In March 2020, Ridgestone and Great Lakes facilities elected to lock down sites, meaning non-essential visitors were prohibited from entry. Over time, leadership realized that the lockdown measures were becoming increasingly difficult for their residents and were not sustainable. Ridgestone and Great Lakes facility directors identified four key factors that created contagion risk that would contribute to an outbreak spread—which had already happened at multiple competing facilities:

• Vulnerable populations: Over the last decade, the average age of residents had increased from the mid-70s to the late 80s, and new residents were arriving with higher rates of multiple, chronic, high-maintenance conditions,
• Close living quarters: Residents consistently preferred social clustering and socializing in communal areas where family and friends visited,
• Difficult-to-clean surfaces: High use and shared surfaces became prime suspects for cross-contamination—such as high touch doorknobs, guard rails, chairs, tables, game boards, pianos, and shuffleboard sticks—demanding that they be cleaned more frequently and thoroughly. By implication this required that more time be diverted from the priority of resident oversight and care, and
• Difficult-to-monitor visitors: Visitors, EMTs and residents entering sites can unwittingly carry in germs on their hands or contaminated gifts, which meant that visitation standards required a diplomatic and compliance-friendly rethink.

Management teams at all eight facilities observed increased time and labor intensity to maintain protocols for standard hygienic clean-up responses. The pandemic increased response frequency for simple events such as resident coughing and intensive cleaning for more significant interventions. Conventional disinfectant solutions were soon understood to be extremely short-acting.