You Asked, You Answered: Thanksgiving Planning Survey Results

Members | November 15, 2020 | by Dee Pekruhn

In response to many member discussions and concerns about Thanksgiving travel and gatherings, LeadingAge hosted a Community Holiday Planning Survey last week. Members who serve older adults in congregate living settings were invited to respond to questions about how they are preparing for resident and staff participation in Thanksgiving celebrations. These results are reviewed below; for greater detail on member solutions to this issue, visit this article on Member Solutions for a COVID Safe Thanksgiving (updated).

To support members in planning Thanksgiving policies related to resident and staff travel and gatherings, LeadingAge fielded the Community Holiday Planning Survey last week. Our intent was to add to the growing list of anecdotal member solutions – and ongoing questions - that we’ve heard from many members across the country. This survey, geared towards members who serve older adults in congregate living settings (affordable housing, assisted living, independent living, life plan communities / CCRCs, and nursing homes), received 113 responses. It is important to understand, when reading these results, that this is not a scientific survey or a methodologically drawn scientific sample. Generally, the findings were consistent with what we have heard members say they are planning as they prepare for Thanksgiving and end of year holiday celebrations. Thanks to all who participated in the survey.

Question One: What are you considering in terms of residents traveling for a family holiday gathering?

LeadingAge members are wrestling with this question. Because of all the advisory information on Thanksgiving and holiday travel risks that CDC has issued, members expressed concern that their residents and staff may be at great risk of COVID exposure at a family gathering, especially those held indoors with marginal COVID protections and blending families from multiple households. The goal of this first question was to learn how members are preparing their residents to think critically about Thanksgiving travel this year.

Not surprisingly, the vast majority of respondents (81%) were encouraging residents not to travel at all for Thanksgiving. Other marginally-endorsed solutions included encouraging residents to travel for Thanksgiving only in special circumstances (9%), encouraging residents only to travel locally (5%), or not providing any guidance or information to residents regarding Thanksgiving travel (5%). None of those who responded this survey are planning to encourage residents to travel out of state. These responses consistently reflect member concerns about travel and their residents’ increased risk of exposure, especially as COVID cases are on the rise across the country. Some states are starting to implement their own restrictions on travel, and any who travel to another state must know if they will have to self-quarantine upon arrival or return.

Question Two: If residents leave for a family Thanksgiving gathering, what are you recommending when they return?

The great debate embedded for this question has been how to protect the entire community when a resident (or staff member, as discussed later) returns from a Thanksgiving gathering. CDC offers After You Travel recommendations, and some states do have their own requirements or guidelines for the same. (Our CDC and States’ Thanksgiving Guidance article offers more detail.) Ahead of this survey, members were considering asking or requiring residents to self-quarantine, to disclose their travel plans, or to be tested for COVID upon return. The number of days to ask a resident to self-quarantine, and the frequency of negative test results needed to end self-quarantine varied across members. Some were considering a combination of these methods.

Those who responded to this survey most often said (55%) that they are implementing a combination approach of asking residents to self-quarantine, to disclose their travel plans, and to be tested for COVID upon return. Thirty-five percent (35%) of respondents said they would ask or require residents to self-quarantine for a period of time upon return, and a small number (6%) said that they are issuing no recommendations or requirements at all. Only one percent (1%) stated that they would ask residents to disclose their travel plans.

Question Three: What are you planning in terms of residents and families getting together on your property for holidays?

This question aimed to evaluate how members were planning to address the desire of residents and families to gather together on their property – either in a dining room, in a resident’s individual home or room, or in another designated space. Anecdotally, members had shared a range of solutions, from not allowing visitors at all on the property, to welcoming residents and a limited number of guests into the dining room or another shared space. If members plan to welcome guests of residents onto the property for the holiday, nearly all had said (ahead of this survey) that their existing visitor screening protocols would apply.

Our survey found that the majority of respondents (49%) are discouraging residents from inviting guests onto the property for the holidays, except in special circumstances. (Many members define these as end of life, essential caregiver, or compassionate care circumstances.) Other solutions included encouraging residents to have a limited number of guests, only in their home (20%) or encouraging residents to have a limited number of guests, only in an outdoor setting (15%). Anecdotally, we know that many members have been planning to offer residents the option to have a Thanksgiving meal delivered to their home, including a limited number of guest meals.

Very few who responded to this survey said they were welcoming residents’ visitors into the Dining Room (1%) and none reported that residents could have visitors without limitation. Prior to this survey, members who are welcoming residents’ visitors into the Dining Room are doing so with many enhanced protocols; see our Member Solutions article for more detail.

Question Four: What are you planning in terms of preparing staff for family holiday gatherings?

Similar to your considerations for how to prepare residents for travel to and return from Thanksgiving gatherings, members were weighing the same considerations for staff. Afterall, staff would be just as likely to travel for and gather with family for Thanksgiving, and members were debating whether to implement the same preparations as were used for staff travel during the ‘summer vacation’ phase. Prior to the survey, members were discussing solutions ranging from providing staff with CDC advisories and information, to requiring a self-quarantine period prior to returning to work if they traveled for the holiday. For some members, the self-quarantine question necessarily hinged on to where and how far the staff member planned to travel, given that some areas and states have greater travel and self-quarantine requirements than others.

A good majority of survey respondents (72%) are planning to offer CDC information and advisories to staff about Thanksgiving travel and gatherings. If staff are planning to only gather locally with family, some respondents (12%) said that there would be no return to work restrictions. However, others (9%) said that staff would be required to self-quarantine if they traveled out of state for Thanksgiving, and a small group (4%) stipulated further that staff who gather with family outside of their household would have to self-quarantine. A small group (3%) stated that staff may travel out of state for Thanksgiving with no return to work restrictions.

Question Five: What leave arrangements are you offering to staff who may have a higher risk of exposure during the holidays due to travel, college kids returning home, etc.?

The debate over how to compensate staff members for leave necessitated by the risk of potential exposure to COVID echoed similar considerations to those explored by members during the summer. Members considered the same range of options for staff COVID leave time, including requiring negative test results upon return, to a period of self-quarantine paid for by FMLA or vacation leave time. Of all the survey questions, the responses to question five demonstrated the greatest range of members’ planned solutions.

The key to understanding the diversity of responses here is within the question itself; members were asked what they would require of staff who had a higher risk of exposure to COVID, which assumes that it is unknown whether the staff member in fact has been exposed to and contracted COVID 19. Because this question reflects the real uncertainty of knowing if Thanksgiving travel and gatherings have exposed staff to COVID, the answers to the survey reflect the uncertainty members expressed in knowing how to set policy for this holiday.

Less than half- but the majority of respondents (44%) – said that staff would be allowed to use paid time off / vacation leave time to self-quarantine following their travel or higher-risk exposure gathering. Twenty five percent (25%) stated that staff in this higher-risk category would have no return to work restrictions if they produced a negative test result for COVID. Some had no return to work restrictions at all (18%) and others (11%) said they would allow staff whose job functions allowed it to work from home during the self-quarantine period. A small group (3%) are planning to allow staff to use FMLA/ CARES Act coverage to pay for the self-quarantine period.

Overall, we hear, both from member anecdotes and this pulse survey, that members are giving great consideration and thought to how to best prepare residents and staff for the COVID risks of holiday travel and gatherings. Where travel is involved, most who responded to this survey are urging residents not to travel and are recommending or requiring self-quarantine for both residents and staff upon return from the holiday. In a similar vein, many members who took the survey are strongly urging residents not to have visitors, or only under special circumstances, on property. Information and advisories given to staff and residents are a clear priority, and members are taking a variety of approaches when it comes to staff who have a higher risk of exposure to COVID during the holidays.

We hope this survey and its results have been helpful; please also visit our Member Solutions and CDC and States Thanksgiving Guidance articles for greater detail. See anything missing? Please email Dee Pekruhn at dpekruhn@leadingage.org and we’ll address it.