Senior living center searches for new normal as COVID risks remain

JACKSON – While 90% of COVID-19 deaths in October were among Americans age 65 and up, that age group makes up only 16% of the nation’s population, the Centers for Disease Control and Prevention reported. Even as the pandemic continues to take an especially high toll on the elderly, Jackson’s new skilled nursing and memory care center has had zero COVID deaths.
Sage Living, the $35 million building that replaced St. John’s Living Center, opened its doors in the middle of the global pandemic in August 2021. Keeping safe from COVID has come with costs that the center continues to weigh every day.
“We have the same amount of responsibility a year ago as we do today,” said Seth Robertson, executive director of senior living at Sage Living, while walking through the center. “We’ve been in outbreak more than we’ve not been.”
So, he said, Sage Living has to continually decide: “What risks are we willing to take?”
It’s not an easy calculation to make. While many are eager to return to business as usual, the threat of COVID continues to stunt the lives of older populations, especially in senior living centers.
At 105, Fred Miles has expressed frustration to his son, Greg Miles, about a big cut in the Sage Living’s activity schedule since the pandemic started.
“I just need something to do. I need a job,” Greg Miles remembered his dad saying to him.
With the new building, the rent has doubled from around $6,000 to $12,000 per month for the skilled living center though “a lot of the activities the residents would do has really been diminished to the bare minimum,” Miles said.
At the beginning of the pandemic, while Sage Living was still under construction, most of its residents lived at St. John’s Living Center, a long-term care facility, owned by St. John’s that had been around since 1991. 
In 2017, voters approved a $17 million specific purpose excise tax request to pay for part of the cost of constructing Sage Living and an inpatient rehabilitation facility next door. SPET money comes from 1 cent of sales tax, which is paid by residents and visitors alike in Teton County.
Aside from its gargantuan windows overlooking the National Elk Refuge, Sage Living is bigger than the previous Living Center, with more room to walk around, a larger outdoor garden and private bedrooms for each resident. The new senior care center also has a secure “Memory Neighborhood” for folks with brain changes.
Until the COVID vaccine was developed and made available, the long-term care center took more stringent precautions to keep residents safe, in line with recommendations made by the CDC.

“The hardest part was for the whole first year of the pandemic, [residents] were pretty much confined to their room,” said Toni Ellis, a certified nursing assistant at Sage Living. “We brought meals to them, which was tough because our biggest social event used to be meals.”
On March 13, 2020, the Centers for Medicare and Medicaid Services issued a lock-down order, restricting nursing home access to only essential workers. As a result, residents were cut off from family and friends for six months.
Visitation restrictions have since eased, though access has fluctuated depending on community COVID transmission rates. At times that has meant only masked outdoor visits, or requiring a negative PCR test for indoor visits or some combination of masking and testing. Last winter, visitors had to sit behind a glass window in an insulated room outside of the building to see loved ones.
“You had to talk through a little microphone to communicate for the entire winter,” Greg Miles said. “What are we saving people from anymore, if this late stage in their life is really sad?”
The No. 1 priority for the center was resident health, as hard as it may have been for the seniors and staff alike.
“Watching our residents feel bored was hard,” Ellis remembered. “When they were just sitting around doing nothing, it was not a very good atmosphere.”
Since guidelines have relaxed, Sage Living has been able to provide a more vibrant living experience, like its staff had always hoped. Common spaces have started to be used, family members can visit again, and the community has grown increasingly involved in the center once more.
“Music therapy has helped me immensely,” Danny Keller, 76, said while taking in the sunshine at the entrance of the center.
Sage Living offers a number of enrichment activities, including film screenings, bingo, blackjack and boat rides.
Keller, whose son, wife and grandchildren live just down the street, adores the music therapy program, as it has provided him not only a creative outlet but also an effective memory exercise.
“I’ve spent thousands of hours writing lyrics on an iPad,” he said. “When you get to my age you can’t think about a lot of negative stuff, so I use writing to control what I think about.”
Former professional rock climber Peter Hahn, 74, has been living at St. John’s long-term care centers for seven years. He was pleased with the quality of care he received, despite pandemic-induced limitations.
“I’ve been to hospitals in Stanford and the Bay Area, but for a rural hospital they are doing awfully well,” Hahn said. “The medical staff and regular staff had more of a challenge than we patients had. There are only small things to get pissed off about — like laundry and food.”
The nurse staffing shortage continues to be one of the pandemic’s most enduring legacies at Sage Living.
Of the 56 rooms the center offers, 11 remain unfilled, despite a growing resident waitlist. While Sage Living offers one of the most competitive certified nursing assistant wages in the country, at $22 an hour, the center still struggles to find enough CNAs.
Many of the CNAs at Sage Living commute two hours, each way, from Idaho Falls. The center offers condensed shifts, in which they work day and night for a few days, and provides them with lodging on work days, so that the commute is only once a week.
Wearing masks, washing hands, quarantining and constantly keeping away from the coronavirus didn’t help an already challenging CNA staffing dilemma.
“I think we have lost more [staff] in the last two years, than what I’ve seen in the previous 10,” Ellis said. “We had a few people that went to different departments at the hospital, and a few that just weren’t able to work around the COVID-thing.”
Ellis has worked for St. John’s long-term care centers for 12 years, commuting from Idaho Falls nearly every week. She admitted it’s hard having COVID “always on your mind” and trying to communicate with seniors while wearing a mask.
“Your voice is muffled behind a mask,” Ellis added. “They don’t know what we look like. They don’t see our smile and facial expressions that they need.”
COVID-complications aside, the CNA has stuck around because of how her job makes her feel.
“A lot of the people in the memory unit can’t remember things, they don’t know where they’re at or what’s going on,” Ellis said. “I love it when I come in and one of the residents says to me, ‘I miss you, where have you been?’ and you see in their eyes that they recognize you.”
Despite a challenging start, Sage Living is slowly lessening its COVID constraints, attempting to balance residents’ physical health with their mental health.
“As the rest of the world opens up, we’ll probably follow suit,” Robertson said. “But we’ll do it in a more mindful and careful manner.”
 
This story was published on Nov. 23, 2022.