Pandemic Disruption Spurred Innovation in Aging Services
Groups share their success stories and some lessons for the future
The COVID-19 pandemic upended delivery of community-based services and supports from Massachusetts to Minnesota to Southern California. Senior centers, caregiver support groups, exercise and therapy classes were suspended. Many older adults became virtual shut-ins, fearful of or unable to get to the grocery store or pharmacy or to see friends.
But throughout the U.S., aging-service agencies have developed creative approaches to address the needs of both older adults and family members who care for them.
Almost all service providers point to technology as the key to offering everything from health care to food delivery to mental health counseling to elders and their family caregivers.
There was no plan initially for how to deal with this influx of an estimated 450,000 seniors who needed assistance.
Many say that even when the pandemic ends, they plan to continue offering online options as either stand-alones or part of hybrid models to better meet the needs of their clients.
"We put individuals at the center and figured out what they needed and how to get it to them," said Dina Schmidt, administrator of Nevada's Aging and Disability Services Division. "The aging-services network had to not only absorb current clients, but all older adults who had become essentially homebound."
Creating Action Teams
There was no plan initially for how to deal with this influx of an estimated 450,000 older adults who needed assistance, Schmidt said during a recent presentation at the American Society on Aging OnAging 2021 conference.
So, she and her team helped spearhead the Nevada COVID-19 Aging Network (Nevada CAN). It's a statewide, inter-organizational, coordinated collaboration aimed at ensuring that every older Nevadan could access medical, social and daily essentials at home, thereby reducing COVID-19 and its impact.
The effort focused on in three priority areas, according to Dr. Peter Reed, a public health gerontologist and director of the Sanford Center for Aging at University of Nevada, Reno School of Medicine, who helped pull together the effort in just two weeks. "We created action teams to deal with the biggest priorities," he said.
The work was organized around the following teams and themes:
- Telehealth: Reed managed the telehealth action team, which ensured access to health care services including geriatric assessments, psychiatry, primary care and other clinical services.
- Social support: Another action team facilitated remote connections to education, wellness and social engagement, from one-on-one to group peer sessions and volunteer opportunities.
- Food and medicine: A third team handled delivery of these essential items to clients.
The program structure is very focused and very simple, according to Reed. An online assessment form simply asks people what they need and people can check off numerous requests for assistance. Forms are routed to the appropriate action team or teams for follow-up with local aging- service partners.
The initiative is also linked to the statewide 2-1-1 help line, so older adults without computers or smartphones can call and obtain the same services.
Since April 1, 2020, Nevada CAN has served over 400,000 meals, conducted over 15,000 telehealth visits and provided over 4,000 hours of virtual support.
"Transitioning services to a remote format is not as simple as just buying an iPad and giving it to somebody."
It was a great to see how many people rallied fast, with everything they had, said Jeff Klein, executive officer of Nevada Senior Services. "But it also brought home just how weak our infrastructure was in many places, or just didn't exist at all," he added.
Additional federal funding would help many of these vital services remain in place.
Distributing Pre-programmed iPads
In the Upper Midwest, Lutheran Social Services of Minnesota already had a plan in place. Six years earlier, it had begun to loan pre-programmed iPads to assist with virtual support, telehealth and other services to rural elders and caregivers, many of whom lived vast distances from in-person social supports and health care.
Once the pandemic shut down in-person assistance, the nonprofit ramped up to purchase additional tablets, train older adults and caregivers and provide help wherever it was needed throughout the state.
"Transitioning services to a remote format is not as simple as just buying an iPad and giving it to somebody," said Nicole Bauer, senior director for Caregiver and Companion Services at the organization. "However, one of the more positive things that has come from COVID is the increase in use of technology to get access to service, and we're now able to support our entire state instead of the six regions we formerly operated in." Bauer and her colleagues also spoke at the American Society on Aging conference in April.
Lutheran Social Services technology program coordinator Jessica Claeys, a social worker by training, never thought she'd be helping so many people learn how to use tablets. It took plenty of patience and persistence, along with ongoing telephone support, to get many elders comfortable with technology.
"We could see the confidence growing, where people can now order groceries or get medication delivered," she said.
One 87-year-old client who never sent an email before is now using FaceTime regularly with family and friends, something the agency encourages to help mitigate social isolation.
Another Virtual Program That Worked
In Los Angeles, a similar effort was underway. A modified Zoom platform allowed the Family Caregiver Support Center at the USC Leonard Davis School of Gerontology to continue delivering programs and health care visits with clients through custom apps, according to Donna Benton, a geropsychologist (psychologist for elders) who directs the program.
Caregivers found it very helpful, especially those caring for people with disabilities or cognitive impairments, and the online flexibility reduced missed appointments. Timely online visits also save problems down the road, as clinicians and social workers can spot little problems before they become bigger ones.
"We encourage CMS (the Centers for Medicare & Medicaid Services) to continue reimbursement systems through hospitals and health agencies post-pandemic," Benton said. "It's going to be vital for overall improvements in health care, social services and helping with social isolation."
Another bonus of virtual programs and support is the ability to hold events several times daily to better coordinate with caregiver and care recipient schedules. It also means more people from different ethnic groups can gather, since virtual outreach and leadership can happen statewide, compared with local in-person classes.
As more post-pandemic restrictions are lifted, Benton predicts that education, support and training classes will be smaller and that there will be more combinations of online and in-person sessions.
While technology adoption among older adults in the Los Angeles area is increasing, according to a recent report from USC, there is still a huge need to strengthen broadband access throughout the state, said Benton.
"We have to make broadband available so we get rid of those redline districts, and supplement access based on income, to make it more affordable," she noted.
President Biden is now trying to push his infrastructure plan through Congress which contains funding to expand broadband services and allocates $400 billion to expand home and community based services — money that many organizations hope to tap into to keep these virtual programs going long after in-person services are back.