Affordable Senior Housing Maintenance and Renovations, COVID-19, and the Precarity of Residents’ Health Safety
BY TAM E. PERRY, ZACH KILGORE, MICHAEL APPEL, MICHELE WATKINS, CLAUDIA SANFORD, AND DENNIS ARCHAMBAULT
Abstract:
Low-income older people in particular face a number of risks and precarities related to health, housing, and care. This article offers case studies from members of a city-wide advocacy group, Senior Housing Preservation-Detroit. Although the coalition’s work began in raising awareness about risks arising from displacement due to HUD building contracts expiring, its work was altered by COVID-19. Thus the article outlines how community-based initiatives protected older residents from risks at the intersections of poverty, housing, and health amidst the COVID-19 pandemic.
Key Words:
affordable senior housing, rehabilitation, safety, pandemic, building renovations, coalition, housing preservation, gentrification
Older people face a number of risks and precarities related to health, housing, and care, and this is especially the case for low-income residents. In Detroit, a predominantly African-American city, 30.6 percent of its residents live in poverty (Census Reporter, 2021). Nineteen percent of Detroiters ages 65 and older experience poverty (Census Reporter, 2021). In recent years, attention has shifted to the challenges of displacement, eviction, and homelessness among older people (Perry et al., 2015; Perry, Archambault, and Sanford, 2017), and Detroit is characterized by such trends. Yet, “on the ground” stories of groups coming together to mitigate risks and build community are often less well-documented.
This article offers case studies from members of a city-wide advocacy group, Senior Housing Preservation-Detroit (SHP-D). Although the coalition’s work began in raising awareness about risks arising from displacement due to HUD building contracts expiring, its work was altered by COVID-19. This article thus outlines how community-based initiatives were involved in protecting older residents from risks at the intersections of poverty, housing, and health amidst the COVID-19 pandemic.
SHP-D was formed in 2013 to address displacement of older adults from HUD housing as building contracts expired. This multiagency coalition has worked continually to raise public awareness of the concerns of older adults living in low-income senior buildings (Perry et al., 2015; Perry, Archambault, and Sanford, 2017; Perry et al., 2020). Before the pandemic, the coalition advocated for city-wide efforts to support older adults facing displacement. As the pandemic’s scope emerged, to protect residents and staff of senior housing from COVID, SHP-D recognized the need to extend its focus to housing and community involvement and sensitization and education regarding additional safety of residents and staff.
Detroit was one of the American cities that saw a rise in COVID cases during the early days of the pandemic and witnessed older adults’ and persons of color’s (of all ages) greater vulnerability and mortality to the virus. Eighty one percent of COVID deaths were in people ages 60 and older, and 81.2 percent of deaths have been among African Americans (Detroit Health Department, 2021).
In March 2020 as the pandemic emerged, SHP-D scheduled regular meetings to share approaches for keeping residents living in low-income senior buildings safe. As older adults of color were disproportionally affected by COVID-19, efforts were needed to support residents, including decreasing their need to travel, as many used public transportation. The coalition also successfully advocated for COVID testing to be brought to senior buildings (and now vaccine distribution) and addressed mask distribution and food insecurity in several senior buildings (see Archambault, Sanford, and Perry, 2020).
Yet, pandemic responsiveness varied across building sites; while some building operators stepped up, others were less attentive to resident needs and factors such as reduction in staff hours left residents feeling abandoned. Another key area for discussion at coalition meetings during the pandemic was how to keep renovation projects going as the pandemic contributed to uncertainty, fear, and illness in senior buildings.
We begin our article by setting the context for building renovations in normal and COVID times, then present three case studies of older people whose buildings and apartments were being renovated during the pandemic. Case studies highlight how COVID affected planned projects, how stakeholders such as developers, staff, and residents responded and raise key considerations for future emergencies affecting senior housing communities.
Renovations in “Normal Times” and “COVID Times”
Stable housing is a key social determinant of health and well-being. Any change in stability can lead to imbalance and anxiety. Building renovation projects are almost always disruptive and stressful processes in which delayed timelines are common. Despite such stresses, residents often welcome renovations that incorporate universal design principles and/or contribute to a better quality of life in their units and common areas—such as better heating and cooling systems, new windows, doorways modified for greater accessibility, and upgraded emergency call systems.
Residents appreciate efforts to update and/or modernize private units (e.g., kitchens and bathrooms), as well as enhancing common areas with private office space for healthcare delivery and/or larger mailrooms to better accommodate the growing delivery of mail-ordered packages. Such transformations can preserve senior buildings’ marketability, which typically have a refinancing cycle of fifteen to twenty years. If residents perceive that they will benefit from the renovations, they often will tolerate disruptions. But, if renovations are viewed as part of a resident displacement process they are unlikely to benefit from, the stresses can be unbearable (Perry et al., 2015).
‘AS THE PANDEMIC EMERGED, SHP-D SCHEDULED MEETINGS TO SHARE APPROACHES FOR KEEPING RESIDENTS OF LOW-INCOME SENIOR BUILDINGS SAFE.’
Many concerns for the health and well-being of residents during building renovations are timeless. Information should be communicated to residents keeping in mind literacy levels and communication modality (email, paper delivery under door, signs posted in hallways, telephone calls, linguistic use among residents). Also, if residents are going to live in the same unit throughout construction, mitigation of dust and noise that can contribute to the exacerbation of existing health concerns, particularly asthma, must be incorporated into plans.
Sometimes residents are asked to leave their apartments and remain in common rooms for the duration of a day, which disrupts routines like medication timetables, meal preparation, mealtimes, and sleep schedules. Sometimes renovations require temporary stays in similar units, in which one’s possessions are packed, moved to the temporary stay apartment, and then moved back to the newly renovated apartment. All renovation projects should address the variability of residents’ mobility and cognitive ability, as well as ensuring the temporary unit fits the tenant’s needs.
The pandemic added another level of complexity and serious risk to the equation, bringing about specific conditions that raised risks to older residents. Not only were the residents at risk for displacement, but also they were at risk of infection with COVID-19.
During the pandemic, any such renovations had to be addressed within larger strategies of controlling COVID-19 spread among residents and staff (see Sudo, 2021, on labor and supply chains). Renovation could be considered more difficult, more disruptive, and potentially deadly. Residents and staff already worried about transmissibility to others with whom the residents and staff interacted—family, friends, or others. Staff may be working other jobs, or living with family members, some of whom may be high risk for COVID-19. The introduction of renovation into this equation meant more and different types of people entering the building, sharing the same air space. The stakes were high.
What follows are three case studies on the renovation of buildings and units occupied by older people in the city of Detroit. The first focuses on how to carry out maintenance and renovation in this risky context. The second focuses on a building under renovation when COVID-19 struck. The third outlines how resident involvement shifted during the pandemic.
Case Study One: Covid-19 Safety Precautions in Building Operations
At one organization in charge of operating numerous senior housing buildings in Detroit, the staff began preparing for the global pandemic on February 28, 2020, because after watching national news, the building staff wanted to prepare for what might be a long haul. How would building operations occur? The staff anticipated a run on masks, hand sanitizer, and basic cleaning supplies; staff were instructed to place large quantity orders with all suppliers.
At the beginning of March 2020, as plans for the State of Michigan shutting down evolved, a decision was needed on whether or not the staff should be considered “essential workers.” After careful consideration with team members who served residents, the staff decided to consider themselves “essential workers.” They would maintain regular schedules and, in some of the buildings, increase their presence from five to seven days a week.
With multiple buildings to oversee, the staff had concerns for their well-being, but also knew the residents relied upon them, as often staff are their only “family.” This approach ran in stark contrast to other senior properties where staff hours were significantly reduced during the early days of COVID-19.
Later in March, as more states began to shut down, the national organization in charge of this senior building created a COVID-19 task force in charge of planning a coordinated strategy for addressing resident needs. The national headquarters offered mandatory webinars explaining the strategy, with roles and responsibilities of each staff position. National guidance identified four response levels activated by a “triggering event,” which would elevate or lower the property in risk levels, depending upon the nature of a COVID-19 outbreak.
The local building director had discussions with staff to clarify instructions and support them. While unknowns in the initial strategy created some higher levels of stress, when adjustments were made as the pandemic progressed, staff were relieved that the organization’s modifications were in line with public health department actions.
‘BUILDING STAFF OFTEN BEGAN THEIR DAYS CALLING RESIDENTS TO CHECK IN AND SEE HOW THEY WERE DOING; THIS PRACTICE CONTINUES.’
After staff trainings, staff sent letters to residents canceling group activities and volunteer events. All common areas were closed and remained closed to adhere to state shutdown mandates. The staff requested residents communicate with building offices by phone if they were sick. Staff requested residents limit the number of visitors to only those necessary for their well-being. Building staff often began their days calling residents to check in and see how they were doing; this practice continues.
The organization implemented a Wellness Screening Tool paper questionnaire for visitors. This tool helped with contact tracing as well as deterred visitors if they were sick or had been sick. Residents also received the Wellness Screening Tool, flyers on social distancing, mask-wearing, and national and state health department information. Residents walking in and out of buildings without masks were given masks. Despite the same memos from the local office, different buildings engaged in differing levels of social activity, resulting in varying numbers of COVID-19 positive cases.
As COVID-19 infections and deaths increased, the staff instituted a sanitation cleaning protocol requiring maintenance to clean and sanitize all common areas, along with high-touch areas like door handles, at least three times per day. If a building had a positive COVID-19 case, the staff contracted with an outside company to clean, disinfect, and sanitize all common areas including walls, rails, door handles, and any other high-touch areas (at additional costs of $3,000–$5000 each time someone tested positive).
Building managers notified every resident and staff of any COVID-19 positive cases in a building, without disclosing personal information. The staff requested in writing (by mail and hand-delivered to resident’s doors) the infected person to quarantine according to the CDC guidelines. In addition, if a person had been in contact with others, the staff would send a letter to notify them and request they quarantine as well.
To avoid entering residents’ apartments unnecessarily, some routine maintenance was suspended (e.g., replacing drip pans in ovens, replacing a single light bulb if an area has many light bulbs) and inspections (e.g., annual inspections to avoid going into units unnecessarily). Emergency work orders were prioritized. (e.g., no heat, no air, plumbing leaks; light bulbs for those with visual impairment). In some buildings where renovations were underway as the pandemic hit, building-based safety precautions developed by local contractors were put in place, before there were standardized protocols. Some included limited entry of construction personnel who were required to wear PPE, attended entry, and exit points that included temperature check, a Vendor/Contractor Wellness Screening Tool, and a Maintenance Entry Log (which documents rehabilitation or repairs in specific areas of a building). Overall, staff were reassured with the protocols, but residents’ comfort levels varied about having additional personnel in the building, and in their units.
To contribute to staff well-being, the staff celebrated birthdays and anniversaries, and weekly calls served as morale boosters. To acknowledge the positive, in the face of sheer exhaustion, the calls always noted, “the sun is shining” or “the sun is shining, just not here, but it’s shining in our hearts.” Staff experienced “Start, Stop, Change, and Pivot” in their work lives so staff were allowed flex schedules for remote work to accommodate those who had school-age children.
While government support for “heroes pay” was available, the process and guidelines lacked clarity. Therefore, the parent organization created an alternative by providing a monetary bonus to all staff for their efforts. The team continues to demonstrate perseverance and resilience during these challenging times.
Case Study Two: A Renovation in Progress as the Pandemic Develops
This case study focuses on the financial implications of a renovation in progress. In a unit renovation of a senior building, the original pre-pandemic timeline was to move residents in five phases, while their units received welcomed upgrades (new floors, painted walls, new doors, countertops, and cabinets). Ten to fifteen tenants would be relocated, on premises, to vacant units during each phase. Then, state-level public health mandates on construction stoppage affected the project.
As other types of construction were permitted to begin again, senior housing was initially excluded. Executive Order 72 (State of Michigan, 2020) did not allow construction projects in senior residences, nursing homes, adult foster-care facilities, hospice facilities, substance abuse disorder residential facilities, independent living facilities, and assisted living. There was ambiguity about how senior apartments should be categorized. However, the parent organization of these senior residences wanted to start the project to prevent it from continually being delayed, thus affecting the residents over a longer period of time.
After much deliberation, renovations started with these measures in place: temperature checks were required at every entrance, sign-ins, surveys, questionnaires, contact tracing, rearranged layout of rooms to be rehabbed so the work areas were isolated from residents. Also, contractors had to use separate entrances from the main residents’ entrance. It is important to keep in mind that staff were at the same time addressing resident well-being (in detailed ways, similar to those in Case Study One), but also examining budget and construction schedule disruptions.
In addition to the four- to five-month delay due to mandated work stoppage, cost increases were incurred from additional cleaning (one to two weeks of cleaning delays between each phase) and the separating of building trades (to reduce the number of people in a building), which led to scheduling delays. It is important to note that there were six months of additional vacancies not predicted in the original final models. The total increased cost was estimated at $500,000; the project was originally expected to be a $9.5- to $9.7-million project. It is hoped the project will receive federal subsidies that would alleviate some of these construction expenses.
Case Study Three: Planning and Starting a Renovation in the Pandemic: Getting Resident Input
This case study focuses on how renovations involving older adults in a pandemic were planned and initiated. As in the two previous case studies, extensive COVID-19 protocols were put into place for residents. In this building, staff translated public health materials into multiple languages, and instigated technology training on iPads that were distributed to leaders at the buildings. However, residents were used to being highly involved in decision making and these public health guidelines created a cultural change in the decision-making process. If residents needed to submit votes on issues, times were assigned to drop off ballots. Common spaces typically used to solicit group comments could no longer be used for those purposes. Importantly, this building has not seen a significant change in the number of residents attending programs as it shifted from in-person to virtual meetings. Some volunteers who were frustrated with virtual communication resigned, but they were replaced by new resident volunteers.
THIS BUILDING HAS NOT SEEN A SIGNIFICANT CHANGE IN THE NUMBER OF RESIDENTS ATTENDING PROGRAMS AS IT SHIFTED FROM TO VIRTUAL MEETINGS.
Tenants also have been less willing to fill out forms (e.g., income certifications and signing of HUD-mandated notices for renovations), perhaps due to less in-person contact with staff. The governmental requirement to deliver notices about construction projects to residents through certified mail created a challenge due to mail delays, and residents’ unwillingness to go to mailboxes. Thus, it is important to note these governmental documents, which are crucial to maintaining older residents in affordable housing, have been affected by this change in engagement. Maintenance in current units, such as in the above case studies, prioritized emergencies rather than routine checkups. At times, tenants were asked to do their own apartment checkups; additionally, bed bug inspections have been postponed.
As the building planned during late fall 2020 for a renovation, this community previously used to high engagement in decision making had little opportunity to offer which types of renovations interested them. They were offered paper ballots and allowed a vote on expenditures with pros and cons listed, but it was a learning curve for everyone involved on how to give feedback on the desired outcomes of the renovation. The renovation started in common spaces and so avoided workers entering apartments during the second wave of the pandemic. This allowed for the closing off of certain spaces, separating the construction area from where residents live their lives, including using laundry (one person allowed in the room at a time). As the renovation continues, residents and staff keep thinking about how to engage residents in creative ways.
These three case studies highlight the common effects of COVID-19 on each renovation and how timing and case-specific factors create different responses. At the most general level, these examples point to the need for timely and responsive risk management. In these cases, the health risks of COVID-19 greatly complicated the already challenging job of managing a renovation project in occupied senior apartment buildings. The fact that each of the buildings were owned and managed by a nonprofit housing provider may help account for the relatively speedy and creative responses.
As community organizations with long-term commitments to the housing and its residents, these owners—together with their management and construction contractors—were relatively well-positioned to work through the sometimes competing demands of renovation, property management, and tenant safety. The case studies also were presented at an event in partnership with the City of Detroit in March 2021, as a way for the SHP-D coalition to demonstrate leadership on best practices. The coalition’s work including sharing best practices, and working together in such an uncertain environment builds on the trusted relationships among coalition members.
The Road Ahead
These case studies paint a picture of safety and renovation concerns during a pandemic. As a coalition, we advocate for greater understanding of these concerns in terms of their timelessness and timely application.
Timeless
Many older adults face an affordable housing crisis. Affordable housing is consistently underfunded (Couch et al., 2020). For those older adults relying on Social Security for their primary, or possibly sole, source of income, affordable housing needs to address those at the lowest incomes levels—typically 30 percent of area median income and below. Examining who qualifies for “affordable” housing should always be part of the consideration.
Need to address conditions in housing for low-income older adults; renovations are a less expensive way to provide affordable housing than creating new affordable housing. But, the Low Income Housing Tax Credit (LIHTC) is used for new construction more often than for renovations. If greater tax credits were offered for rehabilitating current buildings, more updates would be possible (Michigan State Housing Development Authority, 2020).
Attend to the multifaceted challenges these older adults may encounter in renovation. Communication with residents may need to be pictographic and not too wordy, to consider cognitive ability and literacy levels. Greater support for understanding the renovation process may be needed for older adults with mental health concerns.
Ensure an ethically responsible approach to construction, which includes input from many institutions. These include safety protocols incorporating public health mandates (temperature checks, health pre-screening), building owners/managers/development rules, and federal and state agency housing rules.
Promote best practices in temporary relocation of older adults. How can the safety of tenants be ensured when temporary space is used by different tenants? How does the packing of residents’ belongings consider privacy, especially in cases with infection concerns?
Timely
Senior buildings should have a blueprint that can be adapted for the next short- or long-term emergency.
Older adults may have difficulty going out to obtain essentials. The SHP-D coalition distributed a food insecurity survey, and tenants expressed reluctance to going out for essentials. Consider the option for resources, such as testing and vaccines, to be brought to buildings, due to the prevalence of co-morbidities. Make available communication in a variety of technological modalities to reach a range of older adults. Address social isolation early on using resources created in previous emergencies (games, websites, call-in programming).
Recognize that each senior building has its own culture with shared strengths, communication practices, histories of adherence to guidelines, and resident expectations.
Staff may experience considerable stress and concerns. Provide adequate and timely information about best practices to keep staff and residents safe. Reimburse for additional costs like PPE, cleaning supplies, technology upgrades for the workplace, and for work-at-home expenses and building cleaning, as well as mental health and caregiving concerns.
For renovation projects during emergencies:
Establish best sources for accurate information.
Understand how to apply state and national guidelines to mandates for independent living, including construction stoppages/starts and resident and visitor access.
Establish a clear designation of responsibilities for cleaning, discuss the type of masks expected by construction trades (N-95, medical grade, or cloth). Understand whether construction trades have similar sick policies to the building staff’s (paid leave, when too sick to work). Construction safety plans should account for sharing of the same workspaces (building staff and construction staff).
Support changed timelines for construction projects, including timelines affected by a moratorium on construction or inspection delays. Extended loan periods or allowing pauses without accrual of loan interests may be advisable.
Acknowledgements: We would like to acknowledge the City of Detroit’s Housing and Revitalization Department for its sustained interest in addressing the concerns highlighted in this article. We also would like to thank all the members of SHP-D, for their steadfast work on behalf of older adults, particularly those with extremely low-incomes, during the ongoing pandemic. Lastly, Dr. Perry would like to thank her students at Wayne State for assistance for this project: Kimberly Shay, Misha Ansari, Abeer Gobah, Samir Al-Khouri, and Sukrut Nadigotti.
Tam E. Perry, PhD, is an associate professor at the Wayne State University School of Social Work, and research chair of SHP-D. Zach Kilgore, MA, is a project manager at CSI Support & Development, and co-chairs the SHP-D Preservation Committee. Michael Appel, MA, MSW, is a senior project manager at Develop Detroit, and co-chairs the Preservation Committee. Michele Watkins, CPM, is vice president of Housing for Volunteers of America Michigan, and an active SHP-D member. Claudia Sanford is a tenant organizer with United Community Housing Coalition and SHP-D chair. Dennis Archambault, MA, is the vice president of Public Affairs with Authority Health and SHP-D communications chair.
References:
Archambault, D., Sanford, S. and Perry, T. E. 2020. “Detroit’s Efforts to Meet the Needs of Seniors: Macro Responses to a Crisis.” Journal of Gerontological Social Work 63(6–7): 706–8. doi/abs/10.1080/01634372.2020.1797974.
Census Reporter. 2021. “Detroit City: Wayne County, MI.” Retrieved May 17, 2021.
Couch, L. 2020. “Falling Short: Federal Housing Assistance Is Failing Older Adults." Generations. Retrieved February 20, 2021.
Detroit Health Department. 2021. “COVID-19 Dashboard.” Retrieved May 17, 2021.
Michigan State Housing Development Authority. 2020. 2019–2020 LIHTC Scoring Criteria. Retrieved May 17, 2021.
Perry, T. E., et al. 2015. “Senior Housing at a Crossroads: A Case Study of a University/Community Partnership in Detroit, Michigan.” Traumatology 21(3): 244–50. doi:10.1037/trm0000043.
Perry, T. E., Archambault, D., and Sanford, C. S. 2017. “Preserving Senior Housing in a Changing City: Innovative Efforts of an Interprofessional Coalition.” Public Policy & Aging Report. 27(10): S22–6. doi.org/10.1093/ppar/prx020.
Perry, T. E., et al. 2020. “Advocating for the Preservation of Senior Housing: A Coalition at Work Amidst Gentrification in Detroit, MI, Housing Policy Debate.” Retrieved May 17, 2021.
State of Michigan. 2020. Executive Order 72. Retrieved June 10, 2021.
Sudo, C. 2020. “Senior Housing Construction Could 'Crash to Zero,' Builders Brace for Covid-19 Effects.” Senior Housing News, March 19. Retrieved February 18, 2021.
