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No family wants to think that their elderly parent or grandparent would have to live with bed bugs. But it happens all the time. In fact, bed bug infestations in senior living facilities are often some of the most intense and persistent infestations PMPs have to deal with.

“Ninety percent of the work we do is bed bugs, and some of the worst cases we’ve seen have been in senior living facilities,” says Greg Osborne of Bug Bakers of Columbus, Ohio. “Why do they grow out of control? Because elderly people are more tolerant of bed bugs. I’ve seen bugs crawling on them as we talk, and it doesn’t faze them. Plus, when you have a lot of people living in adjoining units, bed bugs spread rapidly. And then there are cases where facility directors don’t want to admit there’s a bed bug issue. Some are concerned about cost; others worry about bad PR.”

Let’s break these challenges down and explore some solutions.

HIGH TOLERANCE. Overall, seniors tend to be more tolerant of bed bug infestations than the general population. In part, that’s because they may be less aware of them. Declining eyesight can make the tiny pests nearly impossible to see, and a lack of immune response means that seniors often don’t experience the itching, redness or welts bed bug bites are sometimes known for.

Dini Miller, professor of Urban Pest Management at Virginia Tech, explains, “Prescription medications can suppress the immune system. Older people who take these drugs may have no reaction at all to bed bug bites. So the first signal that bed bugs may be present — waking up with itchy bites — can be absent in the elderly. Certain medications can also cause itchiness as a side effect, so if they do wake up itchy, they are likely to attribute it to their medication.”

There’s one more reason seniors tend to be more willing to live with bed bugs: embarrassment. They are of a generation where a very strong stigma was attached to having bed bugs. Rather than facing potential scorn from their peers, they often keep quiet about the issue, convincing themselves, “It’s not so bad.”

SPREADING LIKE WILDFIRE. We all know how fast bed bugs can spread in apartment complexes and other multi-unit environments. That spread can be multiplied in senior living facilities, because residents tend to be very social, spending a lot of time in common areas as well as visiting one another’s units.

“We recently tested bed bug monitors in an elderly housing facility where some of the units were infested,” says Miller. “During our research, one thing became obvious: The volume of social interactions contributed to the spread of the bugs. The neighbors would congregate in the hallway every day to talk, bringing their bugs with them.”

On several occasions, Miller also has been able to identify certain gentlemen who have played a leading role in their facilities’ bed bug proliferation. “Women outnumber men 10 or 15 to one in these communities. That makes the men incredibly popular. If they have bed bugs and are visiting a variety of ladies, you have to look at every living area with scrutiny. Every visit is an opportunity for these bugs to spread,” she says.

Dan Rao of MD Weaver in Natick, Mass., adds that visitors from outside a facility can be carriers, too. “I’ve seen a situation where the source of an infestation was an adult child who lived in a halfway house but would stay with his senior parent on the weekends,” he says. “In another instance, I got a call from a senior complex with an infested library. I tracked the bugs to a resident who spent a lot of time on the computer there. Wherever this man went, he was spreading bed bugs. Turns out he often invited homeless people to visit him in his apartment. They could have well been the source.”

It’s not like seniors stay put in the facility either. Many of them still drive, and so infested facilities need to consider whether the residents’ cars might be a source of bugs too, Miller points out. “They go out just like the rest of us do, coming and going, bringing things in and out. They can be constantly transferring bugs from facility to car and back again.”

LACK OF REPORTING. Of course, residents carry only a portion of the burden of reporting bed bugs. Facility management needs to be diligent about watching for infestations and pick up the phone to call their local PMP when an issue arises. Sadly, this may not happen as quickly or as often as it should. When directors fear that their reputation will be tarnished, or when they simply aren’t willing to pay for treatment, bed bug populations escalate.

HOW TO APPROACH. Once you get the call from a senior living facility, what’s the best way to go about resolving the issue? Miller suggests a highly consultative approach. “This isn’t a situation where we can just go to the facility manager and say, ‘Do this prep.’ We need to be thinking all the time — assessing the condition of each unit and communicating with the residents,” she says. “We need to spend time talking with them to find out where they are in terms of their ability to understand and accept what’s happening. Then we have to determine the kindest and most effective way to work with them.”

Here are some considerations as you plan your approach:

UNLIKELY TO PREP. Maybe they’re unable to do it, or maybe they’ve done it in the past and it was so traumatic, they vowed never to do it again. You may be able to engage management or residents’ family members in this endeavor, but no matter how this goes, count on an overwhelming amount of clutter. These residents likely moved from their family home, with three or four bedrooms, into a one-bedroom unit. They have a lifetime of belongings crammed into a tiny space.

Compassion is key, Miller reminds. “I recommend that PMPs consider getting large heat chambers as an alternative to asking people to throw their belongings away. Recent research says that getting rid of mementos can contribute to dementia for elderly people. It’s our job to help these people, not hurt them.”

TIME TO TEACH. Education is a strong bed bug management tool. Osborne says that post-treatment education is the best service his team offers. “We explain to residents one-on-one the importance of taking steps to ensure their bed bugs don’t return,” he says. “We leave them with an after-care sheet that helps them establish healthy routines.”

Garey Clark, Clark Pest Remedy, McDonough, Ga., holds classes for senior tenants, working with management to get as many to attend as possible. “We cook up some hot dogs and teach them what to look for, what to do — and not do — if they suspect they have bed bugs, and how to avoid bringing them home,” he says. “We’ve found that people are exposed to a lot of false information, so these classes are every bit as important as doing the treatment.”

Beyond the customers, it’s important to educate your technicians about the unique circumstances surrounding senior living facilities and the special skills and qualities — communication, empathy and compassion, for example — they need to be truly successful with these accounts.

MOST SENSITIVE ACCOUNTS. Senior living facilities are some of the most sensitive accounts you can treat. PMPs have a variety of tools for managing bed bugs — among them, heat, mattress encasements, traps, diatomaceous earth, silica dust, and targeted applications of traditional pesticides and newer biopesticides. In senior housing, many PMPs opt for heat treatments and other non-chemical options.

“You have to be careful what you put out around these elderly people,” says Clark. Although he has relied primarily on heat treatments for the past decade or so, Clark has been experimenting with a relatively new biopesticide that puts the insect-killing fungus Beauveria bassiana to work.

Miller has been testing this product as well, reporting, “It’s not instant, but if you apply it and come back in two weeks, you’re likely to see an amazing decline. One of the residences I treated was a trailer where there had been no trash pickup in two years. I put out the bands of biopesticide required by the label once a month, and in spite of the remarkable clutter and structural issues, it gave us control. This product and desiccant dusts offer the strongest residual effects.”

No matter which treatment approach you use, says Miller, the most important thing to remember is that you have what it takes to be the hero. “We have to remember that our job is to save the day for these seniors — not wimp out saying, ‘Well, they wouldn’t prep or they have too much stuff.’ We need to go in asking ourselves, ‘How can I resolve this bed bug issue given the variety of challenges I’m presented with?’ And then we need to solve the problem. These special customers deserve that peace of mind.”

The author is a frequent contributor to PCT.