and to teach activities like Healing Touch and Reiki.” And twenty-three and a half years later, they are still standing as one of the top living care facilities in the United States

Educating Today’s Youth on Assisted Living

At 31-years-old, I was curious on what lessons our millennial generation could take away from what Clark and Aegis Living have set out to do.

“I’d like the current generation to stop thinking about assisted living facilities as ‘an old folk’s home,’” Clark suggested. “Because for us older folk, we see it in a way where we get to spend the last three or four years of our life in a spectacular place. They look a lot like a Four Seasons Hotel, or other upscale hotels—they have spas, bars, stages, and theaters.”

But as for the industry’s infrastructure, COVID-19 has certainly changed things. “We created Outdoor Living Room’s to bring residents together with their loved ones, and Chat Suites to offer another way to connect virtually,” he says.

What has been exciting for Clark, is the outreach by his competitors. “I’m having these individuals calling me whom I haven’t spoken to in 10 years, asking how we’ve innovated and so on. We’re building brand new buildings, exploring ventilation systems with habit filters, and other technology.”

The Swiss Cheese Analysis

It’ll be one whole year come January 2021 that COVID-19 will have completely disrupted our way of life. But what do we have to show for it?

Medically Speaking…

Medically, the first doses of the Pfizer and BioNTech coronavirus vaccine were injected into health care workers on December 14, after it was authorized by the U.S. Food and Drug Administration for emergency use last week. The first doses have already been delivered to all 50 states, including the District of Columbia and Puerto Rico. However, it will likely be months before the vaccine is widely available to the rest of the population.

But for older folks, they are still very high-risk and must be protected. It’s an even scarier time for facilities like Clark’s.

“It’s a scary time. In our case, not knowing what was happening, we locked down ourselves, before any government intervention. We amassed a massive surplus of PP&E.

And I’m proud to report today between our staff residents and contract employees—we’re about a little over 5,000 people—we have kept cases down. Over the course of the pandemic, approximately 10 percent of all residents (or less) have tested positive for the virus, which is much lower than industry averages.

We attribute our success to enacting the relationships we have with the scientific community—the Gates Foundation and the Institute for Disease Modeling that is providing the White House data;

We have  Fred Hutch, a leading research institute, that dealt with SARS and AIDS and various cancers;

We have the University of Washington that has a very progressive infectious disease program. We reached out to our network in California and, and even the University of Minnesota and so on. So we’ve been very progressive in fighting this disease which allows us to be a source of tips and ideas to others.”

As of December 2020, soon-to-be-former U.S. President Donald Trump has not received the vaccine yet, and won’t be administered one until it is recommended by the White House medical team, a White House official told CNN. Earlier this year, Trump tested positive for the coronavirus, and is currently still receiving the benefits of the monoclonal antibody cocktail he was given. He is likely to get his vaccination once he receives a timing window to receive vaccination.

The FDA also plans to grant emergency use authorization to Moderna for their vaccine, according to FDA Commissioner Dr. Stephen Hahn and Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research. As part of the President-elect’s plan to combat the virus, Biden said his administration would aim to distribute 100 million vaccine shots, which would be sufficient to cover 50 million people—all within his first initial 100 days in office.

President-elect Joe Biden and incoming first lady Jill Biden received their first doses of the Pfizer vaccine on December 21 in Delaware.

Politically Speaking…

Politically, we are more divided than ever, with hatred and disdain for one another. That was evident on January 6, where pro-Trump mobs stormed and attacked the U.S. Capitol in the middle of Congress attempting to certify election results.

Socially, hundreds of thousands are still out of work, a dollar figure for the second round of stimulus checks still haven’t been agreed upon, and our daily lifestyle has been completely disheveled.

Legislatively Speaking…

According to Clark, Aegis has done really well, referring to The Swiss Cheese Model, first developed by James Reason to help illustrate how analysis of major accidents and catastrophes tended to reveal multiple, smaller failures that allowed a hazard to manifest as a risk.

Take a piece of swiss cheese, full of holes. Each slice of cheese represents a barrier, any one of which is sufficient to prevent a hazard turning into consequences. However, under the theory, assume that no single barrier is foolproof—they all have failings or “holes” and when the holes are allowed to align, by adding another layer of cheese to the previous piece, a risk event can manifest as negative consequences.

“I think we’ve embraced that really, really closely,” Clark says. “…that’s like you going out and washing your hands and walking around in the community without a mask on. And then according to Professor Reason, you would add another layer of cheese on top of that previous layer. Now, it’s like wearing a mask, as the holes get smaller. And then you add a mask and a visor, as the holes continue to get smaller—until you have added so many layers that there’s no place for the virus, there’s no holes for the virus to go through. I think that’s an incredibly powerful metaphor for what we’re really trying to do.”

The Aegis CEO emphasized that they are looking at how many layers of “cheese” they can add to “minimize the number of holes the virus can go through.” The senior living company had its first case February 28, following the first death in the U.S.. But the problem, according to Clark, was that for approximately 10 days, the senior living community impacted did not have any information on testing results from the CDC. “Since we didn’t know that we even had a problem, we didn’t have PPE and infection control and safety protocols in place.”

Adding an additional layer of cheese, or protection is going to save people’s lives, which is why Aegis formed a virus council at the very beginning. “It has physicians, researchers, doctors, psychologists on this council that are living the data right. And in Seattle, we have the Gates Foundation, Institute for Disease Modeling, Fred Hutch, and the University of Washington.

Clark says that there are only really two things that matter with COVID-19—the amount of viral load you inject, otherwise known as an inoculation issue, and an individual’s T-cell response. “This is really a molecular trigger to an individual’s immune system.”

From a legal perspective, exploring the requirements of how individuals, if at all, could be granted a “compassionate care” visit was even more convoluted. For example, what happens when a wife who sues for access to an assisted living facility because she wants to visit her disabled husband confined to care because of the pandemic?

Thankfully, Aegis Living has experimented with ideas like hugging walls. “I have great empathy for those people,” Clark answered. “Let’s say somebody is in the last five days of their life—for example, your mom or dad before they pass on. We have needed to innovate through some features such as a “hugging wall,” where there are silicon arms patients and family members can reach through to have contact with each other without disrupting the sanitation protocols we need to uphold. It’s a balancing act every day, but we need to respect all sides in these delicate situations.”

As for the future, Clark believes the industry needs to focus on scientific data and certainty, rather than capitalizing off fear. “This is both for our employees and for the people in our communities. We have people fearing that if they go to the grocery store, they’re going to get COVID. We didn’t want our employees to go to an ER if they were sick because they would get COVID. So we started providing them food they could buy right at our community.”

Taking employee and patient health even more seriously, Aegis Living put they and their families on a preventative telehealth program called “98.6”, which allows for any member of the family to click on his or her iPad or iPhone, with immediate connection to a physician on the line, rather than travel to an emergency room in the event they become sick (unless a doctor has directed them to do so).

Clark believes that in the coming seasons, we can expect to see more of these preventative measures being implemented. “By informing people on what we can do and how we can address it based on actual evidence is much more reassuring to the brain than simply recycling positive news.”

As for Clark’s latest book, “30 Summers More,” which began as a chronicle of the 60,000 people he has overseen the care of, Clark revealed that within the first six months of writing the novel, he ended up in the hospital.

“I’ve always been a hard charging CEO who’s burned the midnight oil and loves life, and so on. Consequently, I ended up in this hospital with this gastrointestinal situation in which I was about two seconds away from a blood transfer and surgery. And I told my wife, ‘I’ve never been in a hospital for one day in my life.’ So I asked her to bring my manuscript because I wanted to work on it.

And as I was looking at it, I said to myself, ‘Oh my god, this book is not about the 60,000 people I’ve cared for, this book is about 40-, 50-, 60- and 70-year old people who are involved in life, taking care of other things and other people and not focusing on themselves.’ And that started a mission for me, where I became obsessed with finding out about the best practices of living not only a long life but a good quality of life. If you give up on your purpose, you give up on life. And, you know, I think ‘retirement’ should be out of the American communication system altogether.”