Pandemic has exposed challenges to care for seniors
Pandemic has exposed challenges to care for those 65 and older
Laptops and translators. That’s what a team of Alvernia University professors and students needed to help a group of low-income seniors get through the pandemic isolation.
For months, the team had been planning an in-person initiative to help the seniors maintain their health.
The plan, said Dr. Robin Zappin, assistant professor of physical therapy, was to bring in nursing and occupational and physical therapy students to a couple of Reading Housing Authority facilities to assess seniors’ health and educate them on how to stay well.
Mobility is a key to independence as you age, and that was a big part of the initiative.
As the pandemic took hold in March 2020 and officials rushed to prevent the spread of the deadly virus, the lively common areas of senior housing were shuttered. The Alvernia initiative faced the challenge of forging ahead, somehow.
Even if the seniors did not catch COVID-19, the Alvernia team feared their health would deteriorate.
Relegated to their small apartments, the seniors avoided doctor appointments and found themselves more vulnerable to falls. Without the relationships cultivated in the common areas, the team worried some seniors would have cognitive declines.
Hospitals, medical practices and even insurers quickly turned to telehealth.
To pivot to telehealth, you need technology.
These seniors had no smartphones or laptops. Lack of equipment and broadband access for low-income seniors has been known for years but the need became acute during the pandemic. Also, three-quarters of the seniors spoke primarily Spanish.
Lack of technology is one of the problems the pandemic has laid bare in caring for Berks County’s seniors, say those who work with them. Seniors, those 65 and older, are a diverse group economically, racially and ethnically.
Latinos are a growing segment of the senior population in Berks.
The pandemic, with its epicenter in long-term care facilities, also pulled into focus the lack of funding and staffing.
Monica Reyes, Berks County Community Foundation health and human services officer, said there were three areas where response fell short for seniors in long-term care.
She said lack of testing, lack of personal protective equipment and lack of coordination for rapid response with hospitals to provide assistance to nursing homes were main issues for seniors in nursing homes.
On March 15, the foundation issued a report examining Berks County’s response to the pandemic. Among the eight recommendations is a call to include a review of technology infrastructure in strategic planning process of the county and in Reading.
The report, which laid out a plan to study creation of county health department, also called for the Berks County COVID-19 Advisory Panel or a community advisory panel to provide guidelines and recommendations regarding anticipated health care concerns caused by the pandemic.
The report noted that Harvard School of Public Health and Mayo Clinic studies suggest that there will be an onslaught of health problems as a result of the pandemic.
Research needs to be conducted on the effects of the pandemic in the community. Health and social issues of priority should be mental health, housing, food insecurity, school performance, and the long-term effects on COVID survivors.
There is much work ahead, say advocates. But the recovery comes with the opportunity to address issues that had long been smoldering in senior care before the pandemic, some say.
Left behind
The data of deaths from COVID paint part of the picture.
According to a Reading Eagle analysis of data from the Berks County coroner’s office, half of all COVID deaths were people over the age 65 who lived in longterm care facilities such as nursing homes or assisted-living.
Long-term care has been at the epicenter of the COVID-19 pandemic, said Zach Shamberg, president and CEO of Pennsylvania Health Care Association.
“We have called for the prioritization of long-term care in the pandemic response and we must remain vigilant to ensure that prioritization becomes a reality moving forward,” he said in a news conference in early March. “Anything less for the third-oldest state in the entire country is unacceptable.”
The news conference looked back at the impact of the pandemic on long-term care, including personal protective equipment shortages, the workforce and staffing crisis, testing accessibility and visitation.
Shamberg and Mark Parkinson, president and CEO of American Health Care Association and National Center for Assisted Living called for change.
The nursing home industry in the United States is facing an estimated $94 billion projected loss as a result of the pandemic, Shamberg and Parkinson said. According to an analysis by their groups,
thousands of facilities may close in 2021 due to costs associated with COVID and a loss of revenue.
Parkinson said that after it was understood how the virus spread asymptomatically, policy mistakes were made, particularly not prioritizing seniors in longterm care.
“We were not made a priority,” he said. “Our residents were not made a priority. There were very limited amounts of tests available and they weren’t coming to long-term care. There was a limited supply of PPE and it wasn’t coming to long-term care.”
He said the consequences speak for themselves. Thousands, possibly tens of thousands of people, died who did need to die.
Prioritizing the elderly in long-term care for vaccines has made a difference and saved lives, Parkinson and Shamberg said. New residents and new workers should continue to be given a priority.
In Pennsylvania, nursing homes, assisted-living communities and personal care homes collectively spent $96.2 million per week for personal protective equipment in 2020.
One-time testing for every worker and resident cost approximately $30 million collectively each week during the early months of the pandemic. Long-term care providers in Pennsylvania are projected to spend approximately $2.7 billion collectively in 2020 and 2021 on costs relative to COVID.
“Our aging population continues to grow rapidly,” Shamberg said. “Long-term care is well overdue to receive proper Medicaid funding, as the pandemic exacerbated the existing financial problems. Without the necessary funding, the care of tens of thousands of Pennsylvania’s seniors will be in jeopardy.”
Shamberg said the industry’s staffing crisis needs solutions. He pointed to the temporary nurse aide program as an example of innovation. The state gave emergency certification to aides hired during the COVID crisis. The desire is to see the temporary aides become certified nursing assistants.
Parkinson said another lesson from the pandemic is that public health should not be politicized.
“Let’s try to somehow make sure that public health is not politicized in the future,” Parkinson said. “There’s no reason why a pandemic should have developed into a political fight between red states and blue states, between liberal people and conservative people. The virus doesn’t really care so we just need to somehow de-politicize public health because I think the politicization of COVID has had tragic consequences.”
Shamberg said the pandemic has given a bullhorn to advocates to talk about existing challenges with funding and staffing. Given the aging of baby boomers, the challenges will only grow.
‘Demand change’
State Sen. Judy Schwank said the pandemic has revealed where gaps in care are.
“I do think this has been a real wake-up call for elected officials,” said Schwank, who is a member of the Senate Aging and Youth Committee.
“Government can’t be the answer to everything but there is so much we haven’t been paying attention to,” Schwank said.
Schwank said she has heard the desperation from seniors without smartphones or computers as they seek a COVID vaccine. Without the technology they could not access vaccine appointments. Even phone calls didn’t help.
“Not even getting anybody to answer a phone is very frustrating,” she said.
Schwank said it has been frustrating to get that need across to departments responsible for planning vaccine distribution.
“I get a sense sometimes when dealing with health care or technology, if you’re older you are kind of ignored,” she said. “Your needs aren’t thought of or accommodated.”
As baby boomers get older the situation may change, she said.
“I think this is a demanding audience that might demand change in terms of services and in terms of how the business community responds to the needs of older adults,” she said.
She noted that businesses already have adapted through COVID with curbside pickup and delivery services.
Caregivers
in
nursing homes or in private homes are “woefully underpaid for they have to do,” Schwank said.
She said the staffing crisis in nursing homes was brought to the forefront during the pandemic. Paid slightly above minimum wage, many caregivers work part-time at multiple jobs, she said.
Schwank, who has followed the issue for years, said increased funding for facilities should go to salaries rather than directly to a facility’s general fund.
She said she’s looking at
how more at-home care can be supported, as well.
Improvising solutions
At the Reading Housing Authority, Alvernia students improvised to connect the seniors.
With the donation of 10 laptops in May, students took their wellness expertise to the seniors through telehealth and ingenuity.
One student set up the computer in the common area so seniors could work with the team virtually.
The virtual visits had to be coordinated with translators who were volunteers from the university.
Dr. Mary Ann Durant, assistant professor of nursing, and Dr. Marcia Thompson, assistant professor of
physical therapy, said they discovered that between March and May in 2020 the seniors were getting very inactive.
Students found seniors uninformed and misinformed about COVID and safety precautions.
Durant said the seniors wanted to know more and be involved.
Durant said telehealth is a change in health care that could better meet the needs of seniors, if they can get access.
Durant said in general the public rallied around seniors during the pandemic with all kinds of groups stepping up to bring them food.
What is next?
Durant said families that took long-term care for granted will likely become more involved.
Thompson said the issue of access to loved ones during
the pandemic may influence family decisions about whether a senior can be cared for at home.
Many families are still grieving, Thompson said.
They need support. It’s just the start of the mental health issues experts say will need to be addressed through and after the pandemic. Depression is another.
“They haven’t had the time to actually grieve so that’s going to be something that will be needed,” Durant said.
The Alvernia initiative has had ripple effects for mental health.
“Giving someone accurate information is one of the biggest steps you can take,” said senior Sarah Bystrycki, a physical therapy major who participates in the initiative. “The information helps calm anxiety so a person can work on healing.”